Osteoporosis is a major health problem for Americans. Seven to 8 million Americans have the disease. Seventeen million are at an increased risk for developing it. Eighty percent of those affected are women. Persons with osteoporosis suffer from a loss in bone mass and bone strength. Their bones become weak and brittle, which makes them more prone to fracture. Any bone can be affected by osteoporosis, but the hips, wrists, and spine are the most common sites. Peak bone mass is reached between the ages of 25 and 35. After age 35, everyone's bones lose density.

Causes:

The actual causes of osteoporosis are unknown. Certain risk factors increase the likelihood of developing osteoporosis, however:

Being female. Women are 4 times more likely to develop osteoporosis than men. The reasons are as follows:

• Female bones are generally thinner and lighter
  
  
• Women live longer on average than men
  
  
• Women have rapid bone loss at menopause due to a sharp decline of estrogen.

The risk also increases for women who:

• Go through menopause before age 45. This could be natural menopause or one that results from surgical removal of both ovaries.
  
  
• Experience a lack of or irregular menstrual flow
  
  
• Having a thin, small-framed body
  
  
• Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well.
  
  
• Lack of physical activity, especially activities such as walking, running, tennis, and other weight-bearing exercises. Or, exercising too much to the point where menstrual periods cease.
  
  
• Lack of calcium. Adequate calcium intake throughout life helps to insure that calcium deficiency does not contribute to a weakening of bone mass.
  
  
• Heredity factors. The risk increases if there is a history of osteoporosis and/or bone fractures in your family.
  
  
• Smoking cigarettes
  
  
• Alcohol consumption. Regularly consuming alcoholic beverages may be damaging to bones. Heavy drinkers often have poor nutrition and may be more prone to fractures because they are more prone to falls.
  
  
• Taking certain medications such as: corticosteroids (anti-inflammatory medicines used to treat a variety of conditions such as asthma, arthritis, lupus, etc.); some antiseizure medicines; overuse of thyroid hormones; and aluminum-containing antacids
  
  
• Other disorders such as hyperthyroidism, hyperparathyroidism, and certain forms of bone cancer.

Prevention

• Be sure to eat a balanced diet.

• Plan to get your recommended Adequate Intake (AI) for calcium every day. AIs are the Dietary Reference Intakes that have been set by the Food and Nutrition Board of National Academy of Sciences.

To get your recommended calcium:

• Choose high-calcium foods daily:

• Soft-boned fish and shellfish, such as salmon, sardines, or shrimp

• Skim and low-fat milks, yogurts, and cheeses. [Note: If you are lactose intolerant, you may need to use dairy products that are treated with the enzyme lactase, or you can add this enzyme using over-the-counter drops or tablets.]

• Vegetables, especially broccoli, kale, and collard greens

• Beans and bean sprouts as well as tofu (soybean curd), if processed with calcium

• Calcium-fortified foods such as some orange juices, apple juices, and ready-to-eat cereals

• Take calcium supplements, if necessary and advised by your doctor

• Follow a program of regular, weight-bearing exercise at least 3 or 4 times a week. Examples include walking, jogging or low-impact or non-impact aerobics. (A person with osteoporosis should follow the exercise program outlined by his or her doctor.)

• Do not smoke. Smoking makes osteoporosis worse and may negate the beneficial effects of estrogen replacement therapy.

• Limit alcohol consumption.

• Check with your doctor regarding medical management to prevent further bone loss and/or osteoporosis fractures, especially if you are at high risk for getting these. He or she may prescribe:
  
  
  • Estrogen replacement therapy, if you are female

  • Calcitonin

  • Alendronate sodium (Fosamax)

Signs and Symptoms

Osteoporosis is a "silent disease" because it can progress without any noticeable signs or symptoms. Often the first sign is when a bone fracture of the hip, wrist, or spine occurs.

Symptoms include:

• Gradual loss of height
  
  
• Rounding of the shoulders
  
  
• Back pain
  
  
• Stooped posture or dowager's humps
  
  

Treatment and Care

Special X-rays, such as dual energy X-ray absorptiometry (DEXA) can measure bone mass in various sites of the body. They are safe and painless. These tests can help doctors decide if and what kind of treatment is needed.

Treatment for osteoporosis includes:

• Medication therapy: Estrogen replacement therapy (ERT), calcitonin, or alendronate sodium (Fosamax)
  
  
• Dietary measures: A balanced diet rich in calcium, and calcium supplementation if necessary
  
  
• Daily exercises approved by your doctor
  
  
• Proper posture
  
  
• Fall-prevention strategies:
  
  
• Use grab bars and safety mats or nonskid tape on your tub or shower.
  
  
• Use handrails on stairways.
  
  
• Don't stoop to pick up things. Pick things up by bending your knees and keeping your back straight.
  
  
• Wear flat, sturdy, nonskid shoes.
  
  
• If you use throw rugs, make sure they have nonskid backs.
  
  
• Use a cane or walker if necessary.
  
  
• See that halls, stairways, and entrances are well lit. Use night lights in hallways, bathrooms, etc.

There is no cure for osteoporosis. The focus of treatment is to prevent the disease (see Prevention measures above), prevent further bone loss, and build new bone.

Apr.1999 © 1999 Don R. Powell, PhD, and Amer. Inst. for Prevent. Medicine.

American Institute for Preventive Medicine
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Farmington Hills, MI 48334

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(248) 539-1800
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www.aipm.healthy.net

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