Treating and Preventing Osteoporosis
Due to an increase in media attention during the last few years, ]]>osteoporosis]]> has become a household word. But despite the abundance of available information, contradictions and confusion abound.
Much of the existing information on osteoporosis consists of brief reports about new research results and does not explain the complexity of the issues or the risks involved in prevention and treatment options. Increasing use of the media by manufacturers to advertise hormones and other prescription medications, nonprescription medications, and ]]>calcium-rich food products]]>, is promoting the spread of biased information.
This article provides some basic information about osteoporosis, including what it is, who is at risk, and how to prevent it.
What Is Osteoporosis?
Osteoporosis is a disease of the bones in which the bones become so weak that they break easily. Bones are made up of living tissue that is constantly being renewed. This process, called remodeling, consists of two stages—bone resorption and bone formation. During resorption, old bone is broken down and removed. During bone formation, new bone is built to replace the old.
The remodeling process changes naturally throughout the life cycle. During childhood and early adulthood, new bone is formed faster than old bone is removed. Between ages 25 and 35, a peak bone mass (maximum density and strength) is reached. Per NOF: " About 85-90% of adult bone mass is acquired by age 18 in girls and 20 in boys. "After age 35, bone loss outpaces bone formation. In women, the rate of loss is greatest during the first four to five years after ]]>menopause]]>.
Osteoporosis occurs when there is an excessive amount of bone loss and/or insufficient bone formation. The bones become thin and weak, increasing the chance of ]]>fractures]]>. Fractures are most common in the hip, spine, wrist, and ribs, but can occur in any bone. These fractures can result in trouble walking, severe pain, loss of height, spinal deformities, and decreased function.
Because bone loss occurs without symptoms, people may not realize they have osteoporosis until a sudden bump or fall causes a fracture. ]]>Bone density tests]]> are available, but some studies have shown that low bone density alone does not always indicate osteoporosis or an increase in the risk of fractures. In addition, there are variations in how the results are interpreted, and the most accurate tests are quite costly.
Who Is at Risk?
In the United States, 10 million people have osteoporosis, and another 34 million have bone mass low enough to increase their risk for the disease. There are a number of factors that can put you at greater risk for developing osteoporosis, but they are only general indicators of risk.
For example, although osteoporosis occurs most often in older people, it can develop at any age. Women are four times more likely than men to develop it because they usually have smaller, thinner bones and lose bone rapidly after menopause. But men also develop osteoporosis, especially after age 65. Whites and Asians are at higher risk, but Blacks and Hispanics can also get the disease.
You can't change your age, gender, or race, but there are certain risk factors for osteoporosis that you can control. Among them are the amount of ]]>calcium]]> in the diet and how well the body absorbs it, amount and type of physical activity, and hormonal balance. Although both the media and the medical community focus on the decrease in estrogen after menopause as the cause, it is only one of many factors.
The risk of osteporosis is also increased with certain medications such as steroid medications, some anticonvulsants and others, as well as by certain diseases, including anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases.
Prevention at All Ages
Since osteoporosis occurs mainly in older people, why should you be concerned about it during earlier years? Prevention of osteoporosis can begin in childhood, when bone mass is increasing. Diet, exercise, smoking, and use of alcohol and caffeine all affect bone formation throughout life. Preventive measures are also important when bone mass is decreasing, during midlife and just after menopause in women.
Calcium and Vitamin D
Although you must work at it, it is possible to get adequate amounts of calcium from your diet. Dairy products are the best dietary source of calcium. Other sources include sardines and salmon canned with bones, broccoli, dark green leafy vegetables such as spinach, and tofu processed with calcium salts.
If you cannot or do not regularly get enough calcium from your diet, you may need to take a calcium supplement. However, supplements should be used only to supplement the calcium in your diet, not replace it. There are several different calcium compounds on the market. They differ mainly in price and how easily they are absorbed. Be sure to discuss calcium supplementation with your physician.
It is generally recommended that daily calcium intake be at least 1000 mg in premenopausal women and in men and 1500 mg in postmenopausal women who do not take estrogen.
A useful way of estimating one’s dietary calcium intake is first to calculate the average number of diary servings per day (a yogurt, glass of milk, etc) and multiply it by 300. If the amount is less than recommended, then taking the supplement may be necessary.
Vitamin D is also important and often deficient in many persons’ diets. Our usual source of vitamin D is sunlight, but with so many of us spending abundant time indoors (and wisely using sunscreen when outdoors), fewer get adequate sun exposure—especially during the wintertime. Some studies suggest that between a quarter to a half of US adolescents and adults are deficient in vitamin D, sometimes despite apparently adequate dietary sources of this vitamin.
Salmon and other fatty fish are good vitamin D sources. Milk is almost always fortified, and the recommended daily intake of 3 or more glasses (preferably fat-free) should provide adequate Vitamin D. If, however, you are not a consistent milk drinker, or if you want to check on your vitamin D status, ask your doctor to do a blood test of your 25-hydroxy Vitamin D.
