Medication for Osteoporosis | Preventing Osteoporosis

What is Osteoporosis? |The Definition of Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to break. Osteoporosis leads to literally abnormally porous bone that is more compressible like a sponge, than dense like a brick.



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) and wrist. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks.

In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. Although it's often thought of as a women's disease, osteoporosis also affects many men.

The Symptoms of Osteoporosis

The osteoporosis condition can be present without any symptoms for decades, because osteoporosis doesn't cause symptoms unless bone fractures. Some osteoporosis fractures may escape detection until years later. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. Then the symptoms are related to the location of the fractures.

Fractures of the spine (vertebra) can cause severe "band-like" pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain as well as loss of height or curving of the spine, which gives the individual a hunched-back appearance of the upper back, often called a "dowager hump."

A fracture that occurs during the course of normal activity is called a minimal trauma fracture or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.

Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial accidents. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality.

Symptoms occur late in the disease and they are:


- Loss of height as a result of weakened spines. A person may find that his/her clothes are no longer fitting and their pants looking longer. Patients may loose as much as 6 inches in height.

- Cramps in the legs at night

- Bone pain and tenderness

- Neck pain, discomfort in the neck other than from injury or trauma

- Persistent pain in the spine or muscles of the lower back

- Abdominal pain

- Tooth loss

- Rib pain

- Broken bones

- Spinal deformities become evident like stooped posture, an outward curve at the top of the spine as a result of developing a vertebral collapse on the back.

- Fatigue

- Periodontal disease

- Brittle fingernails

Symptoms of bone weakness from advanced osteoporosis:

* Thin bones
* Brittle bones
* Weak bones
* Fractures
* Fracturing easily
* Backache
* Loss of height
* Spine deformation

What Causes of Osteoporosis?



Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. The body may fail to form enough new bone, or too much old bone may be reabsorbed, or both.

Two essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. Calcium is essential for proper functioning of the heart, brain, and other organs. To keep those critical organs functioning, the body reabsorbs calcium that is stored in the bones to maintain blood calcium levels. If calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, bone production and bone tissue may suffer. Thus, the bones may become weaker, resulting in brittle and fragile bones that can break easily.

Usually, the loss of bone occurs over an extended period of years. Often, a person will sustain a fracture before becoming aware that the disease is present. By then, the disease may be in its advanced stages and damage may be serious.

The leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men. Women, especially those older than 60 years of age, are frequently diagnosed with the disease. Menopause is accompanied by lower estrogen levels and increases a woman's risk for osteoporosis. Other factors that may contribute to bone loss in this age group include inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and other age-related changes in endocrine functions (in addition to lack of estrogen).

Other conditions that may lead to osteoporosis include overuse of corticosteroids (Cushing syndrome), thyroid problems, lack of muscle use, bone cancer, certain genetic disorders, use of certain medications, and problems such as low calcium in the diet.

What are the Risk Factors for Developing Osteoporosis?

Factors that will increase the risk of developing osteoporosis are:

* Female gender; especially women who are thin or have a small frame, as are those of advanced age.

* Caucasian or Asian race; especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis than other women.

* Thin and small body frames;

* Family history of osteoporosis (for example, having a mother with an osteoporotic hip fracture doubles your risk of hip fracture);

* Personal history of fracture as an adult;

* Cigarette smoking; eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors.

* Excessive alcohol consumption;

* Lack of exercise;

* Diet low in calcium;

* Poor nutrition and poor general health;

* Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from conditions such as celiac sprue;

* Low estrogen levels (such as occur in menopause or with early surgical removal of both ovaries);

* Chemotherapy can cause early menopause due to its toxic effects on the ovaries;

* Amenorrhea (loss of the menstrual period) in young women also causes low estrogen and osteoporosis; Amenorrhea can occur in women who undergo extremely vigorous training and in women with very low body fat (example: anorexia nervosa);

* Chronic inflammation, due to diseases (such as rheumatoid arthritis and chronic liver diseases);

* Immobility, such as after a stroke, or from any condition that interferes with walking;

* Women who are postmenopausal, including those who have had early or surgically induced menopause, or abnormal or absence of menstrual periods are at greater risk.

* Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the thyroid gland (as in Grave's disease) or is caused by taking too much thyroid hormone medication;

* Hyperparathyroidism, a disease wherein there is excessive parathyroid hormone production by the parathyroid gland (a small gland located near the thyroid gland). Normally, the parathyroid hormone maintains blood calcium levels by, in part, removing calcium from the bone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis;

* Vitamin D deficiency. Vitamin D helps the body absorb calcium. When vitamin D is lacking, the body cannot absorb adequate amounts of calcium to prevent osteoporosis. Vitamin D deficiency can result from lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis;

* Certain medications can cause osteoporosis. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

How is Osteoporosis Diagnosed?

An examination to diagnose osteoporosis can involve several steps that predict your chances of future fracture, diagnose osteoporosis, or both. It might include:

1. An Initial Physical Exam

2. Various X Rays that detect skeletal problems. A routine x-ray can reveal osteoporosis of the bone, which appears much thinner and lighter than normal bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, x-rays are not accurate indicators of bone density. The appearance of the bone on x-ray is often affected by variations in the degree of exposure of the x-ray film.

3. Laboratory Tests that reveal important information about the metabolic process of bone breakdown and formation. A number of lab tests may be performed on blood and urine samples. The results of these tests can help your doctor identify conditions that may be contributing to your bone loss.

The most common blood tests evaluate:

* blood calcium levels
* blood vitamin D levels
* thyroid function
* parathyroid hormone levels
* estradiol levels to measure estrogen (in women)
* follicle stimulating hormone (FSH) test to establish menopause status
* testosterone levels (in men)
* osteocalcin levels to measure bone formation.

The most common urine tests are:

* 24-hour urine collection to measure calcium metabolism
* tests to measure the rate at which a person is breaking down or resorbing bone.


4. A Bone Mineral Density test to detect low bone density. A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can identify osteoporosis, determine your risk for fractures, and measure your response to osteoporosis treatment.

The Treatment of Osteoporosis | Medications for Osteoporosis | Prevention of Osteoporosis

Because osteoporosis is difficult to reverse, prevention is the key to treatment.



Calcium and vitamin D are needed for strong bones. If calcium intake is not sufficient or if the body cannot absorb enough calcium, bone tissues become weaker. Throughout life calcium intake is important for bone formation. Vitamin D plays a crucial role in calcium absorption. Building strong bones by eating calcium-rich foods, maintaining a well-balanced diet and exercising during childhood and adolescence can be the best defense against osteoporosis.

Menopausal hormone replacement therapy -- either estrogen alone or a combination of estrogen and progestin -- was used for prevention and treatment of osteoporosis. However, in July 2002, a landmark study revealed that hormone therapy increases the risk of breast cancer, heart disease, and stroke in some women. Hormone replacement therapy is known to help preserve bone and prevent fractures, but is not generally recommended at this point for osteoporosis because the risks are thought to outweigh the benefits.

In women who have been on hormone replacement therapy in the past and then stopped it, the bone begins to thin again -- at the same pace as during menopause.

Evista is an osteoporosis drug that has some actions similar to estrogen, such as the ability to maintain bone mass. However, studies have shown that it doesn't increase the risk of breast or uterine cancers like estrogen. Evista can cause blood clots and often increases hot flashes.

Actonel, Boniva, and Fosamax (also available as generic) treat osteoporosis by inhibiting cells that break down bone and slowing bone loss. Actonel and Fosamax are usually taken once a week while Boniva is taken once a month. There are strict ways to take these medications, since if taken incorrectly, they can lead to ulcers in the esophagus.

Another new osteoporosis medication is Reclast, which is given as a once-yearly 15-minute infusion in a vein. Reclast is said to increase bone strength and reduce fractures in the hip, spine and wrist, arm, leg, or rib.

Forteo is a new medication used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. A synthetic form of the naturally occurring parathyroid hormone, Forteo is the first drug shown to stimulate new bone formation and increase bone mineral density. It is self-administered as a daily injection for up to 24 months. Side effects include nausea, leg cramps, and dizziness.

Calcitonin is another treatment option for osteoporosis. Calcitonin is a naturally occurring hormone that inhibits bone loss. It is available as a nasal spray or injection and is quite expensive. Undesirable side effects include nausea and skin rashes.

