What is Osteoporosis?

Osteoporosis is a disease in which bones become porous and weak. As they lose strength, they are more likely to break. Bones in the spine, hip, wrist, pelvis, and upper arm are particularly at risk of fracture in people with osteoporosis.

Osteopenia is a condition in which less bone has been lost than in osteoporosis. But people with osteopenia are more likely to develop osteoporosis if something is not done to stop the loss of bone.

About 10 million Americans have osteoporosis and 18 million more have osteopenia. The disease usually progresses without symptoms until it is diagnosed after a fracture.

Symptoms of Osteoporosis

What does OA feel like?
Patients with OA have one or more joints that are painful and stiff. The pain is a deep, dull ache that usually comes on gradually. Pain gets worse when the joint is used and gets better with rest. The joint is stiff after waking up or after not being used for some time, but the stiffness usually goes away fairly quickly. Over time the pain and the stiffness become almost constant.

No matter which joints are affected, OA patients report many of the same symptoms Most patients say that the pain is worse in cool, damp weather. Many OA patients feel or hear crackling or popping in the affected joints (called crepitus). This is most common in the knees.

Joints enlarge or change shape. The enlarged areas are often tender to the touch. In most cases the affected joints can't move through a normal range of motion. In other cases the joints have become so unstable that they can actually move too much or in the wrong direction.

Some symptoms depend on the affected joint. Patients with knee OA may have problems with the joint locking up, especially when they are stepping up or down. Patients with OA of the hip often limp. OA of the hands can affect the strength and movement of fingers and make simple tasks such as getting dressed very difficult. OA of the spine can cause neck and low back pain as well as weakness and numbness.

Diagnosis

The single best predictor of bone strength is bone density. Bone density cannot be determined from plain X-rays, but a specialized low-dose X-ray technique called bone densitometry can be used to measure the amount of bone present in different parts of the skeleton. Research over the past decade has shown conclusively that bone density is related to risk of fracture, in much the same way that blood cholesterol is related to the risk of heart disease. The lower the bone density, the greater the risk of fractures due to osteoporosis.

Take our quiz to find out if you are a good candidate for a bone density test. If you answer "yes" to one or more of these questions, talk to your doctor about getting a bone density test.

Types of Bone Density Tests

We offer a variety of techniques to diagnose osteoporosis by determining the density of your bones. Expert consultation is available to assist in ordering the appropriate diagnostic examination. The different scanning techniques are:

- Dual X-ray absorptiometry (DXA) of the lower (lumbar) spine and hip. This is the most common way to measure bone density. The DXA uses fan beam technology allowing for rapid scanning with very low-energy X-rays. The spine and hip exams each take about five minutes. DXA of the forearm also may be helpful, especially if both hips have been replaced surgically. The Hologic Delphi scanner at Mount Zion also can perform a low-dose X-ray to evaluate for spinal fractures. DXA tests are painless. You will be asked to change into a hospital gown to prevent any clothing or metal objects from interfering with the test. You will lie on a table and the scanning arm is moved slowly over the parts of the body to be scanned. You are not in a tunnel as with an MRI. The test takes about 10 to 15 minutes.

- Ultrasound of the heel. Bone density of the heel predicts overall fracture risk. However, ultrasound of the heel is not as good at predicting hip and vertebral fractures as DXA of the hip and spine. There are some instances in which your doctor might select this exam instead of, or in addition to, a DXA.

Other bone related examinations also may be helpful, depending on your particular circumstances.

- Quantitative computerized tomography (QCT) of the lower (lumbar) spine. This exam uses a standard CT scanner. Two vertebrae in the lower back are selected for single cross-sectional scans, which are analyzed with special densitometry software. The entire procedure takes about 15 minutes. This exam sometimes is used if you have a lot of arthritis in your back, which makes the DXA test less reliable. This exam isn't always covered by insurance and isn't covered by Medicare.

- Lateral radiographs of the thoracic and lumbar spine. Using a conventional X-ray unit, views of the upper and lower spine are taken to see if you have any fractures. This is a 15-minute exam.
The recommended clinical examination consists of DXA of the spine and hip. QCT and lateral radiographs of the spine may be needed depending on the DXA results and your particular circumstances.

Prevent Osteoporosis

After the age of about 30, bone thinning is a natural process and cannot be stopped completely. Whether you develop osteoporosis depends on the thickness of your bones early in life, as well as your health, diet, and physical activity later in life. The thicker your bones, the less likely the bones are to become thin enough to break. Young women in particular need to be aware of their risk for developing osteoporosis and take steps early to slow its progress and prevent complications. Plentiful physical activity during the preteen and teen years increases bone mass and greatly reduces the risk of osteoporosis in adulthood. If you eat a diet adequate in calcium and vitamin D and exercise regularly early in life and then continue with these healthy habits, you may be able to delay or avoid osteoporosis.

