What is Osteoporosis?

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Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrist, hip, pelvis and upper arm. Osteoporosis and associated fractures are an important cause of mortality and morbidity.In many affected people, bone loss is gradual and without warning signs until the disease is advanced. Osteoporosis is also known as "the silent crippler" because a person usually doesn't know they have it until it's too late. Unfortunately, in many cases, the first real "symptom" is a broken bone. Loss of height – with gradual curvature of the back (caused by vertebral compression fractures) may be the only physical sign of osteoporosis.

In the United States, osteoporosis causes more than 1.5 million fractures every year — most of them in the spine, hip or wrist. And although it's often thought of as a women's disease, osteoporosis affects many men as well. About 8 million American women and 2 million American men have osteoporosis, and nearly 18 million more Americans may have low bone density. Even children aren't immune.

Common Symptoms

Many people don't realize they have osteoporosis until they fracture a bone. There are usually no other symptoms - although some older people may lose inches in height or their backs may curve forward. Older people with osteoporosis are especially at risk of breaking a hip if they fall down.

Treatment for Osteoporosis

A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.

Therapeutic Medications. Currently, alendronate, raloxifene and rise dronate are approved by the U. S. Food and Drug Administration(FDA) for the prevention and treatment of postmenopausal osteoporosis. Teriparatide is approved for the treatment of the disease in postmenopausal women and men who are at high risk for fracture. Estrogen/hormone therapy(ET/HT) is approved for the prevention of postmenopausal osteoporosis, and calcitonin is approved for treatment. In addition, alendronate is approved for the treatment of osteoporosis in men, and both alendronate and rise dronate are approved for use by men and women with glucocorticoid-induced osteoporosis.

Bisphosphonates: Alendronate (Fosamax) and Risedronate (Actonel) are pills that need to be taken on an empty stomach with water. These medications help slow down bone loss and have been shown to decrease the risk of fractures.

Raloxifene. Raloxifene (brand name Evista®) is a drug that is approved for the prevention and treatment of postmenopausal osteoporosis. It is from a new class of drugs called Selective Estrogen Receptor Modulators (SERMs) that appear to prevent bone loss at the spine, hip, and total body. Raloxifene has been shown to have beneficial effects on bone mass and bone turnover and can reduce the incidence of vertebral fractures. While side-effects are not common with raloxifene, those reported include hot flashes and deep vein thrombosis, the latter of which is also associated with estrogen therapy. Additional research studies on raloxifene will be ongoing for several more years.

Calcitonin. This medication is a hormone made from the thyroid gland and is usually given as a nasal spray or as an injection under the skin. It may help prevent spine fractures, and is also helpful to control pain after an osteoporotic vertebral (spine) fracture.

Teriparatide.  Teriparatide is a form of parathyroid hormone that helps stimulate bone formation. It is approved for use in postmenopausal women and men at high risk for osteoporotic fracture. It is given as a daily injection under the skin and can be used for up to 2 years. If you have ever had radiation treatment to your bones or if you have parathyroid hormone levels that are already too high, you should not take this medication.

Estrogen/Hormone Therapy. Estrogen therapy alone or in combination with another hormone, progestin, has been shown to decrease the risk of osteoporosis and osteoporotic fractures in women. However, the combination of estrogen with a progestin has been shown to increase the risk for breast cancer, strokes, heart attacks and blood clots. Estrogens alone may increase the risk of strokes. Given the complexity of this decision, consult with your doctor about whether hormone replacement therapy is appropriate for you.

What Causes Osteoporosis?

Many factors will increase your risk of developing osteoporosis and suffering a fracture. Some of these risk factors can be changed while others cannot. Recognizing your own risk factors is important so that you can take steps to prevent this condition from developing or treat it before it becomes worse. 

Major risk factors include:

• Sex. Fractures from osteoporosis are about twice as common in women as they are in men.Age (starting in the mid-30s but accelerating after 50)Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower but still significant risk.Frame size. People who are exceptionally thin or have small body frames are at higher risk because they often have reserved less bone mass to draw from as they age.

• Family history of osteoporosis or osteoporosis-related fracture in a parent or sibling

• Previous fracture following a low-level trauma, especially after age 50

• Sex hormone deficiency, particularly estrogen deficiency, both in women (e.g. menopause) and men

• Anorexia nervosa

• Cigarette smoking

• Alcohol abuse

• Low dietary intake or absorption of calcium and vitamin D

• Sedentary lifestyle or immobility

Certain diseases can affect bone, such as endocrine disorders (hyperthyroidism, hyperparathyroidism, Cushing's disease, etc.) and inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, etc.)

Prevention

The following measures can greatly reduce your risk of osteoporosis. If you already have osteoporosis, these steps can help prevent your bones from becoming weaker. In some cases you may even be able to replace bone you've lost.

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Nutrition The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in a balanced proportion. In particular, calcium and vitamin D are needed for strong bones as well as for your heart, muscles, and nerves to function properly. (See Prevention section for recommended amounts of calcium.)

Exercise Exercise is an important component of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it increases muscle strength, coordination, and balance and leads to better overall health. While exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. Asextra insurance against fractures, your doctor can recommend specific exercises to strengthen and support your back.

Consider hormone replacement therapy Hormone replacement therapy can reduce a woman's risk of osteoporosis during and after menopause. But because of the risk of side effects, discuss the options with your doctor and decide what's best for you.

Don't smoke Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman's body makes and by reducing the absorption of calcium in your intestine. The effects on bone of second hand smoke aren't yet known.

Avoid excessive alcohol Consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body's ability to absorb calcium. There's no clear link between moderate alcohol intake and osteoporosis.

Limit caffeine Moderate caffeine consumption —about two to three cups of coffee a day — won't harm you as long as your diet contains adequate calcium.

Self Care

If you have osteoporosis, it is important not only to help prevent further bone loss but also to prevent a fracture. Eliminate hazards in the house that can increase your risk of falling (remove loose wires or throw rugs, install grab bars in the bathroom and non-skid mats near sinks and in the tub, etc.) Be careful when you are carrying or lifting items, as this could cause a spine fracture. Wear sturdy shoes, especially in winter. Use a cane or walker if you have balance problems or have other difficulties walking.

Maintain good posture Good posture — which involves keeping your head held high, chin in, shoulders back, upper back flat and lower spine arched — helps you avoid stress on your spine. When you sit or drive, place a rolled towel in the small of your back. Don't lean over while reading or doing handwork. When lifting, bend at your knees, not your waist, and lift with your legs, keeping your upper back straight.

Prevent falls Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs, and slippery surfaces that might cause you to trip or fall.

Manage pain Discuss pain management strategies with your doctor. Don't ignore chronic pain. Left untreated, it can limit your mobility and cause even more pain.

Additional Information

National Institutes of Health (NIH): Osteoporosis and Related Bone Diseases, National Resource Center
1232 22nd Street, NW, Suite 500
Washington, DC 20037-1292
Phone: (202) 223-0344 or (800) 624-BONE (2663)
Fax: (202) 293-2356
Web: www.niams.nih.gov

National Osteoporosis Foundation
1232 22nd Street N.W.
Washington, D.C. 20037-1292
Phone:(202) 223.2226
Web: www.nof.org/