Helen
grew up on a farm in the Midwest. She drank lots of milk as a
child. She also walked a lot, but not after high school. That
was when she became a secretary in a local law office. Then she
never found time to exercise. Helen went through menopause at
age 47. At age 61, she was looking forward to retirement —
traveling and working in her garden. But then she slipped on a
small rug in her kitchen and broke her hip. After Helen recovered,
getting around was a lot more difficult — she needed a cane
to walk.
Helen
had osteoporosis, but she didn’t know it. Osteoporosis is
a disease that thins and weakens bones to the point where they
break easily — especially bones in the hip, backbone (spine),
and wrist. Osteoporosis is called the “silent disease”
— you may not notice any changes until a bone breaks. But
your bones have been losing strength over many years.
Bone
is living tissue. To keep bones strong, the body is always breaking
down old bone and replacing it with new tissue. As people enter
their forties and fifties, more bone is broken down than is replaced.
A close look at the inside of bone would show something that looks
like a honeycomb. When you have osteoporosis, the spaces in this
honeycomb grow larger. The outer shell of your bones also gets
thinner. All this makes your bones weaker.
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Who Gets Osteoporosis?
Ten
million Americans have osteoporosis, and 8 million of them are
women. About 34 million more have osteopenia. This means they
don’t have osteoporosis yet, but have lost enough bone to
make them more likely to get it. One in two women and one in eight
men over age 50 will have an osteoporosis-related fracture during
their lives. White and Asian women are most likely to get osteoporosis.
Other women at great risk include those who:
The
risk of osteoporosis grows as you get older. Bone loss may
begin slowly in some people when they are in their late thirties.
At the time of menopause women may lose bone quickly for several
years. Then the loss may continue but more slowly. As men age,
they do not have the same kinds of striking hormone changes as
women do in mid-life because they do not have a menopause. In
men the loss of bone mass occurs more slowly. But, by age 65 or
70 men and women are losing bone at the same rate.
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How Do I Know
If I Am Losing Bone?
Losing
height or having a bone break easily is often the first sign of
osteoporosis. But it doesn’t need to be. Bone density is
a term that describes how solid your bones are. Ordinary x-rays
do not show bone loss until a large amount of bone mass is gone.
The best way to measure bone density is by a DEXA-scan (dual-energy
x-ray absorptiometry). Ask your doctor about this test if you
think you are at risk for osteoporosis or if you are a woman around
the age of menopause or older.
The
DEXA-scan tells what your risk for a fracture is. It could show
that you have normal bone density. Or, it could show that you
have osteopenia or even osteoporosis.
Can I Prevent
Bone Loss?
Osteoporosis
is preventable. A
diet that is rich in calcium and vitamin D and a lifestyle that
includes regular weight-bearing exercise are the best ways to
prevent weakened bones in later life.
Calcium.
Getting enough calcium all through your life helps to build and
keep strong bones. Since 1997 the National Academy of Sciences
(NAS) has suggested that people over age 50 should get 1200 mg
of calcium daily. To do this, make foods that are high in calcium
part of your diet. These include low fat dairy foods, canned fish
with soft bones such as salmon, dark green leafy vegetables, and
calcium-fortified foods like orange juice, breads, and cereals.
If
you think you need to take a supplement to get enough calcium,
check with your doctor first. Calcium carbonate and calcium citrate
are two common forms of calcium supplement. Be careful not to
get more than 2500 mg of calcium a day very often. More than that
amount can increase your chance of developing kidney problems.
Vitamin
D. Your body uses vitamin D to absorb calcium. Being out in the
sun for a total of 20 minutes every day helps most people’s
bodies make enough vitamin D. You can also get vitamin D from
eggs, fatty fish, and cereal and milk fortified with vitamin D.
If you think you need to take a supplement, check with your doctor.
The NAS says people age 51 to 70 should have 400 IU (international
unit) each day. People over 70 should have 600 IU. More than 2000
IU of vitamin D each day may cause harm to your liver and even
lower bone mass.
Exercise.
Exercise makes bones and muscles stronger and helps prevent bone
loss. It is also a way to stay active and mobile. Weight-bearing
exercises, done three to four times
a week, are best for preventing osteoporosis. Walking, jogging,
playing tennis, and dancing are examples of weight-bearing exercises.
Strengthening and balance exercises may help you avoid falls and
lessen your chance of breaking a bone.
Your
Health. Some commonly used medicines can cause loss of bone mass.
These include glucocorticoids (a type of steroids) which are used
to control diseases such as arthritis and asthma, some antiseizure
drugs, certain sleeping pills, some hormones that treat endometriosis,
and some cancer drugs. An overactive thyroid gland or using too
much thyroid hormone for an underactive thyroid can also be a
problem. If you are taking these medicines, talk to your doctor
about what can be done to protect your bones.
