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Osteoporosis is a common bone disease
that affects both men and women, usually as they
grow older. Fortunately, you can take steps to reduce
your risk of developing osteoporosis and avoiding
the often-debilitating bone fractures that can result
from this disease. If you already have osteoporosis,
new medications are available to slow or even stop
its progression.
Fast Facts
-
Age is
not the only risk factor for osteoporosis. Other
diseases and even medications can cause this
condition.
-
A simple diagnostic test known
as a bone density test can provide valuable
information about your bone strength.
-
New medications exist to slow
and even stop the progression of osteoporosis.
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| Osteoporosis
is a condition of weak bone caused by a
loss of bone
mass as well as a change in bone structure.
The first picture is
normal bone and the second shows osteoporotic
bone. |
What osteoporosis is
Osteoporosis is a
silent disease of the bones that makes them weaken
and prone to fracture. Bone is living tissue that
is in a constant state of regeneration, as old bone
is removed (bone resorption) and replaced by new
bone (bone formation). By their mid-30s, most people
begin to gradually lose bone strength as the balance
between bone resorption and bone formation shifts,
so that more bone is lost than can be replaced.
As a result, bones become thinner and structurally
weaker.
The disease is “silent”
because there are no symptoms when you have osteoporosis,
and the condition may come to attention only after
you break a bone. When you have osteoporosis, this
can occur even after a minor injury, such as a fall.
The most common fractures occur at the spine, wrist
and hip. Spine and hip fractures in particular may
lead to chronic pain, long-term disability and even
death. The goal of treating osteoporosis is to prevent
such fractures in the first place.
What causes osteoporosis
Many factors will
increase your risk of developing osteoporosis and
suffering a fracture. Some of these risk factors
can be changed, while others cannot. Recognizing
your own risk factors is important so that you can
take steps to prevent this condition from developing
or treat it before it becomes worse. Major risk
factors include:
·
Older age
(starting in the mid-30s but accelerating after
50)
·
Non-Hispanic
white and Asian ethnic background
·
Small bone
structure
·
Family history
of osteoporosis or osteoporosis-related fracture
in a parent or sibling
·
Previous fracture
following a low-level trauma, especially after age
50
·
Sex hormone
deficiency, particularly estrogen deficiency, both
in women (e.g. menopause) and men
·
Anorexia nervosa
·
Cigarette
smoking
·
Alcohol abuse
·
Low dietary
intake or absorption of calcium and vitamin D
·
Sedentary
lifestyle or immobility
·
Medications:
glucocorticoid medications such as prednisone (Prelone)
(see fact sheet on glucocorticoid-induced
osteoporosis); excess thyroid hormone replacement;
the blood thinner heparin (Calciparine, Liquaemin,
etc.); certain anti-convulsant medications
such as phenytoin (Dilantin) and ethotoin
(Peganone), etc.
·
Certain diseases
can affect bone, such as endocrine disorders (hyperthyroidism,
hyperparathyroidism, Cushing's disease, etc.) and
inflammatory arthritis (rheumatoid arthritis,
ankylosing spondylitis, etc.)
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| As the bone of
the spine thins, factures can occur
that cause a loss of height and a
forward curvature of the spine. |
|
Who gets osteoporosis
Osteoporosis is more
common in older individuals and non-Hispanic white
women, but can occur at any age, in men as well
as in women, and in all ethnic groups.
In the U.S. about 8 million women and 2 million men have osteoporosis.
Those over the age of 50 are at greatest risk of
developing osteoporosis and suffering related fractures.
In this age group, one in two women and one in six
men, will suffer an osteoporosis-related fracture
at some point in their life. Non-Hispanic white
and Asian people are most likely to experience osteoporosis
and osteoporosis-related fractures. Hispanic and
non-Hispanic black people can also develop osteoporosis
and related fractures, but have a lower risk when
compared to non-Hispanic whites and Asians.
How
osteoporosis is diagnosed
A simple test that
measures the bone mineral density (BMD) at different
parts of your body, such as your spine and your
hip, can help determine if you have osteoporosis.
Dual energy x-ray absorptiometry (DEXA) is the best
current test to measure BMD. The test is quick and
painless; it is similar to having an x-ray taken,
but uses much less radiation. Even so, pregnant
women should not have this test done in order to
avoid any risk of damaging the developing fetus.
The results
of the DEXA test are scored in comparison to the
BMD of young, healthy individuals, resulting in
a measurement called a T-score. If your T-score
is –2.5 or lower, you are considered to have osteoporosis
and therefore at high risk for a fracture. T-scores
between –1.0 and –2.5 are generally considered to
show “osteopenia.” The risk of fractures is generally
lower in people with osteopenia when compared with
those with osteoporosis, but if bone loss continues,
the risk for fracture increases.