Eat a nutritious diet that includes adequate amounts of calcium and vitamin D. Both are necessary for building healthy, strong bones. The recommended daily calcium intake for adults age 19 to 50 is 1,000 mg per day. Men and women age 50 and older need 1,200 mg of calcium each day. The recommended daily intake for vitamin D is 5 ug (200 IU) for adults age 19 to 50, 10 ug (400 IU) for adults age 51 to 70, and 15 ug (600 IU) for adults age 71 and older. The best source of vitamin D is exposure to sunlight. Vitamin D is vital for calcium absorption in bones and to improve muscle strength. It may reduce an older person's risk of falling by 22%. If you are not getting enough calcium and vitamin D in your diet, take supplements.

Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, keep bones healthy by working the muscles and bones against gravity.

Don't drink more than one alcoholic drink per day. Drinking more than this puts you at higher risk for osteoporosis.

Don't smoke. Smoking puts you at a higher risk for developing osteoporosis and increases the rate of bone thinning once it starts.

Once osteoporosis develops, getting enough calcium and vitamin D, along with other healthy habits, can slow the process and reduce the chances of bones breaking. It's common for a person's diet to supply only half the calcium the bones need, so you probably need to take supplements. Studies show that taking calcium plus vitamin D significantly reduces hip fractures and other fractures in women who have gone through menopause. Vitamin D is vital for calcium absorption in bones and to improve muscle strength. It may reduce an older person's risk of falling by 22%.http://osteoporosissuffer.blogspot.com/

Treatment of Osteoporosis

Osteoporosis Treatment
Taking Fosamax or Tums is neither the complete nor the optimal treatment for osteoporosis or osteopenia. A comprehensive treatment program customized to your particular needs is the better approach.


Conventional Treatment for Osteoporosis

Lifestyle for Osteoporosis
- Discourage use of alcohol, tobacco, and caffeine.
- Weight bearing exercise.
- Calcium and Vitamin D supplementation.

Medications for Osteoporosis
Estrogen. Estrogen replacement therapy (ERT) in post-menopausal women has been a long-standing treatment to maintain adequate bone density in women. However, recent studies have found that estrogen replacement therapy (at least in synthetic forms such as Premarin) increases risk of heart attacks, strokes, breast cancer, and blood clots.

Calcitonin (Calcimar) is a hormone which directly inhibits the cells which break down bone. It is an alternative for people who cannot, will not or should not proceed with ERT. Calcitonin decreases further bone loss in patients with documented osteoporosis. For reasons that are poorly understood, the increase in BMD associated with calcitonin administration may be transient or resistance may develop. Calcitonin can be provided in two forms, as a nasal inhaler and as an injection. Nasal congestion and rhinitis are the most significant side effects of the nasal form. The injectable formulation has gastrointestinal side effects and is less convenient to use.

The increase in bone density resulting from this therapy is significantly less than that achieved by alendronate (Fosamax) or estrogen, and may be limited to the spine, but it still may have value in reducing the risk of fracture.

Bisphosphonates (e.g. alendronate/Fosamax) are effective for preventing bone loss in osteoporosis. The drug must be taken on an empty stomach with a full glass of water, and the patient must remain upright for at least 30 minutes after taking it to decrease the risk of esophageal irritation.

Selective Estrogen Receptor Modulators (e.g. Raloxifene/Evista) are thought to block estrogen in some sites while also binding and stimulating other estrogen tissue receptors. Raloxifene inhibits bone loss. Reported side effects of raloxifene include vaginitis and hot flushes.

Natural or Alternative Treatment for Osteoporosis

Treatment Goals for Osteoporosis
- Initiate lifestyle and dietary changes to stabilize and/or increase bone mass.
- Assure optimal repair mechanisms to remodel damaged areas of bone.
- Prevent first fracture, or future fractures if one has already occurred.
- Improve mobility and functional status.

Lifestyle for Osteoporosis
- Get at least 15 minutes of sunshine twice weekly to help with vitamin D production.
- Avoid cigarette smoking.
- Seek alternatives to the use of steroid and other medications which can lead to osteoporosis.

Exercise: regular weight bearing exercise is essential for maintaining or building bone density.
Weight bearing exercise includes walking, jogging, lifting weights, heavy housework or gardening, gymnastics, and active sports (soccer, basketball, etc.).

Walking at least 30 minutes daily is an excellent form of exercise which also increases cardiovascular fitness.

Women who exercise retain bone mass throughout life, achieve higher peak bone mass, and have significantly lower risk of fractures later in life.

Regular exercise throughout life also increases strength, balance, and coordination, and may result in decreased falls with age.

Consult your physician to help you to develop an exercise program which is suited to your individual health and fitness needs.

Young, growing bodies need calcium to prevent bone loss later in life

The best time to think about preventing osteoporosis is not at menopause or after a broken hip. It is when a young woman is a teenager and certainly by the time she's in her early 20s and 30s.

