Finding Out If You Have Osteoporosis
Prevention & Treatment or Osteoporosis
- Prevention of Osteoporosis
- Attaining Peak Bone Mass
- Maintaining Peak Bone Mass
- Preventing Bone Loss in Later Life
- Calcium & Vitamin D
- Exercise
- Preventing Falls
- Medications
- Hormone Therapy (Estrogens)
- Selective Estrogen Receptor Modulators -SERMS (Evista)
- Bisphosphonates (Fosamax & Actonel)
- Calcitonin (Miacaicin & Calcimar)
Prevention of osteoporosis begins in childhood and continues throughout life. Prevention requires an adequate calcium intake, regular exercise, and appropriate levels of estrogen in women and testosterone in men. Specific additional aspects of prevention apply at different stages in life.
Building strong bones during childhood, adolescence, and young adulthood may help you avoid osteoporosis later in life. Regular physical activity is important for bone strength. Weight-bearing and resistance exercises such as walking, lifting weights or using weight machines can be of added benefit by strengthening muscles and bones. Adequate calcium intake (young children - 500mg/day, older children - 800 mg/day, young adult - 1300mg/day) and good general nutrition are also very important. Risk factors such as smoking and excessive alcohol use need to be avoided.
Once peak bone mass is reached, in a person's 20s, bone loss over the next 20 years should be slight, unless any of the following occur: a diet low in calcium and Vitamin D; an inactive lifestyle; low estrogen or testosterone levels; or a disease or medication that causes bone loss.
Preventing Bone Loss in Later Life
Bone loss in women usually begins in a person's 40s. It may begin earlier, especially in individuals who have chronic illness, take medications that cause bone loss, or who have other risk factors. Bone loss is most rapid during the first few years after menopause, but persists throughout the postmenopausal years. Loss of bone at the hip can increase in a person's 70s and 80s, perhaps due to changes in activity, muscle strength, or lifestyle. Most men do not begin to lose bone mass until their 50s, and their rate of bone loss is not as rapid as women's. However, men can have substantial bone loss beginning in their 70s, with the number of fractures in men becoming nearly equal to that of women.
Older women and men benefit from adequate intake of calcium (1200 mg/day) and Vitamin D (400-800 IU/day). Also, remaining physically active is essential for keeping muscles toned, joints flexible, and bones strong.
Elderly individuals with osteoporosis should discuss with their physician additional steps for bone health. These include medication, posture exercises, and fall prevention measures, even after fractures have occurred, since this will help minimize further bone loss and help prevent additional fractures and more severe disability.
Calcium is the main building block of the bone and is essential for bone health. But, an adequate calcium intake alone will not ensure healthy bones. Calcium alone will not protect you against bone loss caused by decreased estrogen, physical inactivity, smoking, alcohol abuse, various medications or medical conditions known to cause loss of bone density. However, low calcium intake can contribute to the development of osteoporosis.
Here are links to important information about calcium-
Vitamin D
Vitamin D plays a major role in calcium absorption and bone health. Vitamin D has been called the "key" that opens the intestinal wall "door", so that calcium can leave the intestine and enter the bloodstream. Vitamin D also helps absorb calcium in the kidneys that might otherwise be lost in the urine.
Vitamin D is formed naturally in the body after the skin is exposed to sunlight. Fifteen minutes of sun each day is plenty of time for you to make and store all the Vitamin D you need.
The Calcium and Vitamin D Connection
Exercise is important throughout life to build and maintain strong bones and muscles. Bones are similar to muscles in that they respond to exercise by becoming stronger and denser. Just as muscles get flabby if you don't use them, bones lose density if they are not used.
The two types of exercises that are the best for bone health are weight-bearing and resistance exercises. Weight-bearing means that your feet and legs are bearing your weight. Jogging, walking, stair climbing, and dancing are examples of weight bearing exercises (swimming and bicycling are not considered weight-bearing exercises). Resistance exercise uses muscular strength to improve bone strength. Weight-lifting or using weight machines, has been shown to benefit bone health at all ages.