How osteoporosis is
treated
To maintain bone
health:
-
Make sure there is
enough calcium in your diet (1000 mg per day
of calcium for women before menopause and 1500
mg per day for women who are postmenopausal
and are not taking estrogen replacement therapy).
-
Get adequate vitamin
D intake, which is important for calcium absorption
and to maintain muscle strength (400IU per day
until age 60, 600-800 IU per day after age 60).
- Get regular exercise,
especially weight bearing exercise.
A number of medications
are also used for the prevention and treatment of
osteoporosis:
-
Bisphosphonates:
Alendronate (Fosamax) and risedronate
(Actonel) are pills that need to be
taken on an empty stomach with water. These
medications help slow down bone loss and have
been shown to decrease the risk of fractures.
-
Calcitonin (Calcimar,
Miacalcin): This medication is a hormone
made from the thyroid gland and is usually given
as a nasal spray or as an injection under the
skin. It may help prevent spine fractures, and
is also helpful to control pain after an osteoporotic
vertebral (spine) fracture.
-
Estrogen or Hormone
Replacement Therapy: Estrogen therapy alone
or in combination with another hormone, progestin,
has been shown to decrease the risk of osteoporosis
and osteoporotic fractures in women. However,
the combination of estrogen with a progestin
has been shown to increase the risk for breast
cancer, strokes, heart attacks and blood clots.
Estrogens alone may increase the risk of strokes.
Given the complexity of this decision, consult
with your doctor about whether hormone replacement
therapy is appropriate for you.
-
Selective Estrogen
Receptor Modulators (SERMs): These medications
mimic estrogens good effects on bones without
some of the serious side effects such as breast
cancer. Raloxifene ( Evista ) decreases
spine fractures in women, and is approved for
use only in women at this time.
-
Teriparatide (Forteo):
Teriparatide is a form of parathyroid hormone
that helps stimulate bone formation. It is approved
for use in postmenopausal women and men at high
risk for osteoporotic fracture. It is given
as a daily injection under the skin and can
be used for up to 2 years. If you have ever
had radiation treatment to your bones or if
you have parathyroid hormone levels that are
already too high, you should not take this medication.
Prevention
- Lifestyle changes may be
the best way of preventing osteoporosis:
-
Make sure you are getting
enough calcium in your diet (roughly 1000-1500
mg/day, but will depend on your age)
- Make sure you are getting
enough vitamin D (between 400-800 IU/day)
- Stop smoking
- Avoid excess alcohol intake
-
Engage in weight-bearing
exercises
-
Treat underlying medical
conditions that can cause osteoporosis
-
Minimize or change medications
that can cause osteoporosis; never stop taking
any medication without speaking with your doctor
first
Broader health impact
of osteoporosis
The most health-threatening
consequence of osteoporosis is a fracture. Spine
and hip fractures especially may lead to chronic
pain, long-term disability and even death. The major
goal of treating osteoporosis is to prevent fractures.
Living with osteoporosis
If you have osteoporosis,
it is important not only to help prevent further
bone loss, but also to prevent a fracture. Eliminate
hazards in the house that can increase your risk
of falling (remove loose wires or throw rugs, install
grab bars in the bathroom and non-skid mats near
sinks and in the tub, etc.) Be careful when you
are carrying or lifting items, as this could cause
a spine fracture. Wear sturdy shoes, especially
in winter. Use a cane or walker if you have balance
problems or have other difficulties walking.
Points to Remember
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| Regular weight-bearing
exercise is an important part of prevention. |
- Make sure there is enough calcium and vitamin
D in your diet.
- Get regular exercise.
- Eliminate lifestyle choices that increase
your risk of osteoporosis.
The rheumatologist's
role in the treatment of osteoporosis
As specialists in
musculoskeletal diseases, rheumatologists can help
to determine the cause of osteoporosis. They can
provide and monitor the best treatments for this
condition.
To find a rheumatologist
For more information
about rheumatologists, click here.
For a listing of
rheumatologists in your area, click here.
For more information
The American College
of Rheumatology has compiled this list to give you
a starting point for your own additional research.
The ACR does not endorse or maintain these Web sites,
and is not responsible for any information or claims
provided on them. It is always best to talk with
your rheumatologist for more information and before
making any decisions about your care.
National Osteoporosis
Foundation
www.nof.org
National Institute
of Health Osteoporosis and Related Bone Diseases
Resource Center
www.osteo.org
Updated May
2004
Written by Shreyasee
Amin, MD, and reviewed by the American College of
Rheumatology Communications and Marketing Committee.
****Adopted
From American College of Rheumatology Website:http://www.rheumatology.org/
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