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  » Medical Topic Archive  »  Osteoporosis

Osteoporosis

Prevention
Facts to Know
Questions to Ask
Key Q & A
Lifestyle Tips

PREVENTION

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. Also, once you've had a fracture due to osteoporosis, your risk of future fractures is increased. It is important to prevent the first fracture. Taking preventive steps and reviewing risk factors now are especially smart approaches for women of all ages.
There are four simple steps to prevent osteoporosis:
* increase the amount of calcium and vitamin D in your diet
*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 to help you quit. 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 helpful for preventing additional bone loss. Ask your health care professional what the best osteoporosis prevention strategy is for you.
Dietary Strategies for Osteoporosis Prevention
Adding calcium to your diet may be the easiest health-related change you can make. It's an important one, too. Calcium may reduce fractures caused by osteoporosis by as much as 50 percent. The Institute of Medicine recommends these calcium guidelines based on age:
* for girls ages nine to 18: 1,300 mg/calcium/daily
*for the average woman ages 19 to 50: 1,000 mg/calcium/daily
* for the woman age 51 or older: 1,200 mg/calcium/daily.
If you have asthma, allergies, a thyroid condition or other chronic medical conditions you may need even higher daily calcium intake
National nutrition surveys have shown that many people consume less than half the amount of calcium recommended to build and maintain healthy bones. Good sources of calcium include:
* low fat dairy products, such as milk, yogurt, cheese and ice cream
* dark green, leafy vegetables, such as broccoli, collard greens, bok choy and spinach
*sardines and salmon with bones
*fortified tofu (a soybean product made from curdled soy milk)
* soy milk
* almonds
* calcium-fortified foods and beverages, such as orange juice, cereals and breads
Difficulty digesting milk, which is called lactose intolerance, and stomach upset caused by dairy products, may be more common as you age. If that's the case, yogurt with active cultures, buttermilk, cheddar and Swiss cheeses also are high in calcium but low in lactose, the sugar found in milk and milk products. Many people mistakenly believe they are lactose intolerant when a simple sensitivity to dairy products or some other food substance is really the case. So, it's wise to check with your health care professional before you avoid dairy products. Products that contain lactose (such as Lactaid) can help people with lactose intolerance to consume dairy products.
When your diet isn’t providing enough calcium, you may wish to take calcium supplements. The most common and least expensive is calcium carbonate, which is found in antacid preparations for treating heartburn. However, in clinical studies, researchers found that the formulations of calcium supplements greatly affected the level of absorption. Calcium citrate was better absorbed than calcium carbonate. In addition, calcium carbonate is absorbed best when taken with food, while calcium citrate can be taken any time.
Multivitamins generally do not provide enough calcium to meet the daily needs of a postmenopausal woman. In fact, the mineral calcium isn't always included in a multivitamin preparation, so be sure to read the label if you are relying on your vitamin supplement for calcium. Check for the elemental calcium content of a supplement to add to your average daily intake.
Your diet should also be rich in vitamin D. This nutrient helps your body absorb calcium more efficiently and minimize bone loss. Most of us get the vitamin D we need for calcium absorption exposure to sunlight. You'll also find plenty of this essential vitamin in fortified milk and cereals, as well as vitamin supplements. If your exposure to sunlight is limited, you may want to consider increasing your average intake of vitamin D. At least 400 units (I.U.) of vitamin D daily is recommended for menopausal women, but it's wise to talk to your health provider about your particular needs. Higher doses up to 800 IU may benefit women over the age of 65.
Exercise Strategies
Bone and muscle respond to physical activity by becoming stronger. Although all exercise is beneficial to overall good health, two kinds of exercise are most effective for preventing osteoporosis: weight-bearing, in which you work against gravity, and resistance exercises, such as weight lifting. Weight bearing exercise is any exercise in which your feet and legs bear your weight while you perform it, such as brisk walking, dancing, racket sports and aerobics. This creates high pressure on the bone that helps to build and maintain its strength.
Resistance exercises that strengthen muscle may also be beneficial, particularly for the large muscles of the shoulder, pelvis, hips, back and trunk. Because falls are the most common cause of fractures, balance-improving activities, such as t’ai chi and strength training, may also reduce your risk for falls by as much as 47 percent.
If you do not routinely exercise, before you start, ask your health care professional to recommend a simple, safe program and start soon. Here are a few suggestions for how to start:
For muscle strengthening, you can use stationary weight machines at health clubs and gyms, and you can use free weights or elastic bands in the gym or at home. The important thing to remember is that you don't have to lift heavy weights to benefit from strength training. You should start with a light weight and gradually increase your repetitions and/or resistance as your strength increases. The goal is to build bone strength — not muscle mass, which requires numerous lifts with heavy weights.
A recent study, whose results surprised even the researchers who conducted it, showed that gardening went a long way to help reduce the risk for osteoporosis among the 3,310 women age 50 and older involved in the study. Gardening activities such as raking, thrusting a shovel into the ground, moving a wheelbarrow filled with dirt, weeds or mulch are all considered weigh-bearing exercises.

