Osteoporosis

Osteoporosis Overview

Osteoporosis is a progressive disease in which the bones become weak due to decreased bone mineral density. Over time, the loss of mass weakens bones and makes them more likely to fracture—especially in the hip, spine and wrist.

Eighty percent of Americans with osteoporosis are women. Reasons for this include:

Women have less bone mass to begin with than men
Women tend to live longer than men
Women take in less calcium than men
The rate of bone loss in women speeds up after menopause when estrogen levels fall
Since the ovaries make estrogen, faster bone loss in women may also occur if both ovaries are removed by surgery

Men are at risk of getting osteoporosis later in life.

You may not know you have osteoporosis until you begin to display symptoms, which often don’t show until after a significant amount of bone loss has occurred. Symptoms of osteoporosis include:

Frequent broken bones or fractures
Low back pain
A hunched back
Shrinking as osteoporosis causes your vertebrae to collapse

Your Wellstar physician can work with you on a plan to minimize your risk of developing osteoporosis.

Risk Factors

Osteoporosis most commonly affects post-menopausal women, but other groups carry high incidences, including the elderly and people of Asian and Caucasian descent. Factors that can increase the risk of developing osteoporosis include:

Family history of osteoporosis or broken bones
Thin body and small bones
Certain race/ethnicities
History of broken bones
Low sex hormones (estrogen)
Early menopause, before age 45
Missing periods (amenorrhea)
Low levels of testosterone and estrogen in men
Low calcium and vitamin D intake
Excessive intake of protein, sodium and caffeine
Inactivity
Smoking
Alcohol abuse
Long-term use of steroid medications, some anticonvulsants and other medications
Diseases, conditions and eating disorders such as anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases, hyperthyroidism and others

Let your Wellstar physician know if you have any of these risk factors.

Osteoporosis Prevention

It is possible to maintain bone health and prevent osteoporosis. The best defense against osteoporosis later in life is to begin building strong bones as a child. Women develop about 98% of their bone mass by the age of 20, making early intervention vital. Continue with the following healthy behaviors throughout your life to decrease your risk of osteoporosis:

Eat a diet rich in calcium and vitamin D. The Institute of Medicine recommends you get the following amounts of calcium:
- Up to 1 year old—210 to 270 milligrams (mg)
- Ages 1 to 3 years—500 mg
- Ages 4 to 8 years—800 mg
- Ages 9 to 18 years—1,300 mg
- Ages 19 to 50 years—1,000 mg
- Age 51 and up—1,200 mg
Participate in regular weight-bearing and resistance-training exercises
Avoid smoking and excessive alcohol intake
Consult healthcare professionals about bone health, hormone therapy and medications to prevent or treat osteoporosis
Get a bone density test when age appropriate

Osteoporosis Diagnosis

If you or your Wellstar physician suspect you have osteoporosis, a bone scan, called bone densitometry, can confirm it. Bone densitometry is a low dose x-ray test that evaluates specific bones to determine if there is mineral loss or bone thinning.

Another available test is the dual energy X-ray absorptiometry (DEXA) test. This test measures the density of the bones in your hips, spine and wrist, which are places likely to be affected by osteoporosis.

DEXA tests can:

Show if you have low bone density before a fracture occurs.
Show if your bones are losing density or staying the same when the test is repeated at intervals of one year or more.
Predict the chances that you will have a fracture in the future.
Help you and your physician decide if treatment is needed.

Your physician may also order an ultrasound or a CT scan to help check the density of your bones.

Osteoporosis Treatment

Although there is no cure for osteoporosis, it can be treated. Treatment starts with changes to your diet, specifically increases in calcium and vitamin D intake. Your Wellstar physician will help you get more calcium and vitamin D into your diet through food, drink and supplements.

In addition, you will need to increase weight-bearing exercise, which helps increase bone density, through walking, jogging, climbing steps or similar exercises.

Your Wellstar physician will help you plan a diet and exercise program that is right for you.

Medications

Medications are available to help treat osteoporosis by slowing bone loss and helping maintain bone mass.

Bisphosphonates can slow bone breakdown, preserve bone mass and even increase bone density in your spine and hip, reducing the risk of fractures. Bisphosphonates are used to prevent osteoporosis in people who require long-term steroid treatment for diseases such as asthma or arthritis. Side effects can be severe, and include nausea, abdominal pain, difficulty swallowing, an inflamed esophagus, esophageal ulcers, osteonecrosis (bone death) of the jaw, irregular heartbeats and visual disturbances.
Raloxifene (Evista^®) belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene is recommended only for postmenopausal women, not for men or younger women, to slow bone thinning and increase bone mineral density in the spine and neck. In addition, it seems to lower the risk of breast cancer. A common side effect is hot flashes, and you shouldn't use this drug if you have a history of blood clots.
Calcitonin is a hormone produced by your thyroid gland that reduces bone loss, may prevent spine fractures and may provide pain relief from compression fractures. When delivered as a nasal spray, it may cause nasal irritation, but it's also available as an injection. Calcitonin isn't as potent as bisphosphonates, so it's normally reserved for people who can't take other drugs.
Teriparatide (Forteo^™) is a parathyroid hormone used to treat postmenopausal women and men who are at high risk of fractures. Teriparatide stimulates new bone growth, while other medications prevent further bone loss. Teriparatide is given once a day by injection. Long-term effects are still being studied, so therapy is recommended for two years or less.

Discuss the risks and benefits of all of these medications with your Wellstar physician before deciding which one is right for you.

Ongoing Care for Osteoporosis

If you begin to take medication for osteoporosis, you will still need to continue a diet rich in calcium and vitamin D, combined with regular exercise. Your Wellstar physician may also recommend other long-term therapies including:

Hormone (estrogen) therapy can help maintain bone density, especially when started soon after menopause. However, hormone therapy can also increase your risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Because of these concerns, hormone therapy is no longer a first-choice treatment.
Physical therapy programs may help you increase bone strength and improve posture, balance and muscle strength, making falls less likely.

Protect your back with these measures:

Good posture—keeping your head high, chin tucked, shoulders back, upper back flat and lower spine arched.
Place a rolled towel in the small of your back when driving or sitting for an extended period.
Don't lean over while reading or doing handwork.
When lifting, bend at your knees and lift with your legs, keeping your upper back straight.

Prevent falls with these measures:

Wear low-heeled shoes with non-slip soles.
Check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall.
Keep rooms brightly lit.
Install grab bars just inside and outside your shower door.
Make sure you can get in and out of your bed easily.
Don’t ignore chronic pain, which can limit your mobility and cause even more pain. Discuss pain management strategies with your Wellstar physician.