Other
Lifestyle Changes. Avoid smoking. Also limit how much alcohol
you drink. Too much alcohol can put you at risk for falling and
breaking a bone.
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How Is Osteoporosis
Treated?
Prevention
and treatment of osteoporosis aims to stop bone loss and rebuild
bone to prevent fractures. Along with making life-style changes,
there are several medication choices. Some will slow your rate
of bone loss, and others can help rebuild bone. Talk with your
doctor to see if one of these is good for you:
Alendronate
and risedronate. These 1medicines are bisphosphonates, drugs that
slow the breakdown of bone and increase bone density. They can
lessen your chance of breaks in the spine, hip, and other bones.
Side
effects may include nausea, heartburn, and stomach pain. A few
people have muscle, bone, or joint pain while using these medicines.
These drugs must be taken in a certain way — when you first
get up, before you have eaten, and with a full glass of water.
You should not lie down or eat for at least one-half hour after
taking the drug. They can cause serious digestive problems.
These are available in both once-daily and once-a-week versions.
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Calcitonin.
This is a naturally occurring hormone that increases bone mass
in the spine and may lessen the pain of fractures already there.
It comes in two forms — injection or nasal spray.
The
injection may cause an allergic reaction and has some unpleasant
side effects. The only side effect of the nasal spray is a runny
nose in some people.
Although
it is not prescribed often, calcitonin is most useful for women
who are 5 years past menopause.
Raloxifene. This drug is approved to prevent osteoporosis.
It is a SERM (selective estrogen recep-tor modulator). It prevents
bone loss and spine fractures, but may
cause hot flashes or increase the risk of blood clots in some
women.
Estrogen.
Doctors sometimes prescribe estrogen at the time of menopause
to slow the rate of bone loss and to increase bone mass in the
spine and hip. Estrogen alone, called estrogen replacement therapy
(ERT), is used in postmenopausal women who have had the uterus
removed (hysterectomy). Postmenopausal women who still have a
uterus and choose to take estrogen also receive a progestin to
protect the lining of the uterus. This is called hormone replacement
therapy (HRT).
There
are risks with long-term use of these hormones. HRT increases
the risk of breast cancer, heart disease, stroke, and blood clots,
but lowers the risk of hip and other fractures and colorectal
cancer.
Estrogen increases the risk of uterine cancer in a woman with
a uterus who does not take a progestin and also the risk of blood
clots. Each woman thinking about ERT or HRT should discuss
benefits, risks, side effects, and other possible treatments with
her doctor.
In
the future. Other SERMs and bisphosphonates are being studied
as improved prevention or treatments for osteoporosis. Also promising
as a possible therapy is parathyroid hormone (PTH).
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What About
Falls?
When
bones are weakened by osteoporosis, a simple fall can cause a
fracture or break. This can result in a trip to the hospital,
surgery, and possibly a long-lasting disabling condition in the
case of a hip fracture. Osteoporosis is the cause of 1.5 million
fractures each year.
It is important to prevent falls. Some things
you can do include:
What About Osteoporosis
in Men?
Osteoporosis
is not just a woman’s disease. Men have it also, although
not as often as women do. This may be because most men start with
more bone mass than women and lose it more slowly as they age.
The
disease has not been as well studied in men as in women. Most
prevention and treatment recommendations are based on studies
in women. However, many of the risk factors for men are the same
as those for women — smoking, not enough calcium or vitamin
D, too much alcohol, family history, too little exercise, and
taking certain drugs.
Low
levels of testosterone in older men may increase their loss of
bone and chance of hip fracture.
Older
men who fracture a bone easily or have risk factors for osteoporosis
should get a DEXA-scan. If the scan shows osteoporosis, a man
should talk with his doctor about which treatment is best for
him. Choices are much like those suggested for older women except
for estrogen and raloxifene. These drugs have not been well studied
in men and are not presently prescribed for osteoporosis prevention
or treatment in men. Testosterone supplements may help some men
with low levels of testosterone.
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Resources
National Osteoporosis Foundation
1232 22nd Street, NW
Washington, DC 20037
202-223-2226
Website: www.nof.org
NIH Osteoporosis and Related Bone Diseases
National Resource Center
1232 22nd Street, NW
Washington, DC 20037
1-800-624-BONE
Website: www.osteo.org/
The National Institute on Aging
(NIA) has a book and video about exercise for older people. For
more information and a free publications list, write or call:
NIA Information Center
PO Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
Website: www.nia.nih.gov
National Institute on Aging
U. S. Department of Health and Human Services
National Institutes of Health
August 2002
The health information provided on this website, while helpful,
should not be used to diagnose a problem or illness and is not
intended as a substitute for evaluation or treatment by a physician.