"The biggest thing that we want to emphasize is prevention," said Mark Davis, D.O., a Marshfield Clinic-Wausau Center rheumatologist. "I don't think we spend enough time from a medical standpoint and a community standpoint emphasizing the need for prevention."

Tammi Timmler, M.S., R.D., C.D., a registered dietitian with the Marshfield Clinic-Marshfield Center, agreed. "The role of diet in preventing osteoporosis begins in adolescence. A lot of people forget that this is a time when calcium and other minerals are really important in building bone strength. That is when a growth spurt is going on. Calcium and other minerals play a big role in making bones strong."

Dr. Davis recognizes it's hard to get adolescents and young women to take preventive action. "It's hard to get someone to pay attention to something that may happen 40 or 50 years down the road. They are just not interested in hearing about it" he said.

Osteoporosis, or thinning of the bones, can occur in both men and women but is much more common in women than men. Thinning of the bones results in 240,000 disabling hip fractures a year at a cost of about $20 billion to the health care system. Osteoporosis has been called a 'silent epidemic' because most of the 20 million Americans are unaware they have the condition until they break a bone.

Risk factors for osteoporosis include being thin or small boned, smoking, excessive alcohol, little calcium in the diet, inactivity and a family history of the condition. The best prevention involves increasing calcium, along with Vitamin D and other trace minerals to help in its absorption. Weight-bearing exercises, such as walking and bicycling, also are critical for bone strength. Smoking cessation and limiting alcohol also are important.

While nutritional supplements may help, a diet rich in calcium is preferred, according to Timmler, "In most cases, you have better absorption from food products than from calcium supplements. However, if you do need to take them absorption and utilization of calcium supplements appear to be better when they are taken with meals and taken throughout the day, rather than in a single dose" she said.

Also important for women after menopause is hormone replacement therapy or estrogen. In addition to its benefits in preventing osteoporosis, estrogen relieves uncomfortable symptoms of menopause and prevents heart disease. With some recent studies showing a small increase in the risk of cancer in women who take estrogen, it is not recommended for individuals with a history of breast or uterine cancer or who have had blood clots. For most women, however, the benefits outweigh the risks.

Osteoporosis is a slow thinning of the bones that most often shows up in women as they age. Bones can become weak and break easily, even without a fall. Osteoporosis becomes evident after menopause, with pain and broken bones. The back and hips are the most common areas affected by osteoporosis.

"Most women shouldn't be reluctant to take hormone replacement therapy," Dr. Davis said. "But I see women concerned about the potential for side effects or how it relates to their risk of cancer."

New drugs have come on the market in recent years to treat osteoporosis, including alendronate, nasal calcitonin and raloxifene, but estrogen is the preferred therapy for women who do not have a medical reason not to take it. At times a woman may be prescribed estrogen and one of these new medications, particularly if she has risk factors for osteoporosis.

One tool for convincing women that they should take estrogen is dual energy X-ray absorptiometry (DEXA), a bone scan that measures bone density. It predicts which patients are at risk for developing osteoporosis. DEXA, which uses less radiation than a standard x-ray, takes about 20 minutes and costs about $120 for two scans. DEXA can show a woman graphically where she stands in bone density compared with other women her age. When there is a greater loss than expected, she may be more willing to take estrogen.

Unfortunately, far fewer women take estrogen or another of these drugs than those who should. They may not appreciate how devastating osteoporosis can be, Dr. Davis said.

"Close to 20 percent of women who suffer a hip fracture have a major complication that causes a long-term medical problem or death. Fifty percent of women never completely recover. They live with pain, must use a cane or never get back up on their feet. There's a considerable cost in terms of their daily lives and medical dollars."

How much calcium do you need?

The amount of calcium you need in your diet depends on your age. The following are the latest recommendations from the National Academy of Sciences for daily intake of calcium:

Age - Calcium requirement

- 1 to 3 = 500 milligrams
- 4 to 8 = 800 mg
- 9 to 18 = 1,300 mg
- 19 to 30 = 1,000 mg
- 31 to 50 = 1,000 mg
- 51 and older = 1,200 mg

If you are older, have osteoporosis or at greater risk for it, the recommendation for calcium may be as much as 1,500 mg a day. Your doctor is the best source for a specific recommendation for you.

According to the National Osteoporosis Foundation, the average adult currently gets only 500 to 700 milligrams of calcium a day. That is less than the lower Recommended Daily Allowances set in 1989.

A glass of milk has about 300 milligrams of calcium. Low-fat and skim milk have the same amount of calcium as whole milk. Don't like milk?
Other options are:
- 1-1/4 cups of spinach
- 7 sardines
- 6 ounces of low fat yogurt
- 1 cup pudding
- 1 1/2 ounce cheddar cheese

A cup of a green leafy, vegetable like kale. The calcium in kale, incidentally, is more easily absorbed by the body than many dairy products.

Other excellent sources of calcium include salmon with bones, broccoli, tofu and calcium-fortified products.http://osteoporosissuffer.blogspot.com/