Lean on me - For Bone Strength

What is Osteoporosis?

Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Is Osteoporosis called by any other name?

Thin bones

What are the symptoms of Osteoporosis?

There are no symptoms in the early stages of the disease.

Symptoms occurring late in the disease include:

• Fractures of the vertebrae, wrists, or hips (usually the first indication)
• Low back pain
• Neck pain
• Bone pain or tenderness
• Loss of height over time
• Stooped posture

What causes Osteoporosis?

Osteoporosis is the most common type of bone disease. There are currently an estimated 10 million Americans suffering from osteoporosis, as well as another 18 million who have low bone mass, or osteopenia.

Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient, or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As people age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. Both situations can result in brittle, fragile bones that are subject to fractures, even without trauma.

Usually, the loss occurs gradually over years. Many times, a person will sustain a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and the damage is severe.

The leading causes are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men.

Other causes include excess corticosteroid from Cushing’s syndrome, hyperthyroidism (too much thyroid hormone), hyperparathyroidism, being confined to a bed, and bone cancers.

Researchers estimate that about 20% of American women over the age of 50 have osteoporosis. In addition, another 30% of them have osteopenia, which is abnormally low bone density that may eventually deteriorate into osteoporosis, if not treated.

About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra (bones of the spine).

White women, especially those with a family history of osteoporosis, have a greater-than-average risk of developing osteoporosis. Other risk factors include smoking, eating disorders, low body weight, too little calcium in the diet, heavy alcohol consumption, early menopause, absence of menstrual periods (amenorrhea), and use of certain medications, such as steroids and anticonvulsants.

What Tests are Available to Diagnose Osteoporosis?

Bone mineral density (BMD) testing — as performed in dual-energy x-ray absorptiometry (DEXA) — measures the demineralization of the bones. This has become the gold standard for osteoporosis evaluation. BMD testing should be performed on all postmenopausal women with fractures, all women under 65 with an additional risk factor for osteoporosis (besides menopause), and all women 65 and over.

A spine CT can show demineralization. Quantitative computed tomography (QCT) can evaluate bone density, but is less available and is more expensive than DEXA.

A spine or hip x-ray may show fracture or vertebral collapse in severe cases.

Measuring the amount of calcium in your urine can provide some evidence of increased bone turnover, but is of limited value. A number of newer tests to evaluate bone turnover are becoming available, including measurement of urinary N-telopeptide (Osteomark). In the future, these may enhance your physician’s ability to diagnose early osteoporosis.

What are the treatments of Osteoporosis?

By Mayo Clinic staff

Hormone therapy
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.

Discuss the various options with your doctor to determine which might be best for you.

Prescription medications
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. 
Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They’re also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis. 
Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you’ve had acid reflux or ulcers in the past. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can’t tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations. 
In 2007, the Food and Drug Administration (FDA) approved the first once-yearly drug for postmenopausal women with osteoporosis. The medication, zoledronic acid (Reclast), is given intravenously at your doctor’s office. It takes about 15 minutes to get your annual dose. One published study found that zoledronic acid reduces the risk of spine fracture by 70 percent and of hip fracture by 41 percent. 
A small number of cases of osteonecrosis of the jaw have been reported in people taking bisphosphonates for osteoporosis. These cases have primarily occurred after trauma to the jaw, such as a tooth extraction, or cancer treatment. Risk appears to be higher in people who have received bisphosphonates intravenously. While there is currently no clear evidence that you should stop taking bisphosphonates before dental surgery, let your dentist know what medications you’re taking and discuss your concerns.

Raloxifene (Evista)

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 cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn’t use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.

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. Because calcitonin isn’t as potent as bisphosphonates, it’s normally reserved for people who can’t take other drugs.

Teriparatide (Forteo)

This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men 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 FDA 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 older than 50. Possible side effects of tamoxifen include hot flashes, stomach upset, and vaginal dryness or discharge.

How can you prevent the onset of Osteoporosis?

To help prevent osteoporosis, start with a healthy diet with adequate amounts of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses for bone formation and maintenance is available.

Calcium is essential for building and maintaining healthy bone. Vitamin D, which helps your body absorb calcium, is also essential. To get these and other important nutrients throughout life, make sure to keep an overall healthy, well-balanced diet.

Supplemental calcium should be taken as needed to achieve recommended daily calcium dietary intake. Current recommendations are for nonpregnant, menstruating women to consume 1000 mg/day, pregnant women need 1200 mg/day, and postmenopausal or nursing mothers should consume 1500 mg/day.

High-calcium foods include low-fat milk, yogurt, ice cream and cheese, tofu, salmon and sardines (with the bones), and leafy green vegetables, such as spinach and collard greens. Vitamin D aids in calcium absorption and 400-800 IU per day should be taken by all individuals with increased risk of calcium deficiency and osteoporosis.

You should not smoke, and avoid drinking excess alcohol.

Regular exercise can prevent bone fractures. Exercises where muscles pull on bones cause the bones to retain, and possibly gain, density. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and perhaps even gain density. Researchers found that women who walk a mile a day have 4-7 more years of bone in reserve than women who don’t. Some of the recommended exercises include:

• Weight-bearing exercises — walking, jogging, playing tennis, dancing
• Resistance exercises — free weights, weight machines, stretch bands
• Balancing exercises — tai chi, yoga
• Riding stationary bicycles
• Using rowing machines
• Walking
• Jogging

You should speak with your healthcare provider about bone mineral density measurements which should be taken every 1-2 years. Monitoring is controversial and expensive. Call your health care provider if you have symptoms of osteoporosis, or if you are interested in testing available for diagnosis or early detection.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.

Calcium and Vitamin D
Calcium is one of the most important mineral element for skeletal integrity. Vitamin D is essential for the absorption and effective utilization of calcium in the body. Calcium and vitamin D are necessary for normal skeletal homeostasis. Vitamin D enhances intestinal absorption of calcium. Low concentrations of vitamin D are associated with impaired calcium absorption, a negative calcium balance, and a compensatory rise in parathyroid hormone, which results in excessive bone resorption.

Careful calcium balance studies have shown that calcium balance is related to calcium intake; the less calcium one takes in, the more negative the calcium balance. This can be reversed by increasing calcium intake and maintaining adequate vitamin D stores. In general, calcium balance becomes positive at an average calcium intake of 1000 mg/day in premenopausal women and 1500 mg/day in postmenopausal women who do not take estrogen.

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Source: DSM Nutritional Products