Boning Up on Osteoporosis

An elderly woman stretches before exercising in a grassy outdoor environment

If you’re a woman over age 50, you have a one-in-two chance of breaking a bone-most likely in the spine, hip or wrist- in the coming years. If you’re a man, your chances are one in four.

The cause of these breaks? Osteoporosis, a degenerative disease that causes bones to become thin, weak and highly vulnerable to fracture. In fact, it results in more than 1.5 million fractures each year.

Because thin, brittle bones break so easily, osteoporosis fractures can be much more serious than the broken arm or leg you may have had as a child. The older you get, the greater your risk. For an elderly woman, a hip fracture suffered in a simple fall can be permanently disabling or even fatal.

Who gets it — and why

Ten million or so Americans already have osteoporosis, and another 30 million have low bone density that increases their risk of developing the disease. About 80 percent are women, whose bone loss is attributed to decreased estrogen levels following menopause.

Though men do not experience the same hormonal changes as women, one in three develops thinning bones by age 75.

While estrogen deficiency is a major cause of osteoporosis, it’s not the only one. Certain medical conditions can increase the risk, such as an overactive thyroid and parathyroid, liver disease, rheumatoid arthritis, malnutrition, lack of calcium and/or vitamin D and long-term use of corticosteroids.

Genetics can come into play as well: Caucasian, Asian and Hispanics have a greater risk of osteoporosis than African-Americans. Other factors that can lead to increased bone loss are insufficient exercise, smoking and alcohol use.

Osteoporosis has been called the “silent disease” because it develops painlessly, without symptoms, until a bone breaks.

Bone density tests can analyze bone mass and predict the risk of fracture. Most common is the DEXA scan, which uses dual energy X-rays of the hip and spine to predict osteoporosis. Ultrasound may be used to measure bone density in the heel of the foot.

If you believe you may be at risk for osteoporosis, ask your doctor about testing.

Guard your bones

The good news is, you can take steps to prevent osteoporosis. Building strong bones, especially before age 35, is a good defense, as is a bone-friendly lifestyle. The tips below can help keep bones healthy and strong:

  • Get enough calcium. Men and women age 25 to 65 should have 1,000 mg of calcium daily. Women near or in menopause should boost their intake to 1,200 to 1,500 mg. Calcium-rich foods include low-fat dairy products, dark green leafy vegetables, calcium-fortified bread and juice, and canned fish with edible bones such as sardines. You also can take a calcium supplement; ask your doctor to recommend one that’s right for you.
  • Get enough vitamin D. Vitamin D helps your body absorb calcium. Most people get enough from sunlight, but if you are rarely outdoors, check with your doctor to make sure you’re up to par.
  • Get enough exercise. Weight-bearing exercise that forces your body to work against gravity, such as walking, jogging and dancing, builds strong bones and improves balance and mobility – important factors in preventing potentially bone-breaking falls.
  • Avoid alcohol and tobacco use.
  • Ask your doctor about treatments. While hormone replacement therapy used to be recommended for post-menopausal women to help slow bone loss, it is no longer the first line of defense, especially for long-term use.

Instead, medications called bisphophonates, which include Fosamax, Actonel, and Boniva, may be prescribed to increase bone mass in women past menopause. Fosamax and Actonel are taken daily or weekly; while Boniva is taken once a month. These medications have few side effects, although some people may experience upset stomach or nausea.

Taking the medication on an empty stomach may help prevent this from happening. If you still cannot tolerate the side effects, your physician may recommend that you switch to a selective estrogen receptor modulator (SERM) such as Evista. Although not as effective as bisphophonates, Evista can also help prevent or treat bone loss and, as a bonus, may also help reduce your “bad” cholesterol levels.

For more information about the benefits and risks of each treatment, talk to your physician.