FACTS TO KNOW

1. As many as eight million American women already have osteoporosis, and 34 million have low bone density, putting them at risk for developing the disease. Half of all women over age 50 will have an osteoporosis-related fracture in the years ahead. Significant risk has been reported in people of all ethnic backgrounds.
2. Three out of four women have not discussed bone health with their health care professional or been screened for osteoporosis. Seventy-one percent of women with osteoporosis don't even know they have it, and 86 percent with the disease are not being treated. Make an appointment today to discuss your personal health risks for osteoporosis.
3. Osteoporosis contributes to more than 1.5 million fractures annually, including 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites (approximate numbers).
4. The number of people beyond age 65 years in the United States will increase from 32 million to 69 million by the year 2050, and of this number, more than 15 million will be made up of people older than 85 years. The increase in population is relative to the national cost of osteoporosis, which was estimated at $13.8 billion in 1995. During the next 50 years, the national cost may be as high as $240 billion.
5. Smoking, abusing alcohol and excessive thinness increase your risk for developing osteoporosis. Likewise, if you don't exercise, or if you exercise too much, your risk for developing osteoporosis increases.
6. Bones that are calcium rich are less likely to break. Be sure your diet provides at least 1,000 to 1,200 mg of calcium daily to help keep your bones strong. Drinking or eating three dairy products a day provides the recommended daily intake of calcium, but most women fall short of this requirement. If you are unable to get enough calcium and vitamin D from your diet, your health care professional may recommend a supplement.
7. Menopause increases your risk for developing osteoporosis because your body's natural production of the hormone estrogen declines. Estrogen helps keep bones strong. However, new studies have shown that postmenopausal hormone therapy, available as a combination of estrogen and progestin (a synthetic form of the hormone progesterone) or estrogen therapy alone, poses small, but serious health risks. New, lower-dose versions of the hormone therapies used to treat symptoms of menopause are currently being developed. The FDA recently approved a low-dose version of the combination estrogen-progestin treatment sold as Prempro. Ask your health care professional for more information about risks and benefits of menopausal hormone therapy.
8. Several types of medications, including calcitonin (Miacalcin), raloxifene (Evista) and bisphosphonates (Actonel, Fosomax), are effective in preventing and/or treating osteoporosis. Teriparatide (Forteo), a new drug approved by the FDA in 2002, is the first medication that actually stimulates bone formation instead of slowing the breakdown of bone.
9. Women lose the most bone mass — as much as 25 percent to 30 percent — in the first five to seven years following menopause. Because of declining estrogen levels after menopause, a woman's ability to naturally maintain bone structure is seriously depleted. However, not everyone needs to seek treatment. Bone density testing helps target those at greatest risk for bone loss and osteoporosis.
10. A bone density test measures the strength of your bones to determine your risk of developing osteoporosis. This test is not usually performed until after menopause, unless you have an unusual clinical situation or are at high risk for osteoporosis. It is quick, painless and non-invasive. Medicare and many commercial insurers pay for testing for individuals at risk and those with osteoporosis.
11. Bone loss rates can be slowed by regular weight-bearing and muscle-strengthening exercises. Activities such as walking, gardening, jogging, and playing tennis help to strengthen bones and connective tissue.
12. There is no cure for osteoporosis. However, it is preventable and treatable. You can help prevent bone loss and fractures from osteoporosis with proper diet, exercise and medications, when necessary.