Older adults with osteoporosis or low bone density, should follow an exercise program developed by a knowledgeable health care professional. Depending on the person's health status, this exercise program may include walking, stair climbing, and other low-impact activities. With proper supervision and instruction, everyone can participate in weight training. Since falls account for most fractures, exercise programs that emphasize balance training (such as Tai Chi), may be helpful.
Preventing falls is important for older persons, and for anyone with osteoporosis. Each year about one-third of all persons over the age of 65 fall. Falls can result in bone fractures. A variety of factors may lead to falls, including poor balance, muscle weakness, poor eyesight, use of alcohol and certain medications, and hazards in and outside the home.
Safety Tips For Preventing Falls
- Wear supportive, rubber-soled, low-heeled shoes. Avoid walking around the house in socks or slip-on slippers.
- Keep floors free of clutter and loose cords and wires.
- Tack down carpets and use non-skid backing on rugs to prevent tripping and slipping.
- Install handrails on both sides of stairs. Have light switches at the bottom and top of stairwells to keep the area well lit.
- Install grab bars besides the toilet, in the tub, and in the shower. If you are unsteady on your feet, try putting a plastic chair with a back and non-skid legs in the shower stall, so you can sit while you shower.
- Place a nightlight between your bedroom and the bathroom. Place light switches within reach of your bed or keep a flashlight nearby. Get up slowly from sitting or lying to avoid dizziness.
- Cover porch steps with gritty, weatherproof paint or treads
- Use caution when walking on highly polished floors or floors with confusing visual patterns. (such as in lobbies of hotels, banks or hospitals)
- Have your vision and hearing checked regularly.
- Talk to your physician or pharmacist about medication side effects. Sometimes a medications can cause dizziness or lightheadedness.
A number of medications are available for osteoporosis prevention and treatment. While these medications do allow bone to rebuild itself to some degree, they are not a "cure" for osteoporosis. Other bone protective measures must be continued, such as adequate calcium intake, exercise, smoking cessation, and fall prevention.
- What is hormone therapy?
Hormone therapy is intended to replace the hormones that ovaries stop making at menopause. It can consist of estrogen alone (also referred to as estrogen replacement or ERT) or estrogen combined with progesterone (also referred to as hormone replacement therapy or HRT). When used to prevent and treat osteoporosis, hormone therapy is not intended to restore a women's pre-menopausal hormone levels, but to provide her with the lowest levels of estrogen needed to protect her bones against osteoporosis.
Some common names of Estrogens and Estrogen/Progesterone:
- Estrogen Pills
- conjugated equine estrogen (Premarin, Cenestin)
- estropipate (Ogen, Ortho-Est)
- esterified estrogen (Estratab)
- micronized estrodial (Estrace)
- Estrogen/Progesterone Combination Pills
- conjugated equine estrogen/medroxyprogesterone (Prempro, Premphase)
- ethinyl-estradiol/norethindrone (Femhrt 1/5)
- Estrogen/Progesterone Transdermal (Skin patch)
- estradiol (estrogen only) (Alora, Climara, Estraderm, Vivelle)
- estradiol/norethindrone (Combipatch)
- What does hormone therapy do?
The exact way that hormone therapy works to prevent bone loss is not fully known. Estrogen is know to be important in maintaining the balance between bone loss and bone gain, by slowing the rate of bone erosion. Progesterone has no effect on bone, but seems to help protect the uterus from endometrial cancer (a risk of estrogen therapy alone).
- When should hormone therapy be used?
For many women, the decision to take estrogen is a difficult one. ERT may prevent osteoporosis and may have other benefits, such as decreasing the risks of heart disease and possibly, Alzheimer's disease and colon cancer. On the other hand, it may increase the risk of breast cancer and endometrial cancer (endometrial cancer risk can be avoided by using the combination or HRT medications). Therefore, a woman should discuss the risks and benefits of taking this medication with her physician. Personal current health and medical history, and future health risks should be taken into account before a decision is made.
- Are there side effects?