]]>Exercise]]> is an important contributor to building and maintaining bone mass at all ages. It also increases the strength and coordination of muscles that support the bones. Weight-bearing exercise, such as walking, jogging, stair climbing, jumping rope, and dancing, is the best for your bones. Weight lifting has also been shown to help strengthen bones and prevent osteoporosis. If you are unaccustomed to exercising, talk to your doctor before you begin. People who already have osteoporosis need to take special precautions when exercising or lifting weights to prevent fractures.
Other lifestyle factors
Smoking, alcohol, and caffeine can contribute to bone loss. To reduce your risk, do not smoke, and limit your use of alcohol and caffeine. If you do drink coffee or caffeinated tea, be sure that you combine these beverages with adequate milk. Smoking is a very serious risk factor for osteoporosis and should absolutely be avoided by anyone seeking to reduce the risk of bone thinning. Carbonated beverages frequently contain added phosphorus in the form of phosphates, which have been shown to increase loss of calcium in the urine. Significant loss of calcium without extra dietary intake is likely to be a risk for future osteoporosis, but it is uncertain how much calcium loss is actually caused by phosphate in soft drinks. This issue is very controversial and remains unsettled. While few think that drinking soda offers actual health benefits, risks associated with soft drink consumption may be related more to associated behaviors (low milk intake, preference for television over physical activity) than to phosphorous content.
Medications for Prevention and Treatment
Several ]]>medications]]> have been approved by the US Food and Drug Administration (FDA) for the prevention and treatment of osteoporosis. ]]>Calcitonin]]> (Miacalcin), a naturally occurring hormone that slows bone loss, is available as an injection or nasal spray. A derivative of parathyroid hormone, ]]>teriparatide]]> (Forteo), is FDA-approved for use in patients at particularly high risk of fracture due to osteoporosis. Two drugs known as bisphosphonates—alendronate sodium (Fosamax) and risedronate sodium (Actonel)—are taken in pill form and help reduce bone loss, increase bone density in the spine and hip, and help reduce the risk of spine and hip fractures. Recently another bisphosphonate has been approved ]]>ibandronate]]> (Boniva) that may be taken just once a month. ]]>Raloxifene]]> (Evista, a drug in the class of Selective Estrogen Receptor Modulators, helps prevent bone loss at the spine, hip, and total body and may increase bone mass. It is available in pill form. Estrogen is another drug option to treat osteoporosis and your doctor may prescribe it for you if he/she determines that the benefits associated with taking estrogen outweigh the risks in your case.
Determining Your Prevention Strategy
There is general agreement that everyone can reduce their risk of developing osteoporosis by making lifestyle changes. A healthful diet and regular exercise are important throughout your life, beginning in childhood. Avoiding smoking and limiting alcohol use (no more than one alcoholic drink daily for women) are two of the most important prevention strategies you can adopt.
Women from midlife on, older men, and anyone else at increased risk for osteoporosis should evaluate their risk factors in order to develop a prevention strategy. How you implement lifestyle changes and whether you take hormones or other medications are decisions that should be made by you and your healthcare provider. As you gather information about osteoporosis, examine it with a critical eye, keeping in mind the credibility of sources.
National Osteoporosis Foundation
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Getting the jump on osteoporosis. Harvard Women's Health Watch . 1996;3:1.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Fast facts on osteoporosis; Bone basics for older women and men; What is bone?; Calcium: important at every age; Exercise for your bone health; Medications to prevent and treat osteoporosis. NIH Osteoporosis and Related Bone Disease—National Resource Center website. Available at: http://www.niams.nih.gov/bone/osteoporosis.htm .
Recker, Robert R. The use of alendronate for treatment of osteoporosis. The Osteoporosis Report. National Osteoporosis Foundation; 1995.
Richardson JP. Vitamin D deficiency-the once and present epidemic. Am Fam Physician. 2005;71(2):241-242.
Riggs BL, Melton LJ. The Prevention and treatment of osteoporosis. N Eng J Med. 1992;327:620-627
Taking hormones and women's health: choices, risks, and benefits. National Women's Health Network. 1995.
US Congress, Office of Technology Assessment. Public Information About Osteoporosis: What's Available, What's Needed? Washington, DC: Government Printing Office; 1994. Background Paper OTA-BP-H-131.
NIH Consensus Development Panel on Optimal Calcium Intake. Optimal calcium intake. JAMA. 1994;272:1942.
Adami S, Felsenberg D, et al. Efficacy and safety of ibandronate given by intravenous injection once every 3 months. 2004;34(5):881-889.
Pyon EY.Once-monthly ibandronate for postmenopausal osteoporosis: review of a new dosing regimen. Clin Ther. 2006;28(4):475-90. Review.
Last reviewed May 2009 by ]]>Rosalyn Carson-DeWitt, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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