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| What is osteoporosis?
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| Osteoporosis is a common
disorder of the bones in which they become weak, fragile
and likely to break or fracture easily. |
What fractures are
most commonly associated with osteoporosis? |
| Fractures of the spine,
the hips and the wrists are most common, but any bone
can fracture
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| What factors contribute
most to the risk of developing a fracture? |
| Low bone mass or density
and an increased tendency to fall down. |
What causes low bone
mass? |
Controllable factors:
- low calcium and vitamin D intake
- lack of exercise
- cigarette smoking
- excess alcohol consumption
- excess caffeine
- medicines, for instance, steroids (prednisone),
excess thyroid hormone
Uncontrollable factors:
- gender (females)
- race (Asian and Caucasian)
- slender build
- heredity (family history)
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What can be done
to reduce the risk of low bone mass related to the use
of steroids? |
| Prescription steroids, like
prednisone, are used to treat some gastrointestinal conditions,
such as inflammatory bowel disease and liver disease.
Patients on ongoing steroid therapy are frequently advised
to supplement with calcium and vitamin D because of the
propensity of steroids to deplete calcium. |
How can you know
whether you have low bone mass? |
| Bone mass can be measured
by a test called bone densitometry. This test can
measure bone mass in your spine, hips, forearms, and heels.
Measurements of bone mass at any of these sites can estimate
your risk of developing a fracture. |
What conditions make
a person more likely to fall? |
| The use of sedatives, poor
vision, Alzheimer’s disease and disabilities of the legs
all make an individual more likely to fall down. Slippery
floors, stairs without railings and throw rugs may increase
the risk of falling |
What are the best
ways to prevent osteoporosis? |
| Consume adequate amounts
of calcium and vitamin D, get regular exercise, limit
alcohol intake, limit caffeine intake, avoid taking steroids
or excess thyroid hormone unless absolutely necessary.
Estrogen, bisphosphonates, and selective estrogen modulators
(SERMS) are medicines your doctor can prescribe to prevent
osteoporosis. |
How do you ensure
you get enough calcium? |
| The recommended daily calcium
intake is 1,000 mg/day in men and pre-menopausal women,
and 1,500 mg/day in post-menopausal women. The best sources
of calcium are dairy products and calcium-fortified citrus
juices. Each serving of a dairy product (1 cup of milk,
1 ounce of cheese, 1 cup of yogurt) or calcium fortified
citrus juices (1 cup) has approximately 300 mg of calcium.
If you cannot take in enough calcium through your diet,
you should speak with your physician about whether to
take a calcium supplement, and if so, what kind. |
How do you ensure
you get enough vitamin D? |
| The recommended daily vitamin
D intake is 400 units. Multivitamins usually contain 400
units per tablet. One or two multivitamin tablets per
day will supply all that a person normally needs. More
than this should not be taken without a doctor’s advice,
since vitamin D can sometimes reach toxic levels in the
body if too much is consumed. Other forms of vitamin D
are available but are more expensive and should be used
only in special situations. |
What types of exercise
are the best for preventing osteoporosis? |
| Aerobic exercises such as
walking, running, and cycling improve bone mass and strength
in the lower spine, hips, and legs. Resistance exercises
(weight training) strengthens whatever bones are used
during the exercise; these are particularly good for the
upper spine and the arms. A combination of aerobic and
resistance exercises is more beneficial than either type
alone. Exercise also helps to improve balance and coordination
and thus reduces the risk of falling. For a specific exercise
program that is best for you, you should consult your
health care provider. |
How much alcohol
do you have to drink to harm your bones? |
| More than 2 drinks a day
appears to increase the risk of developing osteoporosis.
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How much caffeine
do you have to drink to harm your bones? |
| More than 2 servings a day
appears to increase the risk of having osteoporosis. |
Once osteoporosis
is present, how can you treat it? |
| Most of the same measures
that are used to prevent osteoporosis are also appropriate
treatment for patients who already have osteoporosis.
Therefore, individuals with osteoporosis should have an
adequate intake of calcium and vitamin D, exercise regularly,
stop smoking, limit alcohol and caffeine consumption and
avoid taking steroids or excess doses of thyroid hormone.
Medications such as estrogen, bisphosphonates, calcitonin,
and selective estrogen receptor modulators (SERMS) are
very effective treatment measures for osteoporosis. |
How effective are
estrogens in the prevention and treatment of osteoporosis?
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| Estrogen replacement therapy
prevents postmenopausal bone loss. Started at or near
the time of menopause, estrogens have been consistently
found to increase bone mass by about 4% and to markedly
decrease the incidence of osteoporotic fractures in postmenopausal
women. Estrogen replacement is also highly effective as
a treatment for women who have already developed osteoporosis,
including women who are more than 15 years past menopause.
