Osteoporosis : The Bone Thief

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.

Who Gets Osteoporosis?

Millions of  Americans have osteoporosis.  They are mostly women, but more than 2 million men also have this disease.  White and Asian women are most likely to have osteoporosis. Other women at great risk include those who:

• have a family history of the disease,

• have broken a bone while an adult,

• have not gotten enough calcium throughout their lives,

• had an early menopause,

• had surgery to remove their ovaries,

• had extended bed rest,

• used certain medicines for a long time, or

• have small body frames.

The risk of osteoporosis grows as you get older. At the time of menopause women may lose bone quickly for several years. After that, the loss slows down, but continues  In men the loss of bone mass is slower.  But, by age 65 or 70 men and women are losing bone at the same rate.

What is osteopenia?

Millions more Americans have osteopenia.  Whether your doctor calls it osteopenia or just says that you have low bone mass, consider it a warning.  Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life.  that way you will be less likely to break a wrist, hip or vertebrae (bone in your spine) when you are older.

Can my bones be tested?

For some people the first sign of osteoporosis is to realize they are getting shorter or to break a bone easily, like Helen.  Don't wait until that happens to see if you have osteoporosis.  You can have a bone density test to find out how solid your bones are.  Your doctor may suggest a type of bone density test called a DEXA-scan (dual-energy x-ray absorptiometry). if you are age 65 or older or if he or she thinks you are at risk for osteoporosis. 

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.

How can I keep my bones strong? 

There are things you should do at any age to prevent weakened bones.  Eating foods that are rich in calcium and vitamin D is important.  So is including regular weight-bearing exercise in your lifestyle.  these are the best ways to keep your bones strong and healthy.

Calcium. Getting enough calcium all through your life helps to build and keep strong bones.  People over age 50 need 1200 mg of calcium daily. Foods that are high in calcium are the best source.  For example, eat  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 aren't getting enough calcium in your diet, check with your doctor first.  He or she may tell you to take a calcium supplement.  Calcium carbonate and calcium citrate are two common form. You have to be careful, though.  Too much calcium can cause problems for some people.  On most days you should not get more than 2500 mg. of total calcium.  That includes calcium from all sources--foods, drinks and supplements.

Vitamin D. Your body uses vitamin D to absorb calcium. Most peoples' bodies are able to make enough vitamin D if they are out in the sun for a total of 20 minutes every day. You can also get vitamin D from eggs, fatty fish, and cereal and milk fortified with vitamin D. If you think you are not getting enough vitamin D, check with your doctor. Each day you should have 600 IU (international unit)  of vitamin D; as with calcium, be careful.  More than 2,000 IU of vitamin D each day may cause side effects.

Exercise. Your  bones and muscles will be stronger if you are physically active. 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. Try some strengthening and balance exercises, too.  They may help you avoid falls which could cause a broken bone. 

Medicines . Some common  medicines can make bones weaker. These include a type of steroid drug called glucocorticoids used for arthritis and asthma, some antiseizure drugs, certain sleeping pills, some treatments for 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.

Lifestyle. Smoking increases loss of bone mass.  For this and many other health reasons, stop smoking.  Limit how much alcohol you drink. Too much alcohol can put you at risk for falling and breaking a bone.

What can I do for my osteoporosis?

Treating osteoporosis means stopping the bone loss and rebuilding bone to prevent breaks. Diet and exercise can help make your bones stronger. But they may not be enough if you have lost a lot of bone density.  There are alos several medicines to think about. 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, ibandronate and risedronate. These medicines are bisphosphonates, drugs that slow the breakdown of bone and increase bone density. They can make it less likely that you will break a bone, most of all in your spine, hip, or wrist. 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. Even if you follow the directions closely, these drugs can cause serious digestive problems, so be aware any side effects.  These are available in both once-daily and once-a-week versions.

• Raloxifene. This drug is used to prevent and treat 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 this female hormone around  the time of menopause to treat symptoms like hot flashes or vaginal dryness.  Estrogen also slows bone loss and increases bone mass in your spine and hip, so women can use it to prevent or treat osteoporosis.  But estrogen is thought to be risky for some women.  Talk to your doctor.  Ask about benefits, risks, and side effects, as well as other possible treatments for you. 

• Calcitonin. This hormone increases bone mass in your spine and can lessen the pain of fractures already there. It comes in two forms — a shot or nasal spray. The shot may cause an allergic reaction and has some side effects like nausea, diarrhea, or redness in your face, ears, hands or feet. The only side effect of the nasal spray is a runny nose in some people. Calcitonin is most useful for women who are 5 years past menopause.

• Parathyroid hormone (PTH). Also called teriparatide, this shot is given daily for up to two years to postmenopausal women and men who are at high risk for broken bones.  It improves bone density in the spine and hip.  Common side effects include nausea, dizziness, and leg cramps.

Can I avoid falling?

When your bones are weak, a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery.  It might also mean being laid up for a long time, especially  in the case of a hip fracture. So it is improtant to prevent falls. It is important to prevent falls. Some things you can do include:

• Make sure you can see and hear well. Use your glasses or a hearing aid if needed.

• Ask your doctor if any of the drugs you are taking can make you dizzy or unsteady
  on your feet.

• Use a cane or walker if your walking is unsteady.

• Wear rubber-soled and low-heeled shoes.

• Make sure all the rugs and carpeting in your house are firmly attached to the floor, or remove them.

• Keep your rooms well lit and the floor free of clutter.

• Use nightlights.

Do men have osteoporosis?

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
2 AMS Circle

Bethesda, MD  20892-3676

1-800-624-BONE (1-800-624-2663)

202-466-4315 (TTY)
Website: www.osteo.org/

National Library of Medicine

Medline Plus

In Health Topics, go to:

"Osteoporosis"

"Falls"

Website: www.medlineplus.gov

The National Institute on Aging Information Center  has information on health and aging, including a booklet and video about exercise for older people and several helpful Age Pages.  Contact:

The National Institute on Aging Information Center
 Information Center
PO Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
E-mail: niaic@jbs1.com

To order publications (in English or Spanish) online, visit www.niapublications.org.

The National Institute on Aging website is: www.nia.nih.gov.

National Institute on Aging
U. S. Department of Health and Human Services
National Institutes of Health
December 2004