QUESTIONS TO ASK

Review the following 'Questions To Ask' about osteoporosis so you're prepared to discuss this important health issue with your health care professional.
1. Am I at risk for osteoporosis?
2. Do any of my medications increase my risk for developing osteoporosis?
3. What are options are available to prevent or treat osteoporosis?
4. How can I tell if I have fractured a bone in my spine?
5. When and how often should I have a bone density scan?
6. How much calcium should I consume each day?
7. Do any of my medications interfere with calcium absorption?
8. Can I get my daily calcium requirements from my diet?
9. If I have osteoporosis or osteopenia, is there anything I can do to help lessen its severity?
10. What kinds of exercise are best for me and how often should I exercise?


KEY Q & A

1. Why is osteoporosis called a "silent disease"?
Osteoporosis is sometimes called a "silent disease" because it can occur gradually over many years without your knowledge. Often the very first symptom of osteoporosis is a broken bone, also called a fracture that typically happens at the hip, spine or wrist. Osteoporosis thins and weakens your bones, making them fragile and more likely to break. But the good news is that osteoporosis can be prevented and treated. Early detection is important; therefore, you should ask your health care professional for more information about osteoporosis.
2. Can't I just take a multi-vitamin to prevent osteoporosis?
No! Most multi-vitamins contain only minimal quantities of calcium. Calcium carbonate and calcium citrate are available over-the-counter as supplements if your diet is low in this essential mineral. Girls age nine to 18 need 1,300 mg/calcium/daily (the equivalent of three, eight-ounce glasses of milk plus trace sources found elsewhere in the diet will be enough). The average woman age 19 to 50 needs 1,000 mg/calcium/daily for the average woman. And women 51 and older should be getting 1,200 mg/calcium/daily. In addition, be sure your diet (or supplement) also provides between 400 IU (international units) and 800 IU of vitamin D, which helps your body absorb calcium. Taking the recommended daily amount of calcium and vitamin D can cut your risk of fracture by as much as half, particularly in older women. Calcium is found in other dairy products besides milk. Yogurt and cheese also contain calcium, as do soy products like soy milk. Fortified orange and other juices and many types of grains are other sources.
3. If I've already reached the age of menopause, isn't it too late to do anything about osteoporosis?
It's never too late to make lifestyle changes to improve your bone health and receive the appropriate treatment for osteoporosis, if you have it. Although you can't restore all the bone that has already been lost, you can build some new bone and prevent bone loss with a diet rich in calcium and vitamin D, a program of weight-bearing exercise, and, in some cases, medications.
4. Isn't it true that we get shorter as we age?
Substantial loss of height and a stooped posture are not normal results of growing older and can be signs of multiple vertebral compression fractures in the spine. Height loss of one to one and one-half inches can be due to degenerative risk disease and not necessarily osteoporosis related. Frequently, individuals don't know they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or vertebra to collapse. It is these collapsed vertebra that lead to loss of height, stooped or rounded posture (called kyphosis, but also known as “dowager’s hump”) and other spinal deformities.
5. If I have one or more of the risk factors for osteoporosis, does that mean that I probably have the disease but don't know it?
Not necessarily. Your health care professional will take into account a number of factors in determining your likelihood of developing osteoporosis. These include your personal health history, your individual osteoporosis risks, your lifestyle — including whether you exercise and are getting adequate calcium — and possibly the results of a bone mineral density (BMD) test. This quick test measures bone strength, predicts if your bones are at risk for fracture, may be helpful in monitoring the effects of treatment if the test is conducted at intervals of a year or more, and can help predict your future risk for osteoporosis. If you are concerned about your risks, be sure to discuss osteoporosis with your health care professional. Bone density tests are the single best way to predict your risk of fracture.
6. Is the test for osteoporosis painful?
No! A BMD test is safe, quick and painless. Simple measurements are usually taken of the bones in your hip, wrist and spine. You typically remain clothed during the procedure. No dyes are injected. There are several types of BMD tests; some may use a very small amount of radiation, while others do not. Talk with your health care professional to learn more about the procedure and to further alleviate any fears you may have about this simple exam and, be sure to ask your health care professional what your test results mean, when you get them.
7. My health care professional recommended that I start working out with weights, but I'm afraid of lifting such heavy weights. What should I do?
Good news: You don't have to lift heavy weights to benefit from strength training. You should lift a light amount of weight and gradually increase your threshold as your strength increases. The goal is to build bone and muscle strength — not muscle mass, which requires numerous lifts with heavy weights. So enjoy this important activity and work at your own pace. Just remember, if you do not routinely exercise, ask your health care professional to recommend a simple, safe program and start soon.
8. What medications are available to prevent and treat osteoporosis?
There are several medications approved by the U.S. Food and Drug Administration for the prevention and/or treatment of osteoporosis. These medications may postpone or stop bone loss indefinitely, but only when they are taken regularly. Medications currently available include menopausal hormone therapy— which are most often prescribed to relieve the symptoms associated with menopause — and the drugs alendronate (Fosamax), calcitonin (Miacalcin), raloxifene (Evista) and risedronate (Actonel). Teriparatide (Forteo) is the first medication that actually stimulates bone formation instead of slowing the breakdown of bone, as do some other osteoporosis drugs. As with any medication therapy, there are risks and side effects associated with each of these medications. Ask your health care professional for more information.


LIFESTYLE TIPS

1. Get active and get stronger
Remaining – or becoming -- physically active can help prevent osteoporosis. Bones and muscles respond to activity by getting stronger. Two kinds of exercise are the best bet for preventing osteoporosis: weight-bearing, in which you work against gravity, and resistance exercises, such as weight lifting. The more you use your bones to walk, run, lift weights, the heavier and stronger your bones will be. Because falls are the most common cause of fractures, balance-improving activities, such as t’ai chi and strength training, may also reduce your risk, by as much as 47 percent.
Source: National Institutes of Health Consensus Statement: Osteoporosis Prevention, Diagnosis and Therapy. March 27-29, 2000.
2. Turn your thumb green and help prevent osteoporosis
Wondering what type of physical activity to pursue to help keep your bones strong? One new research study says gardening can give you the biggest bang for your exercise buck where preventing osteoporosis is concerned. Pushing a lawnmower, raking, and lifting a wheelbarrow filled with mulch or weeds all are great weight-bearing exercises.
Source: Turner LW, Bass MA, Ting L, Brown B. Influence of yard work and weight training on bone mineral density among older U.S. women. J Women Aging. 2002; 14(3-4):138-48.
3. Make your living space “fracture safe”
Help protect yourself against broken bones that can lead to other health complications and death in older adults. Keep your stairways and living areas well lighted and make sure stairs are not slippery. Clear away clutter and repair any loose floorboards or carpeting. Make sure that all electrical and extension cords are out of the way so you won’t trip on them. Tack or tape down throw rugs. Install grab bars in showers, bathtubs and beside the toilet. And, don’t stand on stools or chairs to get those out-of-reach items – keep things you use regularly where you can get to them easily and safely.
[Source: “Patient Information: Fall Prevention.” National Osteoporosis Foundation. www.nof.org. Accessed April 2004.]
4. Break a bone recently? Speak up!
If you are middle age or older and fracture a bone, talk to your health care professional about having a bone density scan to test for osteoporosis – if he or she doesn’t suggest one. Fractures at these ages are red flags that warrant further investigation for underlying health problems. Don’t just get your cast on and go home!
Source: “Osteoporosis: Progress and Promise. National Institutes of Health. August 2000. http://www.niams.nih.gov/hi/topics/osteoporosis/opbkgr.htm Accessed April 2004.
5. Get creative with calcium
It can be challenging to get the calcium you need from your diet. Try these strategies to make sure you get between 1,000 and 1,500 milligrams of calcium daily: add powdered milk to soups, casseroles and drinks. Just one tablespoon of nonfat powdered dry milk contains 52 mg of calcium and two to four tablespoons can be added to many recipes.
[“Calcium and Vitamin D Recommendations.” National Osteoporosis Foundation. http://www.nof.org/prevention/calcium.htm] Accessed April 2004]
6. Buy juices, cereals, breads, grains and bottled water fortified with calcium. Try the whopper: sprinkle half a cup of diced figs over an 8-ounce serving of yogurt and you’ll get more than half of an adult’s daily calcium needs.
Source: USDA Nutrition Data Laboratory, 2000.
7. Getting adequate vitamin D is also important
Vitamin D helps your body to absorb calcium by allowing it to enter the bloodstream via the intestines. Without it, the kidneys would excrete calcium that otherwise could be utilized. The National Osteoporosis Foundation recommends women over age 51 consume 1,200 mg of calcium per day and 400 to 800 units of vitamin D.
[“Calcium and Vitamin D Recommendations.” National Osteoporosis Foundation. http://www.nof.org/prevention/calcium.htm] Accessed April 2004]