Estrogen replacement significantly increases bone mass
an average of 4% in these individuals. |
What other benefits
result from taking estrogen? |
| Estrogen replacement therapy
reduces postmenopausal hot flashes, genital atrophy, and
depression. Estrogen has been shown to lower serum cholesterol
and LDL cholesterol (the harmful type) and to raise the
HDL (the beneficial type). Most studies indicate that
estrogen may reduce the risk of having heart attacks.
Estrogen also appear to decrease the risk of developing
Alzheimer’s Disease. |
What are the risks
and side effects of taking estrogen? |
| Estrogen replacement therapy
increases the risk of having cancer of the endometrium
(lining of the uterus); taking progesterone with estrogen
effectively prevents this complication. Estrogens also
modestly increase the risk of breast cancer. In addition,
there appears to be a slightly increased risk of developing
blood clots in the legs and pelvis; these clots can sometimes
break loose and go to the lungs. All of these complications
are more likely to occur with higher doses of estrogens.
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What are bisphosphonates?
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| Bisphosphonates are a group
of medications that prevent bone loss. Currently available
bisphosphonates include alendronate (Fosamax®), etidronate
(Didronel®), and pamidronate (Aredia®). A new
medication, residronate (Actonel®) should also be
available soon. |
How effective are
bisphosphonates in preventing and treating osteoporosis?
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| Alendronate (Fosamax®),
given as a 5 mg daily dosage, increases bone mass significantly
in postmenopausal women who are not on estrogen. It is
therefore an excellent choice in patients who should not
or do wish not to take estrogen.
Alendronate (Fosamax®), is the only bisphosphonate
currently approved for the treatment of osteoporosis
by the FDA. The recommended dose of 10 mg once a day
increases bone mass by approximately 8% and markedly
reduces the risk of spine and hip fractures. |
What are the side
effects of taking bisphosphonates? |
| The main side effect is pain
or burning in the lower part of the chest due to the irritation
of the esophagus; this occurs in about 5% of patients.
Absorption of these drugs is greatly impaired when the
pills are taken with food, particularly those that contain
calcium. In order to avoid esophageal problems and
to maximize absorption, alendronate should be taken in
the morning with a full glass of water and the
patient should remain upright and fasting for 30-60 minutes
afterwards. Patients taking alendronate and their
physicians need to be sensitive to the potential gastrointestinal
side effects, the onset of any gastrointestinal symptom,
and the need to consider alternative treatment for osteoporosis
and/or concomitant treatment with medications to reduce/improve
gastrointestinal symptoms. |
What are selective
estrogen receptor modulators (SERMS)? |
| These medications mimic estrogen
actions in some of the body’s tissues (for example, breast).
Currently available SERMS include raloxifene (Evista®),
tamoxifen (Nolvadex®) and clomiphene (Clomid®). |
How effective are
SERMS in the prevention and treatment of osteoporosis?
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| Raloxifene (Evista®)
and tamoxifen (Nolvadex®) have been shown to prevent
postmenopausal bone loss. Raloxifene has been approved
for prevention and treatment of osteoporosis by the FDA;
it increases bone mass by about 2%. And significantly
reduces the risk of spine fractures. |
Are there other benefits
to taking SERMS? |
| The medications raloxifene
(Evista®) and tamoxifen (Nolvadex®) have been
shown to reduce the risk of developing breast cancer.
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What are the risks
and side effects of taking SERMS? |
| These medications can cause
hot flashes and, like estrogen, may increase the risk
of developing blood clots in the legs and pelvis. |
What is calcitonin?
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| Calcitonin is a natural hormone
produced in the thyroid gland: it prevents bone loss.
Because calcitonin that comes from salmon is more potent
than calcitonin that comes from humans, salmon calcitonin
is more commonly used to treat osteoporosis. Calcitonin
is available as a nasal spray (Miacalcin® and Calcimar®).
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How effective is
calcitonin in preventing and treating osteoporosis?
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| The administration of calcitonin
to patients with osteoporosis increases bone mass by 1-2%.
Calcitonin also has significant analgesic properties,
reducing back pain in about 80% of treated patients. |
What are the risks
and side effects of taking calcitonin? |
| Calcitonin administration
may cause nausea and a skin rash. Nasal spray calcitonin
may also cause irritation of the inside of the nose. |
What other medications
may be useful in treating osteoporosis? |
| Slow release sodium fluoride,
growth hormone and parathyroid hormone are under study
as possible treatments for osteoporosis. All of these
medications increase bone mass significantly but their
long term safety and their ability to prevent bone fractures
must be demonstrated before they can be approved for general
use. |
Does osteoporosis
only happen to women |
| No. Osteoporosis can occur
in men, but usually an underlying medical condition is
responsible. These conditions should be identified and
treated appropriately. For example, men who have low serum
testosterone levels should be treated with testosterone
replacement therapy. Alendronate (Fosamax®) and calcitonin
(Miacalcin®) also can be used beneficially. Men with
osteoporosis should have adequate intakes of calcium and
vitamin D, should exercise regularly, should stop smoking
and should minimize alcohol and caffeine consumption.
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