Osteoporosis
Osteoporosis is the weakening
of bone tissue and loss of bone density over time.
Literature says that about 1 out of 5 American women over
the age of 50 have osteoporosis. About half of all women over the age of 50
will have a fracture of the hip, wrist, or vertebra (bones of the spine). The good
part is that osteoporosis can be treated and prevented.
Osteoporosis occurs when the body fails to form enough
new bone, 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, your body uses these minerals to produce bones. If you do not
get enough calcium, or if your body does not absorb enough calcium from the
diet, bone production and bone tissues may suffer.
The leading causes of osteoporosis are a drop in estrogen
in women at the time of menopause and a
drop in testosterone in men. Women over age 50 and men over age 70 have a
higher risk for osteoporosis.
Other causes include:
· Being confined to a bed
· Taking corticosteroid
medications (prednisone, methylprednisolone) every day for more than 3 months,
or taking some antiseizure drugs
·
Vitamin D deficiency
White women, especially those with a family history of
osteoporosis, have a greater than average risk of developing osteoporosis.
Other risk factors include:
·
Absence of menstrual
periods (amenorrhea) for long periods of
time
·
Drinking a large amount of
alcohol
·
Family history of
osteoporosis
·
History of hormone
treatment for prostate cancer or breast cancer
·
Low body weight
·
Smoking
·
Too little calcium in the
diet
Symptoms
There are no symptoms
in the early stages of the disease.
Symptoms occurring
late in the disease include:
·
Loss of height (as much as 6 inches) over time
·
Low back pain due to fractures of the spinal bones
·
Neck pain due to fractures of the spinal bones
·
Stooped posture or kyphosis, also called a "dowager's hump"
Treatment
The goals of osteoporosis treatment are to:
·
Control pain from the
disease
·
Slow down or stop bone
loss
·
Prevent bone fractures
with medicines that strengthen bone
·
Minimize the risk of falls
that might cause fractures
There are several different treatments for osteoporosis,
including lifestyle changes and a variety of medications.
Medications are used to strengthen bones when:
·
Osteoporosis has been
diagnosed by a bone density study.
·
Osteopenia (thin bones,
but not osteoporosis) has been diagnosed by a bone density study, if a bone
fracture has occurred.
BISPHOSPHONATES
Bisphosphonates are the primary drugs used to both
prevent and treat osteoporosis in postmenopausal women.
·
Bisphosphonates taken by mouth
include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel).
Most are taken by mouth, usually once a week or once a month.
·
Bisphosphonates given
through a vein (intravenously) are taken less often.
CALCITONIN
Calcitonin is a medicine that slows the rate of bone loss
and relieves bone pain. It comes as a nasal spray or injection. The main side
effects are nasal irritation from the spray form and nausea from the injectable
form.
Calcitonin appears to be less effective than
bisphosphonates.
HORMONE REPLACEMENT THERAPY
Estrogens or hormone replacement therapy (HRT) is rarely
used anymore to prevent osteoporosis and are not approved to treat a woman who
has already been diagnosed with the condition.
Sometimes, if estrogen has helped a woman, and she cannot
take other options for preventing or treating osteoporosis, the doctor may
recommend that she continue using hormone therapy. If you are considering
taking hormone therapy to prevent osteoporosis, discuss the risks with your doctor.
PARATHYROID HORMONE
Teriparatide (Forteo) is approved for the treatment of
postmenopausal women who have severe osteoporosis and are considered at high
risk for fractures. The medicine is given through daily shots underneath the
skin. You can give yourself the shots at home.
RALOXIFENE
Raloxifene (Evista) is used for the prevention and
treatment of osteoporosis. Raloxifene is similar to the breast cancer drug
tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%.
However, it does not appear to prevent other fractures, including those in the
hip. It may have protective effects against heart disease and breast cancer,
though more studies are needed.
The most serious side effect of raloxifene is a very
small risk of blood clots in the leg veins (deep venous thrombosis) or in the
lungs (pulmonary embolus).
EXERCISE
Regular exercise can reduce the likelihood of bone
fractures in people with osteoporosis. Some of the recommended exercises
include:
·
Weight-bearing exercises
-- walking, jogging, playing tennis, dancing
·
Resistance exercises --
free weights, weight machines, stretch bands
·
Balance exercises -- tai
chi, yoga
·
Riding a stationary
bicycle
·
Using rowing machines
Avoid any exercise that presents a risk of falling, or
high-impact exercises that may cause fractures.
DIET
Get at least 1,200 milligrams per day of calcium and 800
- 1,000 international units of vitamin D3. Vitamin D helps your body absorb
calcium.Your doctor may recommend a supplement to give you the calcium and
vitamin D you need.
Follow a diet that provides the proper amount 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 to form and maintain bones is available.
High-calcium foods include:
·
Cheese
·
Ice cream
·
Leafy green vegetables,
such as spinach and collard greens
·
Low-fat milk
·
Salmon
·
Sardines (with the bones)
·
Tofu
·
Yogurt
STOP UNHEALTHY HABITS
Quit smoking, if you smoke. Also limit alcohol intake.
Too much alcohol can damage your bones, as well as put you at risk for falling
and breaking a bone.
PREVENT FALLS
It is critical to prevent falls. Avoid sedating
medications and remove household hazards to reduce the risk of fractures. Make
sure your vision is good. Other ways to prevent falling include:
·
Avoiding walking alone on
icy days
·
Using bars in the bathtub,
when needed
·
Wearing well-fitting shoes
MONITORING
Your response to treatment can be monitored with a series
of bone mineral density measurements taken every 1 - 2 years.
Women taking estrogen should have routine mammograms,
pelvic exams, and Pap smears.
RELATED SURGERIES
There are no surgeries for treating osteoporosis itself.
However, a procedure called vertebroplasty can be used to treat any small
fractures in your spinal column due to osteoporosis. It can also help prevent
weak vertebrae from becoming fractured by strengthening the bones in your
spinal column.
The procedure involves injecting a fast-hardening glue into
the areas that are fractured or weak. A similar procedure, called kyphoplasty,
uses balloons to widen the spaces that need the glue. (The balloons are removed
during the procedure.)
further reading :
http://www.nlm.nih.gov/medlineplus/tutorials/osteoporosis/htm/index.htm