By Alan Peterson, M.D.

What is osteoporosis?

In osteoporosis, bones lose calcium and become porous (filled with holes). This is called losing bone mass. It weakens the bones and makes them more likely to fracture or break.

Osteoporosis is more common in women. However, by age 65, men lose bone mass as quickly as women do.

Am I at risk for osteoporosis?

The more of the following risk factors that you have, the higher your risk for osteoporosis:

• Family history of osteoporosis
• White or Asian race
• Having a thin body and small bone frame
• Not getting enough calcium
• Not getting enough exercise
• Not getting enough Vitamin D
• Smoking
• Abusing alcohol
• Having an overactive thyroid (hyperthyroidism)
• Taking certain medicines, such as oral steroids used to treat asthma or arthritis for a long time
• For women, going through menopause before age 48 or having surgery to remove ovaries before menopause. After menopause (at any age) women lose bone mass quickly, especially in the first five years after menopause.
• For men, having low levels of the male hormone testosterone

What are the signes of osteoporosis?

In its early stages, osteoporosis may not cause any symptoms. Later on, signs may include broken bones (especially bones in your spine, hips, or wrists), low back pain or a hunched back. You may get shorter over time because osteoporosis can cause your vertebral bodies (the bones in your spine) to collapse. Treatment of osteoporosis is easier if the disease is detected before a lot of bone mass is lost. Doctors can detect osteoporosis with a simple, painless bone density test. This test measures how much bone you have lost. Your doctor can also use this test to tell whether osteoporosis treatment is working. This test is offered at the Walter Aument Family Health Center.

If you are at risk for osteoporosis, talk to your doctor about whether a bone density test is right for you.

How can I prevent osteoporosis or keep it from getting worse?

The list below includes some lifestyle changes that can help keep your bones from getting weaker. Your doctor may also decide to use medicine to help prevent osteoporosis or keep it from getting worse. Prescription medicines for osteoporosis include Alendronate, Risedronate, Raloxifene, Teriparatide, Calcitonin. Calcium and adequate amounts of Vitamin D are also absolutely key to preventing and treating osteoporosis.

Tips to keeping bones strong:

• Be physically active. Include weight-bearing exercises (for example, walking or climbing stairs) in your routine.
• Eat a well-balanced diet that includes enough calcium and vitamin D. Talk to your doctor about how much this might be for you. He might want to measure your vitamin D level in your blood.
• Quit smoking if you are a smoker. Smoking increases the loss of bone mass.
• If you abuse alcohol, this will also increase osteoporosis.

Let’s discuss the prescription medications previously listed.

Alendronate (brand name: Fosamax) can help increase bone mass and reduce the risk of hip and spine fractures. It is FDA-approved to prevent or treat osteoporosis in post menopausal women and to treat osteoporosis in men.

Risedronate (brand name: Actonel) is FDA-approved to help increase bone mass and reduce the risk of spine fractures in post menopausal women. It can also be used to treat men and women who have osteoporosis caused by the long term use of oral steroids like prednisone.

Raloxifene (brand name: Evista) is a drug used to prevent and treat osteoporosis by slowing bone loss and increasing normal bone growth. It is FDA-approved for use by post menopausal women. Raloxifene has some of the effects of estrogen without all of estrogen’s risks.

Teriparatide (brand name: Forteo) is a synthetic hormone taken as a shot once a day. One gives this to himself or herself. It causes new bone growth. Teriparatide is FDA-approved to treat osteoporosis in men and post menopausal women who are at high risk for a fracture.

Calcitonin (some brand names: Calcimar, Miacalcin) is a hormone that helps prevent bone loss and spine fractures in post menopausal women. Calcitonin can be taken as a shot or as a nasal spray. The US Food and Drug Administration has not approved this medicine for men.

What about hormone replacement therapy?

For women, hormone replacement therapy (also called HRT) can be used to counteract the drop in certain hormones that happens at menopause or if the ovaries are removed by surgery. Some women who take HRT may be at increased risk for breast and uterine cancers. The hormone, of course, that we are talking about is estrogen. Other risks include heart disease, gallstones, stroke, blood clots and liver problems. People should talk to their doctor about whether HRT is right for them. Certainly with the increased number of risk factors that have been proven lately, fewer and fewer of physicians are prescribing HRT.

HRT is obviously not recommended for men. Testosterone replacement therapy may be prescribed for men who have osteoporosis caused by low testosterone levels. This needs to be documented by blood testosterone levels.

How much calcium do I need?

Women need about 1200 mg. of calcium a day before menopause. Women need 1500 mg. of calcium a day after menopause. This is most easily taken as a 500 mg. tablet with each meal. Vitamin D is also needed to help with the absorption of the calcium. I certainly urge my patients to get combination medications that include calcium and vitamin D. In spite of this, we are finding that we have been under-dosing many of our patients with vitamin D. Vitamin D levels can easily be measured in the blood to make certain one is getting the proper amount for good bone strength. Some need over 1000 International Units (I.U.) daily of vitamin D.