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Osteoporosis

Osteoporosis, or "fragile bone" disease, is a silent, underlying condition affecting some 25 million Americans, most of them women.  All of us lose some bone as we age, but people with osteoporosis lose an excessive amount.  Their bones become fragile and weak to the point where even a minor fall can result in a fracture.

Although solid in appearance, bone is constantly being broken down (resorbed) by cells called osteoclasts and rebuilt by cells called osteoblasts.  Early in life, the action of osteoblasts outpaces that of osteoclasts and, as long as there is adequate calcium and vitamin D in one's diet, bone mass will increase.  But even in the presence of estrogen, which helps sustain the action of osteoblasts, in a woman's late 20's and early 30's bone rebuilding gradually begins to lose ground to bone resorption.

Osteoporosis begins to take its toll before most women are aware of it.  Unfortunately, most women find out they have osteoporosis when it's too late -- usually after a fracture, loss of height or curvature of the spine has already occurred.  The greatest tragedy is that for many women this costly disease is preventable and treatable.

  • Of the 25 million Americans who suffer from osteoporosis, 80% of them are older women.
  • It is also affecting men in increasing numbers

  • A woman's risk for hip fracture alone is equal to the  combined risk of developing breast, uterine,
  • and ovarian cancer.

  • Half of all Caucasian women over 50 will experience at least one osteoporosis-related fracture of
  • the spine, wrist, hip or other bones in their lifetime.


    Certain factors which may increase the risk of developing osteoporosis include:

  • Family history of osteoporosis
  • Diet low in calcium and vitamin D since childhood, high in salt and protein  (Click here to see calcium content in food)
  • Smoker, moderate to heavy drinker
  • Caucasian or Asian heritage, or thin, small-boned body build
  • Little or no exercise
  • Recent or premature onset of menopause
  • Taking glucocorticoids (steroids), thyroid hormone or other medicines that can cause osteoporosis

As we all age, our bodies continue to lose calcium from our bones. After menopause, the rate of bone loss increases significantly.  Aside from the clinical findings, such as recent fracture, spinal curvature (kyphosis) or loss of height, the most accurate way of determining osteoporosis is with bone densitometry. Bone density scanners use computers to specifically measure bone mass.  The test is fast, painless, and safe - delivering no more X-ray exposure than a cross-continental flight.  According to the guidelines of the National Osteoporosis Foundation, every woman over age 50 (as well as both men and women of all ages with certain risk factors)  should undergo routine, yearly bone   densitometry screening.  Early detection of osteoporosis is important for the effective treatment and prevention of continued bone deterioration.

Although there is no specific "cure" for osteoporosis, certain measures can be taken in order to slow the rate of calcium loss and build bone mass.  Be sure you get enough weight-bearing exercise (walking, aerobics, tennis, dancing, team sports) and enough calcium and vitamin D.  Stick with low-salt, low-protein diets, and stop smoking and excess drinking.  Make sure your environment is "fall-proof" and that you have no medical or physical conditions that can lead to falling.

Various pharmaceutical options are available to treat osteoporosis.  Hormone therapy (estrogen replacement) can help halt bone loss in postmenopausal women although some questions exist concerning the long-term effects of this therapy.  Newer therapeutics include the bisphosphonates (Fosamax) and a nasal spray calcitonin  (Miacalcin). 

Fosamax, the brand-name for the drug alendronate sodium, is directly absorbed into the latticework of bone, inhibiting bone resorption.  In one study, a daily regimen of 5 or 10 milligrams of Fosamax increased bone mass in the spine and hip by 4 percent to 7 percent in just two years, comparable to the increase associated with estrogen replacement.  Another three-year study showed that the drug significantly reduced vertebral fractures and prevented them in women with osteoporosis who had not yet suffered spinal shortening.

A second option, Miacalcin, is recommended for women five or more years past menopause who cannot or will not take estrogen. Calcitonin inhibits bone loss and can increase bone density when there are high levels of calcium in the blood.  Those who use it should consume at least 1,000 milligrams of supplemental calcium and 400 international units of vitamin D each day.  

To keep bones strong, you need to consume 1,500 milligrams (mg) of calcium a day.  Most people get less than 500mg in their daily diet. To supplement, take 500mg of calcium in pill or powder form with breakfast and another 500mg with your evening meal. In order to help your body absorb the calcium, taking vitamin D is a daily requirement; 400 International Units (IU) or 800 IU per day if you’re over age 65 or have osteoporosis.

Unlike Fosamax and Miacalcin, which slow bone breakdown, sodium fluoride, a treatment not yet approved for general use, stimulates the bone-forming osteoblasts.  In a one-year study in postmenopausal women who had sustained vertebral fractures, sodium fluoride increased spinal bone density up to 5 percent and greatly reduced the fracture rate.

One of the newest medications used to combat osteoporosis is a synthetic estrogen, Evista, the brand name for raloxifene, which has been show to stimulate bone formation without the risks associated with postmenopausal estrogen therapy.

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