Medication News
Osteoporosis

What is it?
Whom does it affect?
What are the symptoms?
What are the risk factors?
How is it detected?
How can I prevent osteoporosis?
Can it be treated?

What is it?
Osteoporosis is a condition in which bones become fragile and may break. Osteoporosis is characterized by low bone mass and structural deterioration of bone tissue.

Bone is a living, growing tissue made mostly of collagen (which provides soft framework) and calcium phosphate (which hardens the framework). Throughout a person’s life bone is constantly being re-formed. Older bone is removed in a process called resorption, and new bone is added in a process called formation. Osteoporosis develops when an imbalance exists between bone resorption and bone formation. When bone resorption is greater than bone formation, thin, less dense bone remains. Typically,this process begins occurring after age30.

Whom does it affect?

• It is estimated that 44 million Americans are affected by bone density abnormalities.
• Ten million Americans have been diagnosed with osteoporosis.
• More than 34 million Americans have been identified with low bone mass and are at increased risk of developing osteoporosis.
• Two of the ten million people afflicted are men, and eight million are women.
• Postmenopausal women are at a particularly high risk for osteoporosis since they can lose up to 20percent of their bone mass in the first five to seven years following menopause.
• Although osteoporosis is perceived as an older person’s disease, it can strike at any age.

What are the symptoms?
Osteoporosis is often called the “silent disease.” The process of bone loss is generally gradual and occurs with no symptoms. Most Americans may not know they have osteoporosis until their bones become so weak that they break. Bone weakness and loss may present simply as bone pain, severe back pain, loss of height or a gradual curved or stooped posture. More severe symptoms include fracture of the hip or collapse of vertebrae.

What are the risk factors?
There are several factors that can help identify those at increased risk of developing osteoporosis. These risk factors include:

• History of fracture after age 50
• Low bone mass
• Female
• Thin, small frame
• Advanced age
• Family history of osteoporosis
• Estrogen deficiency as a result of menopause or surgically induced secondary to ovary removal
• Abnormal absence of menstrual periods
• Anorexia
• Low lifetime calcium intake
• Inactive lifestyle
• Cigarette smoking
• Excessive use of alcohol

How is it detected?
Your doctor may determine that you are at increased risk of developing osteoporosis and can recommend that you have your bone mass measured with a Bone Mineral Density (BMD) test. A DXA BMD (link to DEXA info) test measures the bone density in the spine, wrist and hip, which are common fracture sites in osteoporosis. This test can determine the degree of bone loss and can be used to monitor response to treatment. The BMD tests are painless, noninvasive and safe.

How can I prevent osteoporosis?
An adequate intake of calcium throughout a person’s lifetime can aid in osteoporosis prevention. Low calcium intake appears to be associated with low bone mass. Good sources of calcium are milk, yogurt, cheese, leafy dark green vegetables, salmon, almonds, orange juice, breads and cereals. Generally a person requires about 1000-1500 mg per day of calcium. Dietary requirement, however, varies depending on an individual’s age health. For more information on calcium supplementation, see the article on calcium and vitamin D or go to: www.cc.nih.gov/ccc/supplements/vitd.html#food

Vitamin D also plays a big role in osteoporosis prevention by aiding in the absorption of calcium. Vitamin D is created in the skin through exposure to sunlight; so most peopleobtain an adequate amount of vitamin D naturally. Production of vitamin D tends to decrease in the elderly, so they may require supplementation. Daily vitamin D requirement ranges from 400-800 units.

Importantly, it has recently been recognized that children, especially those living in the northern climate are prone to vitamin D deficiency. The clothing requirements of northern climates and the amount of time spent indoors reduces sunlight exposure. Carefully assess the amount of vitamin D your child receives daily.

Taking care of yourself through exercise, avoiding smoking, and avoiding alcohol are also good preventative measures. Exercise helps strengthen the bones, especially weight-bearing exercise such as walking, hiking, jogging, stair-climbing, weight-training, tennis and dancing. Smoking may decrease calcium absorption from the diet, and may lower estrogen levels in women. Alcohol users tend to be more prone to bone loss and fractures due to poor nutrition and increased risk of falling.

Can it be treated?
Generally, with the exception of calcium and vitamin D supplements, products used to treat osteoporosis require a prescription. There are no known herbal or vitamin supplements that have been proven superior to the prescription medications indicated to treat osteoporosis. Prescription products that your physician my select are listed below.

Bisphosphonates, calcitonin, estrogens, parathyroid hormone, and raloxifene have all been approved by the U.S. Food and Drug Administration (FDA) for treatment and prevention of osteoporosis.

Importantly, do not experiment with OTC herbal treatment remedies; these are not appropriate treatment options. Have your physician discuss with you “your risk” for bone loss and osteoporosis as part your next office visit. Assess your child’s risk for vitamin D deficiency and daily calcium intake.

Bisphosphonates (Fosamaxâ and Actonelâ) have been shown to reduce bone loss, increase bone density, and reduce the risk of fractures by slowing or stopping bone resorption. This process allows bone formation to occur at a greater rate. These medications should be taken first thing in the morning on an empty stomach with a full eight-ounce glass of water at least 30 minutes before eating or taking any other medications. After taking the medication, it’s important to sit or stand upright for 30 minutes due to potential irritation the medication could cause in the esophagus.

Calcitonin is a naturally occurring hormone involved in calcium regulation and bone metabolism. In women at least 5 five years beyond menopause, calcitonin slows bone loss, increases spinal bone density, and may relieve pain associated with bone fractures. Calcitonin is a protein and cannot be taken orally because it would be digested before it could work. It is available as an injection or nasal spray.

Estrogens have been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures. However, estrogens can increase the risk of developing endometrial cancer, blood clots and increase the frequency of heart disease. Estrogens should generally not be used to treat postmenopausal bone loss unless an estrogen is required for the treatment of severe post-menopausal symptoms. Products are available that are more effective than estrogens and have demonstrated less severe side effects. Estrogens are available as different formulations, some of which are combined with progestins. Products are available as capsules or tablets or as a skin patch. The Health Alliance pharmacies offer an estrogen patch at no co-pay to members of Alliance Select.

Parathyroid hormone (Forteoâ) stimulates new bone formation and significantly increases bone mineral density. This medication is approved for postmenopausal women and men who have osteoporosis and are at high risk for having a fracture. Forteoâ is self-administered as a daily injection for up to 24 months.

Raloxifene (Evistaâ) is a Selective Estrogen Receptor Modulator (SERM) approved for postmenopausal osteoporosis that prevents bone loss at the hip, spine and total body. SERMs have been developed to provide the beneficial effects of estrogens without their potential disadvantages. Raloxifene is available as a 60 mg pill taken once a day.