Are you at risk for Osteoporosis?

What is Osteoporosis?

Osteoporosis, which means "porous bones," causes bones to become weak and brittle.  In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. A common result of osteoporosis is fractures - most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects a significant number of men.

The strength of your bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.

Bone is continuously changing - new bone is made and old bone is broken down - a process called remodeling, or bone turnover.  A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later.

What keeps bones healthy?
Three factors are essential for keeping your bones healthy throughout your life:

  • Regular exercise
  • Adequate amounts of calcium
  • Adequate amounts of vitamin D, which is essential for absorbing calcium

Screening and diagnosis

Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density. The best screening test is dual energy X-ray absorptiometry (DEXA).

If you're a woman, the National Osteoporosis Foundation recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you:

  • You use medications such as prednisone that can cause osteoporosis.
  • You have type 1 diabetes, liver disease, kidney disease or a family history of osteoporosis.
  • You experienced early menopause.
  • You're postmenopausal, older than 50 and have at least one risk factor for osteoporosis.
  • You're postmenopausal, older than 65 and have never had a bone density test.

Doctors don't generally recommend osteoporosis screening for men because the disease is less common in men than it is in women.

Treatment

Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring. 

If HT isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. They include:

  • Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures.
  • Raloxifene. This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancers.
  • Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection.
  • Teriparatide. This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the Food and Drug Administration recommends restricting therapy to two years or less.
  • Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women over age 50.

Prevention

Getting adequate calcium and vitamin D is an important factor in reducing your risk of osteoporosis. If you already have osteoporosis, getting adequate calcium and vitamin D, as well as taking other measures, can help prevent your bones from becoming weaker. In some cases you may even be able to replace bone you've lost.

The amount of calcium you need to stay healthy changes over your lifetime. Your body's demand for calcium is greatest during childhood and adolescence, when your skeleton is growing rapidly, and during pregnancy and breast-feeding. Postmenopausal women and older men also need to consume more calcium. As you age, your body becomes less efficient at absorbing calcium, and you're more likely to take medications that interfere with calcium absorption.

How much calcium and vitamin D?
Premenopausal women and postmenopausal women who use HT should consume at least 1,200 milligrams (mg) of calcium and a minimum of 400 international units (IU) of vitamin D every day. Pregnant, breastfeeding and postmenopausal women not using HT, anyone at risk of steroid-induced osteoporosis, and all men and women over 65 should aim for 1,500 mg of calcium and at least 800 IU of vitamin D daily. Getting enough vitamin D is just as important as getting adequate amounts of calcium. Not only does vitamin D improve bone health by helping calcium absorption, but it also may improve muscle strength. Scientists are continuing to study vitamin D - which may also protect against certain types of cancer - to determine the optimal daily dose, but it's safe to take up to 2,000 IU a day.

Although many people get adequate amounts of vitamin D from sunlight, this may not be a good source if you live in high latitudes, if you're housebound, or if you regularly use sunscreen or you avoid the sun entirely because of the risk of skin cancer. Although vitamin D is present in oily fish such as tuna and sardines and in egg yolks, you probably don't eat these on a daily basis. Calcium supplements with added vitamin D are a good alternative.

As for calcium, dairy products are one, but by no means the only, source; almonds, broccoli, cooked kale, canned salmon with the bones, oats and soy products such as tofu are also rich in calcium. If you find it hard to get enough calcium from your diet, consider calcium supplements. Supplements are inexpensive and generally are well tolerated and well absorbed if taken properly. Sometimes calcium supplements can be constipating. If this is a problem for you, drink more water and try using a fiber supplement. In addition, check the type of calcium you're using. Calcium phosphate and calcium citrate tend to be less constipating.

Calcium and vitamin D supplements are most effective taken together in divided doses with food.

What else can you do to prevent osteoporosis?

  • Exercise. Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life. Combine strength-training exercises with weight-bearing exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises - such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports - mainly affect the bones in your legs, hips and lower spine. Swimming, cycling and machines such as elliptical trainers can provide a good cardiovascular workout, but because they're low impact, they're not as helpful for improving bone health as weight-bearing exercises are.
  • 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.
  • Add soy to your diet. The plant estrogens found in soy help maintain bone density and may reduce the risk of fractures, particularly in the first 10 years after menopause.
  • 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 secondhand smoke aren't yet known.
  • Consider hormone therapy. Hormone 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. Testosterone replacement therapy works only for men with osteoporosis caused by low testosterone levels. Taking it when you have normal testosterone levels won't increase bone mass.
  • 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.
  • 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. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get in and out of your bed easily.

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