What is osteoporosis | symptoms of osteoporosis | osteoporosis emedicine | Osteoporosis Causes | Osteoporosis and Symptoms | Diagnosis | Osteoporosis Treatment and Prevention
What is osteoporosis | symptoms of osteoporosis | osteoporosis emedicine | Osteoporosis Causes | Osteoporosis and Symptoms | Diagnosis | Osteoporosis Treatment and Prevention
What is osteoporosis
Osteoporosis is a condition characterized by the loss of the normal density of bone, resulting in fragile bone. Osteoporosis leads to literally abnormally porous bone that is more compressible like a sponge, than dense like a brick. This disorder of the skeleton weakens the bone causing an increase in the risk for breaking bones (bone fracture).
Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone fracture. The fracture can be either in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, and wrists are common areas of bone fractures from osteoporosis, although osteoporosis-related fractures can also occur in almost any skeletal bone.
What are the signs of osteoporosis
You may not know you have osteoporosis until you have serious signs. Signs include broken bones, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.
Will I need a bone density test
Check with your doctor. For many women, osteoporosis (or the risk of it) can be diagnosed without testing. When testing is appropriate, doctors use equipment that takes a “picture” of the bones to see if they are becoming porous.
Bone anabolic agents
* Teriparatide
Recently, teriparatide (Forteo, recombinant parathyroid hormone residues 1–34) has been shown to be effective in osteoporosis. It acts like parathyroid hormone and stimulates osteoblasts, thus increasing their activity. It is used mostly for patients with established osteoporosis (who have already fractured), have particularly low BMD or several risk factors for fracture or cannot tolerate the oral bisphosphonates. It is given as a daily injection with the use of a pen-type injection device. In some countries, Teriparatide is licensed to be used for treatment only if bisphosphonates have failed or are contraindicated. (In the U.S., this restriction has not been imposed by the FDA.) Patients with previous radiation therapy, or Paget’s disease, or young patients, should avoid this medication.
* Calcium salts
Calcium salts come as water insoluble and soluble formulations. Calcium carbonate is the primary water insoluble drug, while calcium citrate, lactate, and gluconate are water soluble. Calcium carbonate’s absorption is improved in acidic conditions, while the water soluble salts are relatively unaffected by acidic conditions.
* Sodium fluoride
This agent has been shown to increase bone density in the vertebrae.
What is ibandronate sodium
Ibandronate sodium (brand name: Boniva) is a new drug that is taken once a month. It is not a hormone, but it slows bone loss and increases bone density. Some of the possible side effects include upset stomach, heartburn, nausea and diarrhea.
How much calcium do I need
Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you’re taking estrogen and 1,500 mg of calcium per day if you’re not taking estrogen.
It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, sardines and broccoli.
About 300 mg of calcium are in each of the following: 1 cup of milk or yogurt, 2 cups of broccoli, or 6 to 7 sardines.
If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) help your body absorb the calcium.
Tips to take care bones strong
* Exercise.
* Eat a well-balanced diet with at least 1,000 mg of calcium a day.
* Quit smoking. Smoking makes osteoporosis worse.
* Talk to your doctor about HRT or other medicines to prevent or treat osteoporosis.
Prevention
To reach optimal peak bone mass and continue building new bone tissue as you age, you should consider several factors.
Calcium: An inadequate supply of calcium over a lifetime contributes to the development of osteoporosis. Many published studies show that low calcium intake appears to be associated with low bone mass, rapid bone loss, and high fracture rates. National nutrition surveys show that many people consume less than half the amount of calcium recommended to build and maintain healthy bones. Food sources of calcium include low-fat dairy products, such as milk, yogurt, cheese, and ice cream; dark green, leafy vegetables, such as broccoli, collard greens, bok choy, and spinach; sardines and salmon with bones; tofu; almonds; and foods fortified with calcium, such as orange juice, cereals, and breads. Depending upon how much calcium you get each day from food, you may need to take a calcium supplement.
Calcium needs change during one’s lifetime. The body’s demand for calcium is greater during childhood and adolescence, when the skeleton is growing rapidly, and during pregnancy and breastfeeding. Postmenopausal women and older men also need to consume more calcium. Also, as you age, your body becomes less efficient at absorbing calcium and other nutrients. Older adults also are more likely to have chronic medical problems and to use medications that may impair calcium absorption.
Recommended Calcium Intakes
| Age | mg/day |
|---|---|
| Birth to 6 months | 210 |
| 6 months to 1 year | 270 |
| 1 to 3 years | 500 |
| 4 to 8 years | 800 |
| 9to 13 years | 1,300 |
| 14 to 18 years | 1,300 |
| 19 to 30 years | 1,000 |
| 31 to 50 years | 1,000 |
| 51 to 70 years | 1,200 |
| 70 years and older | 1,200 |
| Pregnant or lactating |
|
| 14 to 18 years | 1,300 |
| 19 to 50 years | 1,000 |
Medications that cause bone loss
The long-term use of glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn’s disease, lupus, and other diseases of the lungs, kidneys, and liver) can lead to a loss of bone density and fracture. Bone loss also can result from long-term treatment with certain antiseizure drugs, such as phenytoin (Dilantin)1 and barbiturates; gonadotropin-releasing hormone (GnRH) drugs used to treat endometriosis; excessive use of aluminum-containing antacids; certain cancer treatments; and excessive thyroid hormone. It is important to discuss the use of these drugs with your doctor and not to stop or change your medication dose on your own.
