Osteoporosis Prevention

What is osteoporosis?
During the normal aging process, bone strength declines. If bone strength decreases below a minimum value, that individual has osteoporosis or "thin bones." As a result, the person has an increased risk that she will develop fractures of the hip and spine bones. These fractures usually occur in the elderly and the resultant reduction in mobility may seriously reduce an individual's ability to live independently.

Who gets osteoporosis?
Women are much more likely than men to develop osteoporosis. Other "risk factors" include: advanced age, white or asian race, thin and short stature, menopause at an early age, cigarette use, lack of physical activity, low dietary calcium intake, alcohol use, an overactive thyroid, stomach surgery, anti-seizure medicines, anorexia nervosa, steroid use and a family member who has osteoporosis. The more "risk factors" a women has, the more likely it is that she will get osteoporosis. Some women who have many risk factors never develop osteoporosis while other women with no risk factors do get osteoporosis

What can be done to prevent the development of osteoporosis?
A person can try to prevent the development of osteoporosis by exercising regularly, ensuring they have an adequate amount calcium in their diet and reducing the use of alcohol and cigarettes. Another way for women to prevent the subsequent development of osteoporosis is to begin taking estrogen pills shortly after they stop menstruating. This is known as "estrogen replacement therapy." While estrogen replacement therapy will decrease a women's risk of developing osteoporosis and heart disease, it may increase her risk of getting uterus cancer and breast cancer. On balance, estrogen replacement therapy is probably a good option for many women, however a thorough discussion of the risks and benefits should be completed before estrogen replacement therapy is initiated.

How is osteoporosis evaluated and treated?
Osteoporosis is determined by measuring the "bone density? using a special x-ray machine. People who have osteoporosis need additional blood tests prior to beginning therapy. Based on the results of these tests, your physician may choose one of several therapies; including calcium pills, vitamin-D pills, estrogen pills, Fosamax, Actonel, Zometa, Evista or calcitonin shots. Although some of these treatments can increase bone strength, few therapies have been shown to prevent the development of future bone fractures. Fosamax and Actonel are the best medications to reduce the possibility of having a new fracture. When taken over the course of 3 years, these medications can reduce the probability of having a new fracture from about 16% down to 12%. In 2004, Foreto was was released on the market. Forteo is given by daily injections and should only be used in very severe cases of osteoporosis. It may be the strongest medicine for osteoporosis but the longterm side effects are not yet well known.

The best "treatment" for osteoporosis is prevention.
All women under the age of 50 should ensure that their diet includes 1,000 mg of elemental calcium. Women over 50 should have a diet which includes 1,500 mg of calcium and 800 U of Vitamin D. A cup of milk or yogurt contains about 300 mg of calcium; some over the counter calcium pills include Tums (200 mg of calcium,) Tums Ex (300 mg) and Tums Ultra (400 mg.) Both Tums 500 and Os-Cal 500 contain 500 mg of elemental calcium. Everyone should attempt to minimize their "risk factors" and women should consider obtaining a baseline bone density at about the age of 65. Women who have a lot of risk factors may want to have their screening bone density done at a younger age.

Men can get osteoporosis.
Increasingly, more men are being diagnosed with osteoporosis. Although the evaluation of osteoporosis in men is a little different, the treatment options are about the same.

Hayward Zwerling, M.D. is a Fellow of the American College of Physicians and of the American Association of Clinical Endocrinologists. He is board certified by the American Board of Internal Medicine in Internal Medicine, Endocrinology and Metabolism.