Calcium Supplements

The following calcium intake has been recommended by The National Institutes of Health Consensus Conference on Osteoporosis for all people, with or without osteoporosis:

* 800 mg/day for children ages 1 to 10

* 1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen

* 1200 mg/day for teenagers and young adults ages 11 to 24

* 1500 mg/day for post menopausal women not taking estrogen

* 1200mg to 1500 mg/day for pregnant and nursing mothers

* The total daily intake of calcium should not exceed 2000 mg

Daily calcium intake can be calculated by the following method:

1. Excluding dairy products, the average American diet contains approximately 250 mg of calcium;

2. There is approximately 300 mg of calcium in an 8-ounce glass of milk;

3. There is approximately 450 mg of calcium in 8 ounces of plain yogurt;

4. There is approximately 1300 mg of calcium in 1 cup of cottage cheese;

5. There is approximately 200 mg of calcium in 1 ounce of cheddar cheese;

6. There is approximately 90 mg of calcium in ½ cup of vanilla ice cream;

7. There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.

Vitamin D

An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. However, vitamin D and calcium alone are not sufficient treatment for osteoporosis. They are given in conjunction with other treatments. Vitamin D is important in several respects:

* Vitamin D helps the absorption of calcium from the intestines.

* A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.

* Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.

Osteoporosis Prevention Through Nutrition and Diet

To ensure that people are getting enough calcium to build and maintain strong bones, doctors recommend eating plenty of calcium-rich foods, such as nonfat milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, and leafy green vegetables.

According to a panel convened by the National Institutes of Health, women who are still menstruating, or who are postmenopausal but taking hormone replacement therapy, should get 1,000 mg of calcium each day. This jumps to 1,200 to 1,500 mg per day for pregnant or breastfeeding women. Postmenopausal women not on hormone replacement therapy should get 1,500 mg/day.

Recommended daily intake for men is 1,000 mg per day (25 to 65 years of age) and 1,500 mg per day from age 65 and up. One 8-ounce glass of skim milk has the same amount of calcium as whole milk, 300 mg.

Because most women take in only half or a third as much calcium as they need through their diet, most doctors recommend calcium supplements to make up the difference. Calcium supplements are available in many forms, but calcium citrate and calcium gluconate appear to be more effective at reducing bone loss.

To help the body absorb calcium, doctors suggest taking vitamin D (400 to 800 IU daily) supplements.

Calcium supplements can inhibit the absorption of certain drugs. Check with your doctor before beginning calcium supplements. You may need to take your supplements at a different time than your other medications.

Other Dietary Ways to Maintain Bone

In addition to eating calcium-rich foods, you should also avoid phosphorus-rich ones, which can promote bone loss. High-phosphorus foods include red meats, soft drinks, and those with phosphate food additives. Excessive amounts of alcohol and caffeine are also thought to reduce the amount of calcium absorbed by the body and should be avoided.

To help keep estrogen levels from dropping sharply after menopause, and thus help prevent osteoporosis, some practitioners advise postmenopausal women to consume more foods containing plant estrogens, especially tofu, soybean milk, and other soy products. However, there is no evidence to prove that these foods help prevent or delay the onset of osteoporosis.
At-Home Remedies

Here are two easy ways to increase the amount of calcium in your diet:

* Add nonfat dry milk to everyday foods and beverages, including soups, stews, and casseroles. Each teaspoon of dry milk adds about 20 mg of calcium to your diet.

* Add a little vinegar to the water you use to make soup stock from bones. The vinegar will dissolve some of the calcium out of the bones, for a calcium-fortified soup. A pint can contain as much as 1,000 mg of calcium.

Osteoporosis Prevention Through Exercise

Not only must you get enough calcium in your diet, you must also exercise to maintain strong bones. Studies have shown that weight-bearing exercises -- those that put stress on bones, such as running, walking, tennis, ballet, stair climbing, aerobics, and weightlifting -- reduce bone loss and help prevent osteoporosis. To benefit from the exercise, you must do it at least three times per week for 30 to 45 minutes. Although swimming and bicycle riding are great cardiovascular exercises, they do not appear to prevent osteoporosis because they do not put enough stress on bones.

resource :
- medicinenet
- emedicinehealth
- endocrineweb
- webmd