OSTEOPOROSIS

What Is Osteoporosis?

Osteoporosis is a serious health problem that causes bones to lose mass 
and break easily. 

Osteoporosis (pronounced OS-tea-oh-po- ROH-sis) is a disease that causes 
bones to lose mass and break easily. The word osteoporosis means bone 
(osteo) that is porous (porosis). 

Osteoporosis is a serious public health problem in the United States. It 
affects more than 24 million people and causes more than 1.5 million 
fractures to vertebrae, wrists and hips each year. It is the major 
underlying cause of bone fractures in postmenopausal women and the 
elderly.

What Happens in Osteoporosis?

In osteoporosis, the rate at which bone breaks down exceeds the rate at 
which it can be replaced.

To understand what happens in osteoporosis, it's important to first 
understand that bone is a constantly changing, living tissue - a 
honeycomb-type structure packed full of calcium and mineral deposits. 
Throughout life, bone undergoes a process called remodeling - breaking 
down old bone and replacing it with strong new bone. Up until 
approximately age 30, as calcium is added to the diet, the rate at which 
bone is replaced is greater than the rate at which it breaks down. By 
age 30, you've reached your peak bone mass - the point at which your 
bones are as dense and as strong as they'll ever be.

By age 40, bone mass begins to slowly decline. After menopause, women 
lose bone mass rapidly due to a drop in estrogen level. For the next 
five to 10 years they lose about two to three percent of bone mass each 
year. Mineral deposits leave the honeycomb structure faster than they 
can be replaced. In other words, the rate at which bone breaks down 
becomes greater than the rate at which it can be replaced.

Bones with less mass are more likely to break or fracture, even in a 
minor fall. The first warning that you have osteoporosis may be a broken 
bone. This has been the case with many postmenopausal women who have 
broken bones in their wrists or spines as a result of lowered estrogen 
levels. In other instances, fractures of the spine have resulted in both 
a loss of height and rounded shoulders, often referred to as a dowager's 
hump.

Women are at greater risk of losing bone mass than men because women's 
bones are 20 to 30 percent less dense than men's. Caucasian and Asian 
women have less bone mass than African American women, which increases 
their risk. However, both men and women tend to break hips in their 70s 
and 80s. Since men also are affected, factors other than lack of 
estrogen must be important in causing hip fractures.

NORMAL BONE OSTEOPOROSIS

Increase Your Calcium Intake

Calcium not only influences bone density, but also affects other body 
processes. For muscles to contract, the heart to beat and blood to clot 
normally. your body must maintain a certain level of calcium in your 
blood. Because these functions take priority over calcium's role in bone 
density. the mineral is drawn from the bones to keep blood levels normal 
when calcium intake isn't adequate.

And as you get older, your body becomes less efficient at absorbing and 
using calcium. To combat this process, it's important to increase your 
calcium intake. 

How much calcium you need depends on your sex, age and risk for 
osteoporosis. Most adults need 1,000 to 1,500 milligrams of calcium a 
day from food and/or supplements. calcium supplements. Unfortunately. 
most only get about half, or 500 milligrams, from their diets.

Getting enough calcium is especially important if you're a woman under 
age 30, because your body is still able to absorb and store calcium in 
your bones easily. Experts recommend 1,500 milligrams per day for teens, 
pregnant or breast-feeding women and older adults. This amount is 
especially important if you are an older adult, because your intestines 
don't absorb calcium as well.

Supplements vary widely in the amount of calcium they contain.
Supplements of calcium carbonate contain the highest amount of useful,
or elemental, calcium. If you take a calcium supplement, be sure to take
it with meals and drink six to eight glasses of water each day.

Avoid Smoking

People who smoke cigarettes have a greater risk of fracture than 
non-smokers. Smoking reduces bone mass. Smokers may have an increased 
risk because they often weigh five to 10 pounds less than non-smokers. 
Smoking also lowers women's estrogen levels. Menopause begins at an 
earlier age for women smokers.

Avoid Heavy Alcohol Use

Men and women who drink a lot of alcohol have a higher risk of 
developing osteoporosis. People who drink heavily have less hone mass 
and lose bone more rapidly. This loss of bone mass may be the direct 
result of alcohol's effect on bone. Heavy drinking also increases your 
chances of falling and breaking a bone.

If you drink alcohol, experts recommend no more than two alcoholic 
beverages per day to keep bones healthy. One alcoholic drink is equal to 
12 ounces of beer, five ounces of wine or one and-a-half ounces of 
liquor.

Exercise

Exercises that place weight on or increase the force of gravity against 
your bones can help you keep bone mass.

Exercises that place weight on or increase the force of gravity against 
your bones can help you keep bone mass. Changes in pressure and force 
that occur during daily activities and exercise cause bones to develop 
mass and strength. When you move your body against the force of gravity 
and do exercises that strengthen muscles, you are producing forces that 
push and pull on your bones. Bones respond to this kind of movement and 
become stronger.

