Osteoporosis
Osteoporosis means porous, fragile bones. It is a disease where there is a large amount of bone loss, wich makes the bones much easier to be broken. Both men and women's bones normally become more fragile as they get older, but if they become so fragile that they break easily, it becomes a major health concern. You may not know that you have osteoporosis until a fracture occurs. Fractures in places such as the hip can be a major concern, and a women's risk of having a hip fracture is the same as the risk for breast, uterine, and ovarian cancer combined. Left untreated, osteoporosis could result in pain, disfigurement, disability, loss of independence, and even death. There are many factors that affect your risk for developing osteoporosis, but one of the most significant is menopause. Studies have demonstrated that estrogen plays a key role in maintaining bone density. After menopause, when estrogen levels decline, bone loss increases.

Osteoporosis is preventable and treatable in most women. The major risk factors that increase the chances of falling prey to this disease are listed in the table below.

PREVENTING OSTEOPOROSIS
Osteoporosis is much easier to prevent than it is to treat. Although many risk factors cannot be controlled, fortunately there are some that can. In addition to eliminating as many risk factors as possible (such as smoking and excessive alcohol intake), it is essential to get enough calcium, vitamin D, and exercise.

DETECTING OSTEOPOROSIS
Early detection of bone loss can lead to treatments that may restore some of the lost bone and help to reduce fracture rates. Since most warning signs don't usually occur until the disease has become advanced, osteoporosis is not easy to detect. One clue is prolonged and severe pain in the middle part of the back. Tooth loss is sometimes another indication of underlying bone loss. Other clues are changes in the shape of the spine and loss of height, even without pain. It is normal to lose some height as you age, but most experts agree that a loss of 2 inches or more is probably cause for concern.

Standard x-rays are not sensitive enough to reveal osteoporosis until 30% of the bone has already been lost. By then, the damage is done and the way back to health is more difficult.

Bone density testing. There are newer, more accurate, safe, and painless tests available to measure bone mineral density (BMD). The gold standard today is the dual energy x-ray absorptiometry (DEXA) measurement of the spine or hip. Although more expensive than a routine x-ray (and in the U.S., sometimes not covered by health insurance), DEXA provides reliable measurements and uses only about 10% of the radiation received in a chest x-ray.

Other tests of other sites of the body (such as the wrist or heel) are less accurate but may be adequate to determine whether BMD is so low that fracture is expected. New peripheral systems utilize ultrasound instead of x-ray.

PRESCRIPTION DRUGS FOR TREATMENT AND PREVENTION
Although taking nutritional suplements (such as vitamins and calcium) and exercising are a steps in the right direction, they can't prevent osteoporosis as well as the prescription hormone estrogen.

Hormone Replacement- After menopause, several forms of hormone replacement are effective in preventing osteoporosis and - if osteoporosis has been diagnosed - restoring some of the bone loss. Estrogen is approved by the FDA both for prevention and treatment of osteoporosis.

Continual use of hormone replacements can reduce the risk of spine, hip, and wrist fractures by 50% to 75%. Hormone replacement is especially recommended for women who have had menopause or a hysterectomy before the age of 40. Experts believe that ERT works best in reducing bone loss during the 5 to 10 years immediately following menopause, when the rate of bone loss is greatest. But there are still benefits for older women who start treatment. To keep bones strong, estrogen should be taken from menopause throughout life, since stopping treatment allows bone loss to resume.

While ERT may be beneficial - not only for the bones, but also in lowering the risk of heart disease and reducing short-term menopause effects (such as hot flashes) - it also has disadvantages, such as increasing the risk of uterine and breast cancer when taken for long periods of time.

Other prescription medications used for osteoporosis prevention and treatment are listed in the following table.

 

PRESCRIPTION DRUGS OTHER THAN ESTROGEN FOR OSTEOPOROSIS PREVENTION AND/OR TREATMENT ALENDRONATE (Marketed as Fosamax) A bisphosphonate, not a hormone Approved by FDA and Health Canada for prevention and treatment of postmenopausal osteoporosis Inhibits bone breakdown Increases bone density and decreases risk of spine, hip, and wrist fractures Apparently safe (although little is known about long-term safety) Must be taken on an empty stomach and must remain upright for 30 minutes after taking a dose Can cause irritation of the esophagus (not recommended for women with swallowing problems) Long-term therapy probably needed (bone loss continues when treatment is stopped) No beneficial effect other than that on bone (many believe alendronate is best reserved for preventing or treating osteoporosis when estrogen is not appropriate) ETIDRONATE (Marketed as Didronel) A bisphosphonate, not a hormone Not FDA-approved for osteoporosis prevention or treatment, but often prescribed to treat diagnosed osteoporosis In Canada, approved for osteoporosis treatment and also available in combination with calcium (marketed as Didrocal) CALCITONIN (Marketed as Calcimar or Miacalcin injections and, in the U.S., as Miacalcin nasal spray) A hormone produced in the thyroid gland Approved for osteoporosis treatment, not prevention Aids calcium regulation and bone metabolism Increases bone density (although to a lesser degree than estrogen or alendronate) May reduce bone pain from fractures Although a hormone, does not help with short-term effects (like hot flashes) and does not affect the breast or uterus Relatively safe with no serious side effects RALOXIFENE (Marketed as Evista) One of a new class of hormone drugs called SERMs (selective estrogen receptor modulators) Recently FDA-approved for prevention of osteoporosis in postmenopausal women Increases bone density, although to a lesser degree than estrogen or alendronate Although a hormone, does not help with short-term menopause effects (like hot flashes) and may even cause hot flashes Although a hormone, does not appear to harm the breast or uterus Studies are ongoing to determine long-term and other effects

Estrogen, bisphosphonates, calcitonin, and raloxifene all work to help bone health, and they all need adequate calcium to work effectively. Note that combining these prescription medications is not advised without very careful supervision, since combination regimens have not been thoroughly studied.

Not every drug is right for every woman. Each woman's decision to begin treatment must be made after a complete discussion with her healthcare provider of each drug's benefits and risks, as well as her own circumstances.

Many other osteoporosis therapies are under investigation. The future promises new and, hopefully, improved ways of dealing with osteoporosis.

Special thanks for the information on this page which was provided by the North American Menopause Society.

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