Bone Mineral Density Test


Alternative Names

BMD test


Definition

A bone mineral density (BMD) test can help your health care provider confirm a diagnosis of osteoporosis. The test can help in several ways:BMD testing is one of the most accurate ways to assess your bone health.When repeated over time, it can be used to monitor your rate of bone loss.It can detect osteoporosis at its earliest stage, so treatment can begin sooner.If you are being treated for osteoporosis, BMD testing can help your health care provider monitor your response to the treatment.



How the test is performed


Several different kinds of machines can do BMD testing. The most common methods use low-dose X-rays (about one-tenth the radiation dose of a chest X-ray). While you are lying in on a cushioned table, a scanner passes over your body. Typically, the machine takes x-rays of your lower spine and hip. In most cases you won't need to undress.
There are portable machines that just measure the bone density in your wrist or heel, and some experts believe these are useful preliminary screening tools that can help identify people who may have osteoporosis. However, your bone density can differ from site to site within your body, so these machines may not give a true picture of your risk of a hip fracture.



How to prepare for the test


Remove any jewelry before the BMD test. Inform your health care provider if you may be pregnant.



How the test will feel


The scan is painless, although you will need to remain still during the test.



Why the test is performed


Your health care provider may request a BMD test to confirm a diagnosis of osteoporosis.



Normal values

The results of your test are usually reported as a "T score" and "Z score."
The T score compares your bone density to a 30-year old.
The Z score compares your bone density to other people of the same age, gender, and race.
In either score, a negative number means you have thinner bones than the standard. The more negative the number, the thinner your bones. A T score is within the normal range if it is a positive number, or at least no more negative than -1.0. (For example, -0.5 is within the normal range, although it is getting borderline.)
Your doctor will help you understand the results.



What abnormal results mean


A T score from -1 to -2.5 indicates the beginning of bone loss (osteopenia).
A T score below -2.5 indicates osteoporosis.

Risks

BMD testing involves exposure to a low level of radiation. Most experts feel that the risk is very low compared with the benefits of identifying osteoporosis before you break a bone.



Special Considerations


Regular BMD testing can be important in combating osteoporosis in certain people. The overall cost-benefit value of screening everyone, including those who are not at high risk, is still a matter of debate. Many insurance companies today will pay for bone density testing under certain circumstances.
Most experts agree women over age 65 years are at highest risk and should have bone density tests.
Woman under 65 with additional risk factors for osteoporosis may also be screened.
Simple bone density scans using portable machines may be available as part of health fairs or screenings. These portable scanners may check the density of your wrist or heel. However, keep in mind that hip and spine scans are more reliable.


Review Date 4/8/2003

Reviewed By A.D.A.M. editorial.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).