Health Resource Center

Osteoporosis

Osteoporosis is the most common bone disease affecting Americans. It develops slowly and eventually thins and weakens your bones, making them more likely to fracture. According to current health news and medical information from the National Osteoporosis Foundation, 10 million Americans are estimated to have the disease and almost 34 million more are estimated to have low bone mass (also called bone mineral density), placing them at increased risk for osteoporosis.

Health Politics, the National Women’s Health Resource Center (NWHRC), and the Bone and Joint Decade have partnered to bring you the following tips and medical information to help you better understand osteoporosis. You can also view a video about current health news on osteoporosis by Mike Magee, MD, host of Health Politics, at our Web site, www.HealthPolitics.com.

Medical Information on Bone Basics
It might surprise you to learn that your bones are complex, living tissue. Your body regularly breaks down and removes old bone tissue, replacing it with new, strong bone. From birth to about age 25 or 30, your body builds new bone faster than it removes old bone tissue and your bones become larger and stronger, reaching what's know as "peak bone mass." At this point, your bones are as dense and as strong as they'll ever be. But, as you age, your body breaks down old bone faster than it builds new bone. As a result, your bones can become more fragile. Many things can affect how much bone mass you lose as you age. Medical information and research tells us that your bone density and strength when you are young affects how your bones will change as you age. Genetics, diet, and physical activity also affect how fragile your bones become. And, there are many things you can do to improve bone health at every stage of your life.

Prevention
According to current health news from NWHRC, nearly one-third of bone loss can occur before a diagnosis of osteoporosis is made. But you can prevent future bone loss caused by osteoporosis with early detection and, if necessary, treatment. A bone fracture in middle-aged and older women should be a red flag to both doctors and women to investigate whether osteoporosis or another condition is affecting bone health. Once you've had a fracture because of osteoporosis, your risk of future fractures is increased. It is important to prevent the first fracture. Medical information now points to taking preventive steps and reviewing risk factors now as especially smart approaches for people of all ages.

The NWHRC recommends four simple steps to prevent osteoporosis:

• Increase the amount of calcium and vitamin D in your diet by consuming low-fat, calcium-rich foods and beverages and/or with calcium and vitamin D supplements
• Exercise regularly; bones and muscles respond to physical activity by becoming stronger; weight-bearing exercises like walking and weight lifting are the most beneficial
• If you smoke, develop a plan now to stop smoking or ask your health care professional to recommend methods and medical information to help you quit; current health news clearly states that cigarette smoking increases your risks for osteoporosis
• Drink alcohol in moderation, if you drink; excessive consumption of alcohol increases your risk of osteoporosis and fractures from falls.

For some women, medication may also be recommended to increase bone density and/or prevent additional bone loss. The NWHRC encourages women to ask their health care professionals about all the medical information and options available to improve their bone health and which strategies make the most sense for their individual health needs. These options may include dietary and exercise strategies, as well as medications, to help prevent osteoporosis. Visit the NWHRC's Web site: http://www.healthywomen.org for medical information and comprehensive discussion about osteoporosis diagnosis, treatment, and prevention. Look for the "Osteoporosis" topic in the "Health Center."

On Oct. 14, 2004, the Surgeon General issued a first-of-its-kind report on our nation's bone health. This report is a call for Americans to take action to improve and maintain healthy bones. It includes medical information and recommendations on what Americans can do to decrease the likelihood of developing osteoporosis. To view the report, visit http://www.surgeongeneral.gov/library/bonehealth/.

Another report, prepared by the editors of Harvard Health Publications in consultation with David M. Slovik, M.D., Assistant Professor of Medicine, Harvard Medical School, Chief of Medicine, Spaulding Rehabilitation Hospital, offers current health news on even more ways than ever before to gauge bone strength and protect yourself from osteoporosis. The report, "Osteoporosis: A Guide to Prevention and Treatment," provides medical information and describes how you can shield your bones through diet, exercise, and medications, and it provides current health news on bone density testing techniques.

To order an exercise video specifically focused on skeletal fitness, visit http://www.ctds.info/exercise-osteoporosis.html.

How dense are your bones? The Mount Carmel College of Nursing provides an osteoporosis risk calculator to help people find out their risk for developing osteoporosis so they can take the necessary steps to help secure a healthy future.

