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What is osteoporosis?
Osteoporosis (say: ost-tee-oh-pore-oh-siss)
occurs when the inside of the bones become
porous from a loss of calcium (see the picture
below). This is called losing bone mass. Over
time, this weakens the bones and makes them more
likely to break.
Once total bone mass has peaked ó around age 35
ó all adults start to lose it. However, women
are more likely to develop osteoporosis than
men. This is due to several factors. Women have
less bone mass than men, tend to live longer and
take in less calcium. In women, the rate of bone
loss speeds up after menopause, when estrogen
levels fall. Since the ovaries make estrogen,
faster bone loss may also occur if both ovaries
are removed by surgery.
If men live long enough, they are also at risk
of getting osteoporosis later in life.
What are the signs of osteoporosis?
You may not know you have osteoporosis until you
have serious signs. Signs include frequent
broken bones or fractures, low back pain or a
hunched back. You may also get shorter over time
because osteoporosis can cause your vertebrae
(the bones in your spine) to collapse. These
problems tend to occur after a lot of bone
calcium has already been lost.
What are the
risk factors for
things put you
The more of
these that apply
to you, the
higher your risk
is. Talk to your
about your risk
- Early menopause (before age 45)
- Family history of osteoporosis
- Surgery to remove ovaries before menopause
- Fair skin (caucasian or Asian race)
- Not getting enough calcium
- Sedentary lifestyle (not getting enough exercise)
- Smoking or tobacco use
- Alcohol abuse
- Eating disorders such as anorexia nervosa
- Thin body and small bone frame
- Fair skin (caucasian or Asian race)
- Hyperthyroidism, either from an overactive thyroid or from taking too much medicine to treat hypothyroidism.
- Long-term use of corticosteroids, which are medicines prescribed to treat inflammation, pain and chronic conditions such as asthma and rheumatoid arthritis.
How is osteoporosis diagnosed?
If you doctor suspects osteoporosis, he or she
may suggest you have a bone scan. A common test
that measure bone density is called a dual
energy X-ray absorptiometry (DEXA). This test
measures the density of the bones in your hips,
spine and wrist, which are all places likely to
be affected by osteoporosis.
Your doctor may also order an ultrasound or a
computerized tomography (CT) scan to help check
the density of your bones.
What is ibandronate sodium?
Ibandronate sodium (brand name: Boniva) is a new
drug that is taken once a month. It is not a
hormone, but it slows bone loss and increases
bone density. Some of the possible side effects
include upset stomach, heartburn, nausea and
How is osteoporosis treated?
Treatment for osteoporosis starts with changes
to your diet. You want to take in more calcium.
Your doctor will suggest ways to get more
calcium through food, drink and possibly a
calcium supplement. He or she may also suggest
you take a vitamin D supplement, which helps
your body process calcium.
Your doctor will also suggest that you increase
your physical activity, especially
weight-bearing exercise. This helps increase
bone density. Examples of weight-bearing
exercise include walking, jogging and climbing
There are medicines available to treat
osteoporosis. They include the following:
Biophosphonates. These medcines help
redece the risk of breaks and fractures, as well
as increase bone density in the hips and spine.
They can be taken in orally (in pill form) of
intravenously (with an injection). Side effects
include nausea, abdominal pain and irritation of
the esophagus (the tube that connects the mouth
to the stomach). People who cannot take
biophosphonates include people who have kidney
disease, low levels of calcium in their blood
and women who are pregnant or nursing.
Calcitron. This is a hormone that helps
slow the breakdown of bone. It is available as
injection or nasal spray. Side effects include
irritation of the lining of the nose and
headache (with use of the nasal spray) and
diarrhea, abdominal pain, nausea and vomiting
(with use of the injection).
Raloxifene. This medicine is used to
prevent and treat osteoporosis in women by
increasing bone density. It is not a hormone,
but it mimics some of the effects of estrogen.
Side effects may include hot flashes and a risk
of blood clots.
Teriparatide. This medicine is a
synthetic form of parathyroid hormone and helps
new bone to grow. It comes in an injectable
form, and is injected once a day in the thigh or
abdomen. It can be used in both women and men
for the treatment of osteoporosis. Common side
effects may include nausea, abdominal pain,
headache, muscle weakness, fatigue and loss of
Alendronate and Risedronate. These
medicines are used to help prevent and treat
osteoporosis. These drugs help reduce the risk
of fractures by decreasing the rate of bone
loss. They are taken orally in pill form. Their
most common side effect is an upset stomach.
Ibandronate. This medicine helps to slow
bone loss and increases bone density. It is
available both as a pill or as an injection. If
you take the pill, you have 2 options: a daily
pill or a monthly pill (the pill you take each
month has a greater dose of ibandronate than the
pill you take daily). If you take the injection,
your doctor or nurse will give you a shot every
3 months. Some of the possible side effects
include lower back or side pain, shortness of
breath, tightness in the chest, and bloody or
How much calcium do I need?
Before menopause, you need about 1,000 mg of
calcium per day. After menopause, you need 1,000
mg of calcium per day if you're taking estrogen
and 1,500 mg of calcium per day if you're not
taking estrogen. You should also aim for 800
international units (IU) of vitamin D each day
to help your body absorb the calcium.
Itís usually best to try to get calcium from
food. Nonfat and low-fat dairy products are good
sources of calcium. Other sources of calcium
include dried beans, pink salmon, spinach and
About 300 mg of calcium are in each of the
following: 1 cup of nonfat or low-fat yogurt, 1
1/2 cups of white beans, 5 ounces of salmon, 1/2
cup of spinach or 2 cups of broccoli.
If you donít get enough calcium from the food
you eat, your doctor may suggest taking a
calcium supplement. Take it at meal time or with
a sip of milk.
Tips to keep
- Eat a well-balanced diet with at least 1,000 mg of calcium a day.
- Quit smoking. Smoking makes osteoporosis worse.
- Talk to your doctor about hormone therapy (HT) or other medicines to prevent or treat osteoporosis.
familydoctor.org editorial staff.
American Academy of Family Physicians
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