There is a slight increase in the risk of breast cancer (about 1% or 1 chance out of 100). Hormone therapy can also have a few more immediate side effects, including breast tenderness, headaches, depression, skin irritation, symptoms similar to premenstrual syndrome, and weight gain.
- Who needs to avoid hormone therapy ?
Hormone therapy should not be given to women with a history of unexplained vaginal bleeding, active liver disease, breast cancer or a history or blood clots.
Selective Estrogen Receptor Modulators
(SERMs)
- What are SERMs?
Selective estrogen receptor modulators (SERMs) have been proven to be effective in the prevention and treatment of osteoporosis. SERMs (like Raloxifene) have a totally different chemical structure than estrogen and other sex hormones. They act like estrogen on the bone, but block estrogen's effect on the uterus and breast. They may be helpful to increase bone density in women who can not take estrogen or those with a personal or family history of breast cancer. In fact, SERMs may actually reduce a woman's risk of developing breast cancer.
- Common names for SERMs:
- Raloxifene (Evista)
- How do SERMs work?
The exact way SERMs act to increase the bone density is not fully known, but they are believed to work like estrogens to slow the breakdown and removal of old bone.
- Are there side effects?
Leg cramps and a worsening of hot flashes are the most common side effects. It may increase the risk of blood clots, especially in women with a history of blood clots or risk factors for clots.
- Who needs to avoid SERMs?
SERMs should not be given to women with a history active liver disease or a history or blood clots.
- What are bisphosphonates?
Bisphosphonates are a relatively new family of non-hormonal medications, which have been proven to be effective in the prevention and treatment of osteoporosis. Postmenopausal women with established osteoporosis, who are unable or unwilling to take hormone therapy, can consider treatment using this type of medication. These medications work only on the bone, so they do not provide relief from menopausal symptoms or any protection against heart disease. There is also no risk of breast or uterus cancer with this type of medication.
- Common names for bisphosphonates:
- alendronate (Fosamax)
- risedronate (Actonel)
- How do bisphosphonates work?
Bisphosphonates bind permanently to the bone surface and slow the activity of bone-eroding cells. This allows the bone building cells to work more effectively, and the result is usually an increase in the bone density. Treatment with bisphosphonates has been shown to increased the bone density in the hip, spine and wrist bones and reduce the risk of fractures in these bones.
- Are there side effects?
The side effects of bisphosphonates are minimal. They may include nausea, abdominal pain or loose bowel movements. In rare cases, hypersensitivity (allergic reaction) to the medication may cause skin rashes.
While some people find it inconvenient to take bisphosphonates on an empty stomach with no liquids other than water, it is very important that these instructions be followed. It is the only way that the body will be able to absorb the medication properly. Even drinking orange juice or coffee with these medications can reduce the ability of the medication to effectively increase bone density.
- Who needs to avoid bisphosphonates?
Bisphosphonates should not be taken if you have kidney problems, unless directed by your physician. There is a small risk of ulcers in the esophagus with the use of alendronate, but this can be minimized by taking the medication as directed.
- What is calcitonin?
Calcitonin is a naturally occurring peptide (protein) hormone that is produced by cells in the thyroid gland (a small gland in the neck). It works to help the body to respond to low levels of calcium, and is used in the treatment of osteoporosis. Calcitonin is used to treat women with osteoporosis who are 5 years or more postmenopausal. It can be given to women who do not wish to take or cannot tolerate estrogen (HRT). Like all osteoporosis medications, it is most effective when used together with adequate calcium and vitamin D intake. Calcitonin is taken either by injection or nasal spray.
- Common names for calcitonin:
- calcitonin (Miacalin, Calcimar)
- How does calcitonin work?
Calcitonin increases bone density and reduces the risk of fractures by interfering with the cells involved in bone erosion. In some individuals, calcitonin may provide relief from back pain causes by spinal (vertebral) fractures.
- Are there side effects?
Nausea is the most common side effect of injectable calcitonin, while irritation of the nose (dryness, itching, tenderness, swelling, sneezing, runny nose) is the most common side effect with nasal calcitonin.