According to current health news from the National Osteoporosis Foundation, certain people are more likely to develop osteoporosis than others. Medical information defines factors that increase the likelihood of developing osteoporosis called "risk factors." These risk factors include:

• Increase the amount of calcium and vitamin D in your diet by consuming low-fat, calcium-rich foods and beverages and/or with calcium and vitamin D supplements
• Personal history of fracture after age 50
• Current low bone mass
• History of fracture in a first-degree relative
• Being female
• Being thin and/or having a small frame
• Advanced age
• A family history of osteoporosis
• Estrogen deficiency as a result of menopause, especially early or surgically induced
• Abnormal absence of menstrual periods (amenorrhea)
• Anorexia nervosa
• Low lifetime calcium intake
• Vitamin D deficiency
• Use of certain medications, such as corticosteroids and anticonvulsants
• Presence of certain chronic medical conditions
• Low testosterone levels in men
• An inactive lifestyle
• Current cigarette smoking
• Excessive use of alcohol
• Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well

Current health news shows that women can lose up to 20 percent of their bone mass in the five to seven years following menopause, making them more susceptible to osteoporosis.

Diagnosis and Treatment
The National Osteoporosis Foundation says that to determine if you have osteoporosis or may be at risk for the disease, your doctor or health care professional will ask you for some medical information about your lifestyle and medical history. He/She will want to know if anyone in your family has suffered from osteoporosis or if they have fractured bones. Based on a comprehensive medical assessment, your health care professional may recommend that you have your bone mass measured.

A bone mass measurement is the only way to tell if you have osteoporosis. Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A bone density test can provide your doctor with useful medical information such as:

• Detect osteoporosis before a fracture occurs
• Predict your chances of fracturing in the future
• Determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of a year or more.

Results of BMD tests are usually expressed as "T-scores," a measure of how far your bone density deviates above or below the average bone density value for a young, healthy, white woman.

• A T-score between +1 and -1 indicates normal bone density.
• A T-score at or below -2.5 usually signals osteoporosis. A T-score between -1 and -2.5 usually signals osteopenia, or low bone density

The medical information about your bone density is also compared to an "age matched" standard. The age-matched reading (Z-score) compares your bone density to the "norm" for your age, sex and size.

The medical information derived from your T-score will help your doctor or health care professional determine whether you are at risk for fracture. Generally, the lower your bone density, the higher your risk for fracture. Your BMD score will be considered, along with your personal health history, osteoporosis risks and lifestyle, including whether you exercise and are getting adequate calcium, to determine your risk for fracture. By weighing all of these factors, your health care professional can determine if osteoporosis poses a significant threat for you now or in the years ahead, according to the NWHRC's "Osteoporosis Diagnosis" discussion at http://www.healthywomen.org.

To learn more from the National Osteoporosis Foundation about current health news on bone mass and bone density tests, visit http://www.nof.org/osteoporosis/bonemass.htm.

The U.S. Preventive Services Task Force recommends that women age 65 and older be routinely screened for osteoporosis and that routine screening begin at age 60 for those women identified at high risk for the condition.

Current health news from WomensHealthChannel says treatment for osteoporosis combines nutrition, exercise, safety measures, and medications. Below are WomensHealthChannel's recommendations for treatment.

Nutrition
Getting adequate amounts of calcium, phosphorus, and vitamin D in a healthy diet is important to encourage bone growth and maintain health. Vitamin D supplements are used in the treatment of osteoporosis. Weight-bearing exercise (e.g., walking, jogging, hiking, dancing) has several positive effects, the foremost being an increase in bone density. Medical information also shows exercise increases strength, coordination, and balance, thereby reducing the risk for falls. Twenty minutes of exercise 3 or 4 times per week is recommended. Women should consult their physician when beginning an exercise program and keep up-to-date with current health news on bone density.

Reducing Your Risk for Fracture
Preventing falls is an important strategy for reducing your fracture risk. Make sure your environment is as "fall proof" as possible.

• Avoid slippery surfaces
• Install hand rails
• Keep surfaces smooth and uncluttered
• Provide adequate lighting
• Use a cane or walker, if you need one
• Wear rubber-soled, flat shoes
• Wear eyeglasses, if your vision is impaired
• Speak to your health care professional about any medical information you need to have about side effects from medications you may take that affect your balance or vision

Medications

• Estrogen therapy (available from a variety of estrogen types and brands)
• Bisphosphonates: (alendronate [Fosamax®]; risedronate [Actonel®])
• Selective estrogen receptor modulator (SERM): raloxifine (Evista®)
• Calcitonin: Miacalcin®
• Synthetic parathyroid hormone: teriparatide (Forteo®)

Current health news from The International Osteoporosis Foundation recommends a healthy diet that includes calcium-rich foods, when it comes to osteoporosis prevention. Dairy foods such as whole or skim milk, yogurt and cheese are rich in calcium that is easily absorbed by the body. Some calcium-fortified beverages (such as orange juices or soy milk) may contain as much calcium as milk. Certain vegetables and fruits (broccoli, lentils, beans and figs, for example) also provide calcium, as does fish containing bones (canned salmon and sardines). Medical information shows that much salt and caffeine may increase the loss of calcium through the urine.

Are you familiar with the calcium content of some common foods? See the chart below: