About 28 million Americans, 80 percent of them women, suffer from osteoporosis, which literally means "porous bones." Most of these people, unfortunately, remain undiagnosed and untreated. The good news? Over the last decade medical research has given us prevention strategies, improved diagnostic techniques and new treatments to help us deal with this often debilitating condition.

  The deterioration of bone structure and bone mass associated with osteoporosis leads to increased bone fragility and susceptibility to fracture. The most common types of osteoporotic fractures are of the vertebrae, hips and wrist.

  Most of the body's skeletal bone mass forms during the adolescent growth years. Just how strong your bones become by the time you stop growing in your early 20s depends on a number of factors, including good nutrition (especially adequate calcium and protein), plenty of weight-bearing exercise and genetics. Peak bone mass is achieved by young adulthood. Men who remain healthy experience very little bone loss until their 70s; for women, bone loss begins after menopause.

  The impact of osteoporosis on the patient can be physically, mentally and financially severe. Pain, limitation of activity and frequent fractures often cause depression. Vertebral fractures can lead to painful curvature of the spine, and hip fractures often require surgery. Patients may face large medical bills for hospitalization, medications, physical therapy and long-term nursing home care. In fact, osteoporosis can often be traced as the primary factor that moved an independently functioning older person into the ranks of the institutionalized elderly.

  Fortunately, we can now diagnose osteoporosis prior to the first fracture. Even more important, we have therapies that can alter the course of this disease.

Are You At Risk?

   While osteoporosis is most often associated with older women, it also strikes men, and can occur at any age. Those most at risk are postmenopausal females of Caucasian or Asian descent; other factors include having a thin or small frame, a family history of osteoporosis, a low-calcium diet, smoking, alcohol use and long-term use of certain medications, especially steroids.

  Postmenopausal women are at such high risk for osteoporosis because estrogen plays a very important role in maintaining bone mass. The decrease in estrogen levels can cause women to lose 20 percent of their bone mass in the five years after menopause. Women who undergo early menopause, either naturally or due to surgical removal of the ovaries, have a very high incidence of osteoporosis.

Diagnosing Osteoporosis

   So how do you know if you have osteoporosis? If you have had one or more vertebral compression fractures, or other non-traumatic fractures, then you probably have osteoporosis. You should see your doctor for a thorough medical evaluation including x-rays and lab work.

  The most accurate way to diagnose osteoporosis is through bone densitometry, which encompasses a variety of imaging methods, including dual x-ray absorptiometry (DEXA). This is a painless, 10- to 15-minute test that provides accurate bone density measurements with a very low dose of radiation. Measurements are usually taken of the lumbar spine, hip and forearm.

Treating Osteoporosis

  Effective osteoporosis treatment revolves around four components. They are:

1. Calcium--from your diet, and also from supplements. Adequate calcium is very important for maintaining strong bones. The National Osteoporosis Foundation recommends that postmenopausal women on hormone replacement therapy (HRT) take 1,000 milligrams of calcium per day, and those not on HRT take 1,500 milligrams. Also know that smoking and excessive alcohol consumption decrease bone mass.
   
   
2. For postmenopausal women, hormone replacement therapy (HRT). The estrogen-bone density link is why HRT is the first line of defense against osteoporosis in postmenopausal women. HRT can reduce or prevent bone loss and reduce the risk of fracture and coronary artery disease. But HRT has risks of its own, so it's best to speak with your doctor. For women who cannot or should not take estrogen, Evista is another alternative.
   
   
3. Physical activity that puts stress on bones. Weight-bearing exercise such as walking, jogging, tennis, weightlifting and dancing helps to maintain bone and muscle strength and agility. Non-weight-bearing exercise such as swimming is not effective.
   
   
4. Medications to treat osteoporosis. For women who find either the risks or side effects of HRT intolerable, there are two other prescription medications that are approved for the treatment of postmenopausal osteoporosis. Miacalcin (calcitonin), a medication that was once injected but now is also available in nasal spray form, prevents further bone breakdown, especially when used in conjunction with calcium and vitamin D. Fosamax (alendronate) was shown to decrease the incidence of hip and spine fracture in clinical trials; more recently, another medication called Actonel was approved by the FDA for treatment of osteoporosis.

  Patients should thoroughly understand the four components of osteoporosis treatment and address each area with their doctor. Each category needs to be considered individually, as well as part of the whole spectrum of possible treatments. Medications are not interchangeable, and have risks as well as benefits; for example, Fosamax is generally considered more effective than Miacalcin, but it has more side effects. Patients should be as informed as possible about their treatment options, and work closely with their doctors to devise the most effective treatment program.

  Prevention, of course, is the best solution. Osteoporosis should not be considered an inevitable consequence of the aging process. It's never too late to treat it!

Eating for Better Bones

Over-the-Counter Calcium Supplements

Calcium supplements are recommended for persons who do not meet their daily calcium requirements from diet alone. The three major choices are outlined at right. Calcium is best absorbed if consumed throughout the day, but taking it all at once is better than not taking it at all. Be sure to read and follow label directions, and choose a national brand to ensure quality. Avoid bone meal or dolomite, as they may contain toxic ingredients.

Calcium Carbonate
(Provides 40% elemental calcium)
Relative Cost: $
Brand Names: Alka-Mints, Caltrate, OsCal, Titralac Tablets, Titralac Liquid, Tums, Tums E-X, Tums 500
Calcium amounts vary from 400 to 1500 mg.

Calcium Citrate
(Provides 21% elemental calcium)
Relative Cost: $$$
Brand Names: Citracal Liquitabs, Citracal 950, Citracal 1500, Citracal 1500-D
The Liquitabs has 2376 mg calcium per tablet. The 1500-D formula includes 200 I.U. vitamin D.

Calcium Phosphate
(Provides 39% or 30% elemental calcium)
Relative Cost: $$
Brand Names: Posture, Posture-D
Both are 1500 mg per tablet for 600 mg of elemental calcium. Posture-D includes 125 I.U. vitamin D.

About the author:
Jan Revella, R.N., arthritis nurse specialist, is founder and director of Arthritis Education by Professionals, Inc., based in Phoenix, Arizona. She is among the most prominent speakers and educators on the subject of arthritis in the United States. Her mission is to empower people with arthritis to use knowledge as power when making decisions about their personal healthcare. Arthritis Education by Professionals, Inc. provides educational programs and services to people with arthritis.

© Copyright 2005. Arthritis Education by Professionals, Inc.