TOPIC: Osteoporosis and Bone Health
Dr. Christian Rhea, Rheumatologist
Monday, August 24, 2009
What Is Osteoporosis? What You Need to Know
What is osteoporosis anyway? Is osteoporosis a normal sign of aging? Does osteoporosis only affect women? Here's the truth: What you don't know about osteoporosis may hurt you.
What is osteoporosis?
Osteoporosis is a common disease that weakens bones. As it does, your risk of sudden and unexpected fractures goes up. Osteopenia is the forerunner of osteoporosis. It is a silent but destructive condition that robs bones during a woman's -- even a young woman's -- most productive time.
No matter what your age or sex, osteoporosis and osteopenia can affect you. Your bones might seem sturdy now. You may be very active and doing the things you want to do. But osteoporosis and osteopenia are quiet, accomplished thieves. In fact, there are usually no visible signs. You may notice a loss of height or a Dowager's hump over time. But chances are good the first sign that you have one of these conditions will be a painful fracture.
What is osteoporosis bone loss?
The bone loss with osteoporosis occurs over many years and is severe. It's so severe that the normal stress on bones from sitting, standing, coughing, or even hugging a loved one can result in painful fractures and immobility. Then, after the first fracture, you are at risk for more fractures. These future fractures may cause you to live with daily chronic pain. They can cause you disability. They may rob you of your independence.
That's why it's important to learn all you can about osteoporosis and osteopenia. Then you can take immediate steps to keep your bones strong. That way you can prevent bone loss and painful fractures.
What are osteoporosis symptoms?
Osteoporosis often progresses without symptoms or pain. Losing height may be noticeable. Or a Dowager's hump may develop with age. Usually, though, a doctor diagnoses osteoporosis after a painful fracture occurs.
That fracture is usually in the back or hips. Painful fractures are debilitating and disfiguring. They can result in loss of mobility and independence.
In WebMD's Osteoporosis Guide, you can read all about the latest medical recommendations and complementary treatments for preventing bone loss. You can read how to prevent osteopenia and osteoporosis and how to reduce your risk of painful fractures. In addition, you can read how osteoporosis medications, along with diet, exercise, and other lifestyle choices, can slow the rate of bone loss and help you prevent fractures.
What is osteopenia?
With osteopenia, there are no warning signs until you fracture a bone. Osteopenia is the forerunner of osteoporosis. If it isn't diagnosed and isn't treated, osteopenia can lead directly to osteoporosis. With osteoporosis, your bones become thin, weaker, and fracture easily.
The good news is if you are diagnosed with osteoporosis, you can get treatments. Those osteoporosis treatments can slow bone loss, increase the amount of bone you have, and lower your chances of fractures. But there's no reason to wait until you can't reverse how weak your bones have become. Detecting osteopenia with a bone density test is easy. From there, making a plan to prevent disfiguring and painful fractures is simple.
Bone Density Scan
What is "bone mineral density" (BMD)?
The absolute amount of bone as measured by bone mineral density (BMD) testing generally correlates with bone strength and its ability to bear weight. The BMD is measured with a dual energy x-ray absorptiometry test (referred to as a DXA scan). By measuring BMD, it is possible to predict fracture risk in the same manner that measuring blood pressure can help predict the risk of stroke.
It is important to remember that BMD cannot predict the certainty of developing a fracture. It can only predict risk. It is important to note that a bone density scan, or test, should not be confused with a bone scan, which is a nuclear medicine test that is used to detect tumors, cancer, fractures, and infections in the bone.
The World Health Organization is the source of the commonly-accepted definitions for osteoporosis (WHO Technical Report Series #843, Geneva 1994):
Normal: A value for BMD statistically within 1 standard deviation of the young adult peak bone mass. The report shows a T score > -1 signifying a BMD within the normal range.
Low bone mass (medically termed osteopenia): A value for BMD statistically less than 1 standard deviation but more than 2.5 standard deviations below that of an average young adult. The report shows a T score between -2.5 and Â£ -1, which signifies an increased fracture risk but does not meet the criteria for osteoporosis.
Osteoporosis: A value for BMD statistically more than 2.5 standard deviations below that of the average peak young adult bone mass. BMD in this range signifies an even higher fracture risk than osteopenia. The report shows a T score Â£-2.5.
Based on the above criteria, it is estimated that 40% of all postmenopausal Caucasian women have osteopenia and that an additional 7% have osteoporosis (Siris et al JAMA 2001).
Because osteoporosis is difficult to reverse, prevention is the key to treatment.
Calcium is the cornerstone of treatment. To help with the absorption of the calcium, vitamin D supplements should also be taken. A regular exercise program -- including weight-bearing exercises, such as walking and aerobics -- can help keep your bones stay strong and free of fractures.
Menopausal hormone replacement therapy -- either estrogen alone or a combination of estrogen and progestin -- was used for prevention and treatment of osteoporosis. However, in July 2002, a landmark study revealed that hormone therapy increases the risk of breast cancer, heart disease, and stroke in some women. Hormone replacement therapy is known to help preserve bone and prevent fractures, but is not generally recommended at this point for osteoporosis because the risks are thought to outweigh the benefits.
In women who have been on hormone replacement therapy in the past and then stopped it, the bone begins to thin again -- at the same pace as during menopause.
