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What are the risk factors?
How can it be prevented?
How is it diagnosed?
How is it treated?
Normal or early menopause (brought about naturally or because of surgery) increases your risk of developing osteoporosis, a condition in which bones are fragile or easily broken. That's because falling estrogen levels during menopause contribute to bone loss.
After age 35, bones lose their strength. According to the National Institutes of Health, the average person achieves maximum "peak" bone density by age 30. Bone loss slows down after 30, speeds up at the time of menopause and continues until old age.
One of every two American women over age 50 will have an osteoporosis-related fracture (usually a hip fracture), and nearly 20 percent will die six months later. Simple falls that would only bruise a young person result in fractures in those with osteoporosis. Small fractures of the spine are frequent and can cause loss of height, curvature of the upper back (dowager's hump) and chronic pain.
What are the risk factors?
Women who meet the following criteria are at risk for osteoporosis:
- Advanced age
- Caucasian or Asian race
- Family history of osteoporosis
- Sedentary lifestyle
- Lack of adequate calcium and vitamin D
- Past menopause, especially if premature
- Long-term use of corticosteroids, such as prednisone (see note).
- Too much thyroid medication and some diuretics can lead to bone loss. Diuretics are medications that cause more urine to pass.
NOTE: The Food and Drug Administration has issued a "black box" warning stating that long-term use of Depo-Provera® may lead to loss of bone density. This drug is an injectable hormone used to prevent pregnancy.
How is it prevented?
Fortunately, building bone density is possible at any age. Bones becomes stronger and denser when you place demands on them. Two types of exercise can help: weight-bearing and resistance exercises. Weight-bearing exercises, such as walking, dancing or jogging, cause your bones and muscles to work against gravity. Resistance exercises are activities using free weights and weight machines.
Medications and exercise can prevent osteoporosis. Lifestyle changes can help the medications be more effective. You can slow or stop the progression of osteoporosis by:
- Staying active.
- Quitting smoking.
- Avoiding excessive weight loss.
- Preventing falls.
- Getting enough calcium and vitamin D via diet or supplements.
- Exercising (weight-bearing or resistance). (Check with your doctor before you start)
How is it diagnosed?
A physician will recommend a bone mineral density test, or BMD, for a patient at risk for osteoporosis. Dual energy x-ray absorptiometry (DEXA) is an x-ray technology used to detect low bone density. The lower the density of the bone, the higher the risk of fractures. Painless, noninvasive and safe, the test evaluates the probability of a fracture and the need for treatment by scanning a patient's wrist, spine or hip for signs of mineral loss or bone thinning. DEXA can make repeated measurements to track bone loss over time. In addition, the scan determines the rate of bone loss and assesses the effectiveness of osteoporosis treatment.
How is it treated?
The goals of treatment for osteoporosis are to stop continued bone loss, or slow it down as much as possible, and to prevent bone fractures.
If you have osteoporosis, your doctor may recommend as part of your treatment:
- Moderate weight-bearing exercise
- More calcium-rich foods in your diet
- Calcium supplements
- Vitamin D
There are also other prescription therapies available for managing osteoporosis:
Bisphosphonates, such as alendronate (Fosamax®) risedronate (Actonel®) and ibandronate (Boniva®) - People taking bisphosphonates should take adequate amounts of calcium and vitamin D. These drugs have been shown to increase bone mass and prevent fractures in women with osteoporosis.
Calcitonin (Miacalcin®) - Calcitonin is a hormone that prevents the progressive loss of bone density, together with an adequate calcium and vitamin D intake. Calcitonin is a nonsteroidal hormone, unlike estrogen. The drug is available as an injection or a nasal spray.
Raloxifene (Evista®) - Raloxifene is one of a group of drugs known as selective estrogen receptor modulators. It is not a type of estrogen, but has been shown to act like estrogen with respect to increasing bone density. Unlike estrogen, raloxifene was not shown to affect breast tissue or the uterus in clinical trials. It is not yet known whether raloxifene reduces bone fractures in women with osteoporosis, although this is being evaluated in ongoing clinical trials. Raloxifene is associated with a risk of problems due to blood clots. Raloxifene has been shown to reduce spine fractures in women with osteoporosis while decreasing their breast cancer risk. (However, raloxifene has been shown to worsen hot flashes.)
Parathyroid hormone, (teriparatide [rDNA origin] injection) (Forteo®) is a medication that stimulates the formation of new bone by increasing the number and action of bone-forming cells.
All drugs have the potential for adverse effects. Ask your doctor for more information.
This article was reviewed and updated June 2007.
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