Some activities that use gravity and your muscles to strengthen your 
bones include aerobics, dancing, jogging, cross-country skiing, stair 
climbing, tennis and walking. Exercise helps you move more easily and 
keep your balance, which helps you avoid falls.

Routine X-rays are the least sophisticated of these tests. On one hand, 
spinal X-rays can help your doctor evaluate spinal fractures or
deformities not detected by a physical examination. However, by the time 
osteoporosis shows up on the X-ray. much damage has been done. 

Measurement tests, including routine X-rays, CT scans and absorptiometry 
tests, are used to determine bone density.

CT scans can measure the density of the entire bone or the inner, 
honeycomb portion. Bone densitometry measurements involve a photon 
energy source being passed over the spine, hip, wrist or other parts of 
the skeleton. Specific techniques include:
single-photon absorptiometry (SPA); dual-photon absorptiometry (DPA);
dual-energy X-ray absorptiometry (DXA); and radiographic
absorptiometry (RA). 

Researchers also have been exploring the usefulness of ultrasound 
techniques to measure bone mass in women at risk for osteoporosis. They 
are investigating ultrasound's ability to:
predict bone mass at the spine and hip; distinguish between people
with and without osteoporosis; predict those women at greatest risk of
hip fracture; and predict who will be susceptible to vertebral
deformities. 

Getting an accurate measure of bone density can help you and your doctor 
evaluate the need for preventive measures and treatment.

Your doctor also may perform one or more laboratory tests to help rule 
out secondary contributing factors to osteoporosis. These laboratory 
tests may include:
serum calcium test; phosphorus test; protein test; thyroid hormone
test; alkaline phosphatase test; and/or tests of liver and kidney
function. 

Several types of doctors may have more training and experience in 
diagnosing and treating people with osteoporosis. One type is a 
rheumatologist, who specializes in treating people with arthritis. 
Another is an endocrinologist, who specializes in treating diseases of 
the body's endocrine system, such as osteoporosis. Orthopedic surgeons 
are doctors who treat fractures related to osteoporosis.

How Is Osteoporosis Treated?

Many of the steps you can take to prevent osteoporosis - such as 
increasing calcium intake, exercising regularly, taking estrogen and 
making lifestyle changes - also may be used to treat it. Exercise is a 
particularly helpful treatment, because it also helps keep muscles 
strong and improves coordination and balance. Having good coordination 
and balance can help prevent falls and subsequent fractures. Keep in 
mind that high-impact exercise such as jogging is not recommended; it 
could damage fragile bones. Ask your doctor about the kind of exercise 
that's best for your condition.

Hormone therapy also can slow the spread of osteoporosis and reduce 
fracture risk. Although most doctors recommend hormone replacement 
therapy for women when menopause occurs or shortly thereafter, 
researchers have found that hormone therapy can improve bone mass, even 
in women who have osteoporosis and have already experienced menopause.

Many of the steps you can take to prevent osteoporosis also may be used 
to treat it.

Besides standard hormone replacement therapy. which typically is a 
combination of estrogen and progesterone (those women who have had a 
hysterectomy only need the estrogen), a naturally occurring hormone 
called calcitonin has been approved by the FDA for controlling bone 
breakdown and relieving pain. This hormone is primarily prescribed for 
postmenopausal women who cannot take estrogen and for people who take 
corticosteroids. It currently is available as an injection.

Fractures are treated in other ways. The treatment may include casts, 
braces or surgery.

Other treatment may include physical therapy, pain relievers and rest.

Treatments Under Study

Several treatments for osteoporosis currently are under study. Some of 
these treatments already are being used in other countries. However, 
they have not yet been approved by the FDA as treatments for 
osteoporosis.

One study showed that calcitriol, a powerful, hormonal form of vitamin D 
prescribed by doctors, decreased fracture rates in women. However, 
vitamin D can be toxic if taken in too large an amount - 100 to 1,000 
times the recommended dose - and may lead to serious side effects, 
including kidney damage and high blood pressure.

Bisphosphonates are compounds that have been found to decrease bone 
loss. Examples of bisphosphonates are alendronate, etidronate, 
clodronate, pamidronate and tiludronate. Clinical osteoporosis trials 
with bisphosphonates have demonstrated preservation of bone mass in 
several parts of the skeleton as well as a possible reduction of spinal 
fractures. Researchers continue to study bisphosphonates as potential 
new therapies for the treatment and possibly the prevention of 
osteoporosis.

Calcitonin, in a nasal spray form, is being studied as a treatment.

Sodium fluoride promotes new bone growth, but may not reduce the risk of 
fracture. The new bone that is formed may be weaker. However, new forms 
of this drug are being tested.

The use of bone-growth stimulators, low- dose parathyroid hormone (PTH),
 tamoxifen and potassium bicarbonate are other treatments that 
researchers are currently investigating.

New methods are continually being developed to detect and treat 
osteoporosis. Your doctor is the best guide to finding the right 
treatment for you.