Osteoporosis: Q & A

Osteoporosis is a debilitating bone condition that affects 25 million Americans and is particularly common in the elderly. Its impact on health, lifestyle, and emotional well-being can be far reaching. In fact, some health professionals feel that osteoporosis is reaching epidemic proportions. Approximately one in four postmenopausal women will suffer at least one fracture by the age of 65.

At the same time, it's important to note that men are vulnerable as well: It strikes an estimated 10 to 15 percent of men in their 70s.

Q. What is osteoporosis?
A. When levels of calcium and phosphorus, the minerals essential to bone formation, are insufficient, bone mass is lost. This causes bones to become dry and brittle.

Q. Who is at risk?
A. Women are much more likely than men to develop osteoporosis because, as a group, they have lighter bones and less total calcium. In fact, women lose bone at a rate three times greater than that of men. Other risk factors include age, family history, race (women of Northern European descent are more susceptible, as are Asian women), low calcium and vitamin D intake, inactive lifestyle, a petite body frame, smoking, and excessive alcohol use.

Q. What are the symptoms? What should I do if I have symptoms?
A. Sometimes the first sign of osteoporosis is a loss of height or the beginnings of a humped back caused by a collapse of weakened vertebrae. However, usually there are no symptoms until a fracture occurs. The first sign may be sudden pain in the back or hip, or painful swelling of a joint after a minor fall.

You should see a health professional if any of these symptoms occur, if a sprain does not improve after four days of home treatment, or if there is a lot of swelling or bruising after even a minor fall.

Q. Can osteoporosis be prevented?
A. The two major strategies for helping reduce the risk of osteoporosis are proper nutrition and regular weight-bearing exercise. Men and pre-menopausal women should consume a minimum of 1,000 mg of calcium per day. Postmenopausal women should consume 1,500 mg. Excellent sources of calcium include skim milk, low-fat yogurt, chopped collards, broccoli, and canned sardines with bones.

The second defense against osteoporosis is daily weight-bearing exercises that place stress on the major joints, thus encouraging bone growth. Excellent exercises include walking, jogging, aerobic dance, and tennis. Recent studies suggest that weight training also may help maintain bone density.

Q. How is it diagnosed?
A. Diagnosis usually occurs after a fracture when an X-ray reveals osteoporosis. An X-ray of normal bone shows a very white, harsh image. But in a bone with too little calcium, this white color is noticeably washed out. The calcium content of bone (typically in the spine and hip) can be measured by dual-energy X-ray absorptiometry (DEXA), in which the absorption of low-level radiation is measured and assigned a number based on the bone's density. This can be done prior to a fracture as well to determine future fracture risk.

Q. How is it treated?
A. Scientists are not sure whether you can slow or prevent further degeneration. But treatment options can minimize the negative effects of osteoporosis.

First, maintaining a balanced diet (with adequate levels of calcium) and exercising regularly may provide benefit to those already suffering from osteoporosis.
Hormone replacement therapy (HRT) has been shown to be an effective treatment for preserving bone density in women. However, there's evidence that HRT may increase breast cancer risk, as well as complications such as breast tenderness, breakthrough bleeding, and bloating. Talk to your doctor about the benefits and risks of HRT.
Another treatment approach is the use of prescription medications to slow the rate of bone loss in women who have significant osteoporosis. Alendronate (Fosamax) has been shown to increase bone density and prevent fractures. Calcitonin (Calcimar and Miacalcin) has been shown to reduce bone loss.
Hip replacement surgery is a common treatment for degenerated hips. With hip replacement, complications are markedly reduced and independence improved.
Finally, because osteoporosis can be painful and can rob people of their independence and self-esteem, victims can become isolated and depressed. Be alert for the signs and symptoms of depression.

Questions to Keep in Mind:

  • Can osteoporosis be prevented? How? Is it too late to start?

  • Should I be screened (DEXA) for osteoporosis if I have a family history?

  • What are some calcium-rich foods? Are calcium supplements helpful?

  •  How  much? How often? Any precautions?

  • What side effects can I expect from HRT? What are the risks of breast cancer?

  • Is alendronate or calcitonin appropriate for me? How do I take it?

  •  How effective is it? What are the risks? Side effects? Are there alternatives?

  •  When is hip replacement surgery indicated? What are the risks?

  •  What benefits can I expect? What do I need to do to prepare for this procedure?

  •  What kind of recovery period can I expect?

  •  Will I need rehabilitation? What kind? How long? What if I don't have the surgery?

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