Osteoporosis

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is osteoporosis?

Osteoporosis is an extension of the natural aging process. When you’re young, your bones get longer and denser until you reach your full height. Even as you grow, your bone tissue is constantly being broken down and rebuilt. Then, in your early 30s if you’re a woman, and at about age 40 if you’re a man, your skeleton begins to slowly lose bone faster than your body can replace it.

From this point on, the skeleton very gradually thins as you age.

But if you have osteoporosis, it’s a different story. By the time you’re diagnosed, your bones will already have lost significant density, making them fragile and easy to break’often spontaneously or after a very minor accident. You’ll have a special risk for fracturing wrists or suffering painful compression fractures of the spine, causing your upper back to curve forward. The greatest danger, however, is hip fractures, which can cause permanent disability. Even worse, studies show that 20% of people over age 50 who break a hip die of complications within a year.

Bone loss is mainly a depletion of the mineral calcium. It affects more women than men because the hormone estrogen plays a crucial role in the female body’s ability to use dietary calcium to build new bone. When you approach or are in menopause, the reduction in your body’s estrogen production deprives your bones of the calcium they need. Some 20% to 30% of bone loss in women occurs in the first five years after menopause. Osteopenia often develops during this critical time. Without treatment, this bone-thinning condition can lead to osteoporosis.

Osteoporosis can also occur in younger women whose estrogen levels fall after hysterectomy or in athletes whose ability to produce estrogen may be hindered by low body fat.

Who is at risk for osteoporosis?

Millions of North Americans have osteoporosis. Most of them are women.

Treatment for osteoporosis

To begin, treatment for your osteoporosis will focus on medications to slow bone loss and reduce your risk of fractures, as well as lifestyle changes to improve your general health and feelings of well-being. If you’ve got osteopenia, your doctor may recommend the same approach to keep your bone loss in check. For severe cases and fractures, surgery may be an option.

Medications for osteoporosis

You already know that calcium helps your body make bones, but how much do you need? Adults up to age 50 require 1,000 mg of calcium daily. Postmenopausal women (and men over age 65) should get 1,200 to 1,500 mg a day. If dietary sources aren’t enough, add supplements. The two with the highest levels of calcium are calcium carbonate (take it with food) and calcium citrate (which can be taken without food). For best absorption, don’t take more than 500 to 600 mg at a time. Calcium needs a partner in its bone-protection work: vitamin D. Most adults need 400 IU of vitamin D daily. If you have osteoporosis, you may require 600 to 800 IU daily. Your doctor may suggest a prescription form of the vitamin called calcitriol (Rocaltrol).

You’ll also need medication to slow bone loss and increase bone mass. What’s best for you depends on the cause of your osteoporosis, the part of your skeleton most affected, and your overall health history. The first choice for many patients are drugs called bisphosphonates: alendronate (Fosamax), risedronate (Actonel), and ibendronate (Boniva). These drugs prevent and treat osteoporosis related to hormones or induced by corticosteroids. All three drugs have been shown to lower the incidence of fractures, including those of the hip. Each morning, you take the medication on an empty stomach with plain water, and stay upright without eating or drinking for at least 30 minutes in order to prevent irritation of the esophagus. Some people prefer the once-a-week forms.

If you are a postmenopausal woman, your doctor may recommend hormone replacement therapy (HRT). Because HRT replaces lost estrogen, it prevents rapid bone loss and increases bone density in the hip and spine. Long-term treatment with HRT is controversial, however, because it carries increased risk for gallstones, blood clots, breast cancer, and other problems. For estrogen’s protective benefits without its side effects, ask about a new class of drugs called selective estrogen receptor modulators (SERMs), such as raloxifene (Evista). SERMs prevent bone loss throughout the entire body, but carry an increased risk of blood clots. They are not right for everyone.

If you can’t take other medications for osteoporosis, your doctor may recommend calcitonin. This naturally occurring hormone inhibits the breakdown of bone and reduces the risk of a fractured vertebra. (It’s not yet known if it protects other bones, too.) This drug also relieves pain in people who already have spinal fractures. Calcitonin is given as an injection (Calcimar) or used as a nasal spray (Miacalcin).

Lifestyle Changes

As with other medical conditions, lifestyle changes can make a big difference when you have osteoporosis. Keep the following bone-building and safety tips in mind:

• Have milk or other low-fat dairy products, on a regular basis. These foods are richest in the calcium you need for strong bones.
• Do some strength-building. For your bones to make the best use of calcium, you need to do weight-bearing exercise (which may also increase bone density). Try brisk walking, jogging, dancing, lifting weights, or climbing stairs. Be sure to ask your doctor for guidelines on what, and how much, exercise is safe for you.
• Limit beverages that leach calcium from your bones. Restrict alcoholic drinks to one a day if you’re a woman or two if you’re a man. Hold the line at two cups of caffeinated coffee a day.
• If you smoke, quit. Tobacco interferes with normal bone metabolism, contributing to osteoporosis.
• Secure rugs firmly to the floor. Tack area rugs down, or use a slip-proof backing, to lessen chances of falls.
• Install handrails in the bathtub, shower stall, or wherever you feel you might need assistance in changing position.
• Check the lighting. Be sure your rooms are well lit during waking hours and that you can find light switches easily in the dark.
• Don’t run for a train or bus. Rushing increases your risk of tripping and falling. Always allow enough time to get there safely.

Related Procedures for Osteoporosis

Your doctor will check your progress with bone density tests called dual energy x-ray absorptiometry, or DEXA. If you have a severe break or problems such as osteoarthritis, joint replacement is an option. This surgery, which replaces part of a hip or knee with manmade materials, can greatly improve your ability to participate in daily activities. If you have a collapsed spinal vertebra, a new therapy called kyphoplasty may relieve pain and prevent kyphosis (dowager’s hump). In this procedure, a tiny balloon expands the collapsed vertebra. Bone-like material is then injected to restore the spine to its normal structure.

Questions for Your Doctor

• How severe is my condition?
• Taking into account my general health and family history, is hormone replacement therapy the right choice for me?
• Are there specific physical activities I should avoid?
• Can I avoid getting the hunched back my grandmother had?

Living with Osteoporosis

If you’re living with osteoporosis, here are a few quick tips to help you take control:

• If a physical activity feels too strenuous or unsafe, stop immediately. Tuning into the signals your body is sending may help prevent serious injury. If the activity is something you still wish to pursue, talk it over with your doctor.
• Take tea and see. A study in Taiwan found that longtime tea drinkers had the highest overall bone density. Researchers determined that drinking two cups of black, green, or oolong tea a day for at least six years protected the bones. This could be because tea contains flavonoids, estrogenlike substances that may keep bones strong.
• Bone up on nondairy sources of calcium. Even if you drink plenty of milk, make sure your diet includes such calcium-rich foods as canned salmon and sardines (eaten with the bones), dark-green leafy vegetables, and white beans. A variety of processed foods, including juices and cereals, are now fortified with calcium.