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FAQ: Osteoporosis Print E-mail
Written by Kimberly Vaughn, MD   
Friday, 30 October 2009

Osteoporosis is the loss of bone density or thinning of the bones. This thinning causes bone weakness, and eventually the involved bone may break.

What is going on in the body?

Bones go through a constant state of bone loss and regrowth. People reach their peak bone mass by about age 30. After the age of 30, bone loss slowly begins to occur. This loss, if it becomes severe, can lead to osteoporosis. The bones become thin and fragile and may break easily.

Initially, bone loss occurs very slowly for both women and men. After the age of 65 to 70, men begin to lose bone more rapidly. Women, on the other hand, begin to lose bone more rapidly after they reach menopause and the body's estrogen level falls. Women may also begin to lose bone more rapidly if they have their ovaries removed during surgery before they reach menopause.

Bone is made up of calcium and proteins. There are two types of bone: compact and spongy. Each bone in the body has both types of bone in different amounts. The first signs of osteoporosis are seen in bones that have a lot of spongy bone. These include the hip, spine, and wrist bones.

What are the causes and risks of the condition?
Some risk factors for osteoporosis cannot be changed. These include:
- Age. Bone density decreases with age.
- Body size. Women with small, thin bodies are at the highest risk.
- Ethnic background. Caucasian and Asian women are at the highest risk, while Latino and African American women are at somewhat less risk.
- Family history. Reduced bone mass and risk for bone fractures seem to run in some families.
- Gender. Women have less dense bones than men and lose more bone mass during and after menopause.

Other risk factors for osteoporosis can be changed, such as:
- cigarette smoking
- a diet low in calcium and vitamin D
- eating disorders, such as anorexia and bulimia
- excess alcohol intake
- low hormone levels associated with menopause
- medicines such as corticosteroids, certain medicines for seizures or high blood pressure
- sedentary lifestyle

Some of the diseases and conditions that can increase an individual's risk for osteoporosis are as follows:
- cancers affecting the bone
- eating disorders, such as anorexia and bulimia
- hyperparathyroidism, a condition in which the parathyroid gland makes too much parathyroid hormone
- hyperthyroidism, a condition in which the thyroid gland makes too much thyroid hormone
- hypogonadism, a condition in which the ovaries in women or testes in men do not function normally
- rheumatoid arthritis , a condition in which the body attacks its own joint tissue

What are the treatments for the condition?
Treatment cannot eliminate osteoporosis. Certain medicines are currently approved by the FDA for treatment of osteoporosis. These medicines may slow or stop bone loss, increase bone density, and help prevent bone fractures. They include the following:
- biphosphonates, specifically alendronate and risedronate
- calcitonin
- estrogen or hormone replacement therapy for women
- selective estrogen receptor modulators, or SERMs, specifically raloxifene

Parathyroid hormone, on the other hand, works by increasing bone mass rather than slowing bone loss. It is given as an injection under the skin each day. At this time, the FDA has not approved parathyroid hormone for the treatment of osteoporosis. Studies have shown that it may help prevent hip and spine fractures. Research on its effectiveness and safety continues.

What are the side effects of the treatments?
Bisphosphonates can cause nausea, stomach irritation, and heartburn if not taken exactly as prescribed. SERMs can cause leg cramps, hot flashes, and occasional blood clots. HRT can cause bloating, breast tenderness, vaginal bleeding, and rarely, blood clots. Calcitonin may cause runny nose, nausea, and flushing. Parathyroid hormone can cause nausea, headache, dizziness, and leg cramps.

What happens after treatment for the condition?
After a person develops osteoporosis, treatment is lifelong. The home should be made safe to prevent accidents. Ways to increase safety include the following:
- Don't lift heavy objects.
- Don't use throw rugs on floors.
- Keep all areas safe, well-lit, and uncluttered to prevent falls.
- Take care with icy, wet, or slippery surfaces.
- Use a cane if needed.
- Use nonskid mats in the shower and bathtub.
- Use proper back support and lifting methods.
- Wear comfortable shoes that have nonslip soles.
- Wear undergarments that have a protective pad around the hips to prevent hip fractures.

Intriguing new research done in older individuals with arthritis found that brisk walking or weight training improved balance in those individuals. Improved balance could very well help individuals with osteoporosis avoid hip fractures and wrist fractures from falls.

How is the condition monitored?
Women on HRT should have yearly physicals and pelvic examinations, mammograms, and PAP smears. Repeat DEXA bone scans may be performed yearly to see the effect of treatment on bone density. Sometimes urine tests may be done to look at bone markers every 3 months during the initial 6 to 12 months of beginning a new treatment. Any new or worsening symptoms should be reported to the healthcare provider.


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