Evista is an osteoporosis drug that has some actions similar to estrogen, such as the ability to maintain bone mass. However, studies have shown that it doesn't increase the risk of breast or uterine cancers like estrogen. Evista can cause blood clots and often increases hot flashes.
Actonel, Boniva, and Fosamax (also available as generic) treat osteoporosis by inhibiting cells that break down bone and slowing bone loss. Actonel and Fosamax are usually taken once a week while Boniva is taken once a month. There are strict ways to take these medications, since if taken incorrectly, they can lead to ulcers in the esophagus.
Another new osteoporosis medication is Reclast, which is given as a once-yearly 15-minute infusion in a vein. Reclast is said to increase bone strength and reduce fractures in the hip, spine and wrist, arm, leg, or rib.
Forteo is a new medication used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. A synthetic form of the naturally occurring parathyroid hormone, Forteo is the first drug shown to stimulate new bone formation and increase bone mineral density. It is self-administered as a daily injection for up to 24 months. Side effects include nausea, leg cramps, and dizziness.
Calcitonin is another treatment option for osteoporosis. Calcitonin is a naturally occurring hormone that inhibits bone loss. It is available as a nasal spray or injection and is quite expensive. Undesirable side effects include nausea and skin rashes.
Osteoporosis Prevention Through Nutrition and Diet
To ensure that people are getting enough calcium to build and maintain strong bones, doctors recommend eating plenty of calcium-rich foods, such as nonfat milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, and leafy green vegetables.
According to a panel convened by the National Institutes of Health, women who are still menstruating, or who are postmenopausal but taking hormone replacement therapy, should get 1,000 mg of calcium each day. This jumps to 1,200 to 1,500 mg per day for pregnant or breastfeeding women. Postmenopausal women not on hormone replacement therapy should get 1,500 mg/day.
Recommended daily intake for men is 1,000 mg per day (25 to 65 years of age) and 1,500 mg per day from age 65 and up. One 8-ounce glass of skim milk has the same amount of calcium as whole milk, 300 mg.
Because most women take in only half or a third as much calcium as they need through their diet, most doctors recommend calcium supplements to make up the difference. Calcium supplements are available in many forms, but calcium citrate and calcium gluconate appear to be more effective at reducing bone loss.
To help the body absorb calcium, doctors suggest taking vitamin D (400 to 800 IU daily) supplements.
Calcium supplements can inhibit the absorption of certain drugs. Check with your doctor before beginning calcium supplements. You may need to take your supplements at a different time than your other medications.
Other Dietary Ways to Maintain Bone
In addition to eating calcium-rich foods, you should also avoid phosphorus-rich ones, which can promote bone loss. High-phosphorus foods include red meats, soft drinks, and those with phosphate food additives. Excessive amounts of alcohol and caffeine are also thought to reduce the amount of calcium absorbed by the body and should be avoided.
To help keep estrogen levels from dropping sharply after menopause, and thus help prevent osteoporosis, some practitioners advise postmenopausal women to consume more foods containing plant estrogens, especially tofu, soybean milk, and other soy products. However, there is no evidence to prove that these foods help prevent or delay the onset of osteoporosis.
Here are two easy ways to increase the amount of calcium in your diet:
Osteoporosis Prevention Through Exercise
Not only must you get enough calcium in your diet, you must also exercise to maintain strong bones. Studies have shown that weight-bearing exercises -- those that put stress on bones, such as running, walking, tennis, ballet, stair climbing, aerobics, and weightlifting -- reduce bone loss and help prevent osteoporosis. To benefit from the exercise, you must do it at least three times per week for 30 to 45 minutes. Although swimming and bicycle riding are great cardiovascular exercises, they do not appear to prevent osteoporosis because they do not put enough stress on bones.
This medication is used to treat a certain type of bone disease (Paget's disease) that causes abnormal and weak bones. Zoledronic acid is also used to treat bone loss (osteoporosis) in women after menopause. It works by slowing the breakdown of bone and keeping bones strong. It also helps to reduce the risk of broken bones (fractures). This medication belongs to a class of drugs known as bisphosphonates.
Another zoledronic acid product is used to treat bone problems that may occur with cancer. The 2 products should not be used together.
How to use Reclast IV
This medicine comes with a Patient Information Leaflet. Read it carefully. Ask your doctor, nurse, or pharmacist any questions that you may have about this medicine.
This medication is given as a single dose by a health care professional. It is given slowly into a vein over at least 15 minutes. Health care professionals must follow all the manufacturer's instructions for properly preparing and giving this drug. Check this product visually for particles or discoloration before using. If either is present, do not use the liquid. If you have any questions about using this medication properly, consult your doctor or pharmacist.
Eat and drink normally on the day of treatment. Drink at least 2 glasses of fluid before treatment unless otherwise directed by your doctor. It is very important that you get plenty of fluids when you are given this medication.
Your doctor may direct you to take calcium and vitamin D each day. If you have Paget's disease, it is especially important that you take the directed amount of calcium and vitamin D during the 2 weeks after your zoledronic acid dose. Vitamin D and calcium are very important to prevent low levels of calcium in the blood. Tell your doctor immediately if you have any symptoms of low calcium such as numbness/tingling (especially around the lips/mouth) and muscle spasms.
The dosage is based on your medical condition and response to treatment. The usual maximum adult dose is 5 milligrams.
For the treatment of Paget's disease, this medication is given as a single dose and may be repeated based on your symptoms. For the treatment of osteoporosis, this medication is given as a single dose once a year.