Osteoporosis

Number of people affected:
Ten million Americans. Eight million of them are women.

Who gets it:
One in two women and one in eight men over age 50 will have an osteoporosis-related fracture during their lives.

Symptoms:
None. Most people don’t know they have osteoporosis until a fall causes a bone to break.

Treatments:
Medication and diet

Doctors to see:
Endocrinologist, Rheumatologist

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Men as well as women are affected by osteoporosis, a disease that can be prevented and treated.

Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone both flexible and strong, which in turn helps it to withstand stress. More than 99 percent of the body's calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood.

Throughout your lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation.

For women, bone loss is fastest in the first few years after menopause, and it continues into the post-menopausal years. Osteoporosis - which mainly affects women but may also affect men - will develop when bone resorption occurs too quickly or when replacement occurs too slowly.

Osteoporosis is called the "silent disease" because bone is lost with no signs. Your loved one may not know that they have osteoporosis until a strain, bump, or fall causes a bone to break or a hip to fracture.

Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).

The best way to measure bone density is by a DEXA-scan (dual-energy x-ray absorptiometry).

This test can:

• Diagnose osteoporosis
• Check bone strength
• See if treatments are making the bones stronger.
• Determine rate of bone loss, and/or monitor the effects of treatment if the test is conducted at intervals of a year or more.

Treatment includes a balanced diet rich in calcium and vitamin D, exercise and various medications, such as:

Alendronate and risedronate. These medicines are bisphosphonates, drugs that slow the breakdown of bone and increase bone density. They can lessen the chance of breaks in the spine, hip, and other bones.

Calcitonin. This is a naturally occurring hormone that increases bone mass in the spine and may lessen the pain of fractures already there. It comes in two forms — injection or nasal spray.

Raloxifene. This drug is approved to prevent osteoporosis. It is a SERM (selective estrogen recep-tor modulator). It prevents bone loss and spine fractures.

One in two women and one in eight men over age 50 will have an osteoporosis-related fracture during their lives. Risk factors include:

• Gender. Women get osteoporosis more often than men.
• Age. The older you are, the greater your risk of osteoporosis.
• Body size. Small, thin women are at greater risk.
• Ethnicity. White and Asian women are at highest risk. Black and Hispanic women have a lower risk.
• Family history. Osteoporosis tends to run in families.
• Anorexia nervosa. This eating disorder can lead to osteoporosis.
• Calcium and vitamin D intake. A diet low in calcium and vitamin D makes a person more prone to bone loss.
• Medication use. Some medicines increase the risk of osteoporosis.
• Activity level. Lack of exercise or long-term bed rest can cause weak bones.
• Smoking. Cigarettes are bad for bones, heart, and lungs.
• Drinking alcohol. Too much alcohol can cause bone loss and broken bones.

Make sure your loved one gets the daily recommended dosage of calcium and vitamin D.

People over age 50 should get 1200 mg of calcium daily. To do this, make foods that are high in calcium part of their diet. These include 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 your loved one needs to take a supplement to get enough calcium, check with your doctor first. Be careful not to get more than 2500 mg of calcium a day. More than that amount can increase the chance of developing kidney problems.

For vitamin D, people age 51 to 70 should have 400 IU (international unit) each day; people over 70 should have 600 IU.

When bones are weakened by osteoporosis, a simple fall can cause a fracture or break. This can result in a trip to the hospital, surgery, and possibly a long-lasting disabling condition in the case of a hip fracture. Some things you can do to prevent falls:

• Make sure your loved one can see and hear well. Use glasses or a hearing aid if needed.
• Ask your doctor if any of the drugs your loved one takes can cause dizziness or unsteadiness.
• Use a cane or walker if your loved one’s walking is unsteady.
• Wear rubber-soled and low-heeled shoes.
• Make sure all the rugs and carpeting in the house are firmly attached to the floor.
• Keep rooms well lit and the floor free of clutter.
• Use nightlights.