Osteoporosis

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Osteoporosis

What Is Osteoporosis?
Osteoporosis is a condition in which your bones become thin and more likely to break. The areas where this occurs most often are your hips, wrists or spine, although all bones are affected and can break.

It happens without your knowing it. You do not feel different in any way until a bone breaks.

Who Is at Risk for Getting Osteoporosis?
Over half of the women older than 65 years of age will have some osteoporosis. The two most important causes are aging and loss of sex hormones after menopause.

Although it is more common in women, osteoporosis also occurs in men. The frequency of osteoporosis in men is 1/3 that of women.

Risk factors for getting osteoporosis include:

* Family History -- Your risk is higher if a parent, sister or brother has osteoporosis, or if you are Caucasian, Asian or have a thin body frame.
* Eating Habits -- Your risk is higher if you do not eat enough dairy foods like milk, yogurt, and cheese from which you get calcium; or if you drink a lot of caffeinated beverages (coffee, cola soda) or alcohol, or eat a lot of animal protein (such as chicken, beef, fish or eggs).
* Smoking -- Cigarettes increase your risk of osteoporosis.
* Medications -- Some drugs used to treat asthma, arthritis and other conditions can also cause osteoporosis. Ask your health care provider about this.
* Activity -- Lack of exercise contributes to osteoporosis.
* Hormones -- The changes that occur at menopause (a decrease in female hormones) contribute to osteoporosis.
* History of skipping menstrual periods from excessive exercise in young women or eating disorders.

How Can Osteoporosis Be Prevented or Treated?

* Eat enough foods that are high in calcium and vitamin D. These foods include dairy products like milk, yogurt and cheese. Choose low-fat or non-fat varieties when possible.
* Calcium supplements may also help to assure that you get enough calcium. Ask your health care provider to suggest a type and amount for you to take.
* Sunshine is a good source of vitamin D. Try to be outside for at least 15 - 30 minutes a day if possible and if this is not possible Vitamin D supplements may be necessary especially for those who are elderly or home-bound.
* Women before menopause and men need about 1000 mg. of calcium each day. This is about 3 - 4 servings of dairy foods or other high calcium foods or a combination of foods and supplements (tablets).
* Women who are pregnant or are nursing, and women who have gone through menopause should have 1500 mg. of calcium a day (or at least 4 servings of high calcium foods). A combination of food and supplements that totals 1500 mg. is also OK.
* Limit the alcohol and caffeine you drink and the animal protein you eat.
* Don't smoke.
* Exercise regularly to keep bones strong.
* If you have been through menopause ask your doctor about hormone replacement therapy or other medications or new treatments to prevent or limit the development and progression of osteoporosis.

Treatment Options
Osteoporosis is a disease in which bones become thin. As a result, the bones are more likely to break. The bones most often affected are in the hip, spine and wrist but the ribs and other bones can also be affected.

It affects about 25 million Americans; most of them are women above the age of 60 but men are also affected.

How Do You Know If You Have Osteoporosis?
In the early stages of osteoporosis there are no signs or symptoms, thus it is often called "the silent disease". The loss of bone progresses gradually until you break a bone. Sometimes this is how you find out that you have osteoporosis. Other signs are a loss of height, a stooped posture and a "humpbacked" appearance.

Sometimes your doctor may suggest a bone density scan because you are in a high risk group and need to see if you will need some form of treatment to prevent or treat osteoporosis. This is especially true around menopause when estrogen levels fall. There are several techniques for measuring bone density and they are safe and painless. These computer analyzed x-rays involve very little radiation ( much less than a chest x-ray) and are more effective than routine x-rays which are not sensitive enough to see bone loss.

What Can You Do to Treat Osteoporosis?
There are a number of treatments available to prevent further bone loss but there are few options available that can replace the bone that has been lost.

Calcium, vitamins and exercise are the first option especially in the early stages of the disease. They are also important in addition to other treatments.

Estrogen is the most common medication for prevention and treatment of osteoporosis in women during the time of menopause and beyond. It is referred to as hormone replacement therapy (HRT) and today estrogen is given with progesterone so that it doesn't increase the risk of developing cancer of the uterus. In addition, HRT has a protective effect for women in the prevention of heart disease. There is some question about whether it increases the risk of breast cancer by a small amount. Talk to your doctor to see if HRT is right for you.

Fosamax (alendronate) is a new drug that not only stops bone thinning but also restores some of the bone that has been lost. Like estrogen it has been shown to cut the risk of repeated fractures.

Fosamax works with the existing bone to prevent breakdown and increase the density of the bone. It seems to have few side effects since it works directly in the bone and is quickly eliminated from the body. The side effects that have been reported are generally mild (nausea and diarrhea) and usually disappear with time. Since this is a new drug the long term effects are unknown. It is a good idea to take the medication with a full glass of water in the morning 30 minutes before eating to avoid irritation of your esophagus (foodpipe) and you should not lie down again until after you have eaten. This will prevent the side effects from irritation of your esophagus.

Fosamax must be taken continuously, possibly for life, otherwise the bone loss returns.

Calcitonin is a hormone produced in the body and has been used for some time in the treatment of osteoporosis to prevent fractures. A new, easy-to-use nasal spray has been approved. It specifically affects the bones and no other parts of the body. It reduces the rate of bone loss much the same way as estrogen does, however, there are almost no side effects.

Resources for More Information:

Beth Israel Medical Center- Rheumatology
(212) 844-8101

National Osteoporosis Foundation:
(800) 223 9994