Exercise
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Weight-bearing exercise is the best for your bones because it forces you to work against gravity. Examples include walking, hiking, jogging, climbing stairs, weight training, tennis, and dancing.
Smoking
Smoking is bad for your bones as well as your heart and lungs. Women who smoke have lower levels of estrogen compared with nonsmokers, and they often go through menopause earlier. Smokers also may absorb less calcium from their diets.
Alcohol
Regular consumption of 2 to 3 ounces a day of alcohol may be damaging to the skeleton, even in young women and men. Those who drink heavily are more prone to bone loss and fracture, because of both poor nutrition and increased risk of falling.
1 Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
Vitamin D
Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people obtain enough vitamin D naturally, by getting about 15 minutes of sunlight each day; however, studies show that vitamin D production decreases in the elderly, in people who are housebound, and for people in general during the winter. They may need vitamin D supplements to achieve the recommended intake of 400 to 600 IU (International Units) daily.
Symptoms
Osteoporosis is often called a silent disease because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).
Treatment
A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.
Nutrition
The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in balanced proportion. In particular, calcium and vitamin D are needed for strong bones and for your heart, muscles, and nerves to function properly. (See “Prevention” section for recommended amounts of calcium.)
Therapeutic Medications:
Several medications are available for the prevention and treatment of osteoporosis:
*
Bisphosphonates. Alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) are medications from the class of drugs called bisphosphonates. These bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis. Alendronate is also approved to treat bone loss that results from glucocorticoid medications such as prednisone or cortisone and is approved for treating osteoporosis in men. Risedronate is approved to prevent and treat glucocorticoid-induced osteoporosis and to treat osteoporosis in men. Another bisphosphonate, zoledronic acid (Reclast), is approved for the treatment of postmenopausal osteoporosis, to increase bone mass in men with osteoporosis, for the prevention of fractures in patients who have recently had a low-trauma hip fracture, and for the prevention and treatment of glucocorticoid-osteoporosis in men and women.
Side effects of oral bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcer.
Side effects of intravenous bisphosphonates include flu-like symptoms, fever, pain in muscles or joints, and headache. These side effects can occur shortly after receiving an infusion and generally stop within 2 to 3 days.
There also have been rare reports of osteonecrosis of the jaw and of visual disturbances in people taking oral and intravenous bisphosphonates.
Some bisphosphonates are marketed with calcium and vitamin D supplements. These nutrients are important for everyone, and people should include adequate amounts of them in their diets.
1. Raloxifene. Raloxifene (Evista) is approved for the prevention and treatment of postmenopausal osteoporosis. It is from a class of drugs called estrogen agonists/antagonists, commonly referred to as selective estrogen receptor modulators (SERMs). Although side effects are not common with raloxifene, those reported include hot flashes and blood clots in the veins, the latter of which is also associated with estrogen therapy.
2. Calcitonin. Calcitonin (Miacalcin, Fortical) is a naturally occurring hormone involved in calcium regulation and bone metabolism. It is approved for the treatment of osteoporosis in women who are at least 5 years past menopause. Although it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, frequent urination, nausea, and skin rash. The only side effect reported with nasal calcitonin is nasal irritation.
3. Teriparatide. Teriparatide (Forteo) is an injectable form of human parathyroid hormone. It is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Unlike the other drugs used in osteoporosis, teriparatide acts by stimulating new bone formation. Side effects include nausea, dizziness, and leg cramps. Teriparatide is approved for use for up to 24 months.
4. Estrogen/hormone therapy. Estrogen/hormone therapy (ET/HT) is approved for preventing postmenopausal osteoporosis and is most commonly administered in the form of a pill or skin patch. When estrogen—also known as estrogen therapy or ET—is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, doctors prescribe the hormone progestin—also known as hormone therapy or HT—in combination with estrogen for those women who have not had a hysterectomy. Side effects of ET/HT include vaginal bleeding, breast tenderness, mood disturbances, blood clots in the veins, and gallbladder disease.
The Women’s Health Initiative (WHI), a large Government-funded research study, recently demonstrated that the drug Prempro (estrogen combined with progestin), which is used in hormone therapy, is associated with a modest increase in the risk of breast cancer, stroke, and heart attack. The WHI also demonstrated that in patients who had a hysterectomy, estrogen therapy alone was associated with an increase in the risk of stroke, but not of breast cancer or cardiovascular disease. A large study from the National Cancer Institute indicated that long-term use of estrogen therapy may be associated with an increased risk of ovarian cancer.
Estrogen therapy is approved for treatment of menopausal symptoms but should be prescribed for the shortest period of time possible. When used solely for the prevention of postmenopausal osteoporosis, any ET/HT regimen should be considered only for women at significant risk of osteoporosis, and nonestrogen medications should be carefully considered first.
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