Thursday, January 07, 2010

Osteoporosis

By Prameela Goli, M.D; F.A.C.R.

Practicing Rheumatologist in Birmingham, AL, Specializing in Treatment of Arthritis, with Special Interest in Osteoporosis, Rheumatoid Arthritis, and Lupus. Phone: (205) 877-2552

ABOUT OSTEOPOROSIS

Osteoporosis is a condition in which bones have lost minerals, especially calcium, making them weaker, brittle, and susceptible to fractures (broken bones). Any bone in the body can be affected by osteoporosis, but the most common places where fractures occur are the back (spine), hips, and wrists. Each year osteoporosis causes an estimated 1.5 million fractures. Fractures may also reduce a person’s ability to lead an active life. It is estimated that 1 out of every 2 women over the age of 50 will be affected by osteoporosis in her remaining lifetime.

Throughout a lifetime, bones grow as the body grows. Old bone is removed from the skeleton and new bone is added. Throughout the teen years, new bone is added faster than old bone is removed—a positive bone balance. The result? Your bones mass increased. This continues through about age 30, when your bones reach what is called “peak bone mass”, or maximum density and strength. After this point, bone removal begins to outpace formation of new bone, which, over time, leads to bone loss. The rate of bone loss is greatest in the first few years after menopause. After that, bone loss continues but more slowly.

HOW OSTEOPOROSIS DEVELOPS

Following menopause, your ovaries stop producing estrogen, a hormone that helps prevent bone loss. Some people may then develop osteopenia, a condition characterized by low bone density. Osteopenia can eventually lead to osteoporosis, a more severe condition with even lower bone density. For someone with osteoporosis, low bone density makes bones brittle and weak, and the risk of fractures rises. Not getting enough calcium and Vitamin D, even during the childhood and teen years, can contribute to osteoporosis. And, if bones did not each the highest possible peak bone mass during developmental years, osteoporosis is even more likely to develop.

WHAT ARE THE SYMPTOMS OF OSTEOPOROSIS?

The risk of fractures (broken bones) is serious. There are no symptoms in the early stages of the disease, and is a silent disease.

Symptoms occurring late in disease include:

• Bone pain or tenderness
• Fractures with little or no trauma
• Loss of height over time
• Low back pain due to fractures of the spinal bones
• Neck pain due to fractures of the spinal bones
• Stooped posture

WHO IS AT RISK FOR OSTEOPOROSIS?

• Have a family history of osteoporosis.
• Have a thin or small frame.
• Are Caucasian or Asian
• Have had broken bones after 50
• Use certain medications, such as corticosteroids (for asthma or arthritis for example).
• Drink 3 or more alcoholic beverages every day
• Cigarette Smoking

TREATMENT
The goals of osteoporosis treatment are to:
• Prevent bone fractures with medicines that strengthen bone
• Slow down or stop bone loss
• Stop the pain from the disease
• Minimize the risk of falls that might cause fractures

There are several different treatments for osteoporosis, including:

BIOSPHOSPHONATES
These include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Most are taken once a week or once a month, or by IV infusion once a year (Reclast).

CALCITONIN
Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes in a nasal spray or injection.

HORMONE REPLACEMENT THERAPY
Estrogens are used to prevent osteoporosis but not to treat osteoporosis. Everyone needs to have a discussion regarding estrogen replacement therapy with their doctor.

PARATHYROID HORMONE
Teriparatide (Forteo) is used for postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shot.

RALOXIFENE
Raloxifene (Evista) is used for the prevention and treatment of osteoporosis

EXERCISE
Regular exercise can reduce the likelihood of bone loss or osteoporosis. Some of the recommended exercises include:

• Weight-bearing exercises – walking, jogging, playing tennis, dancing
• Resistance exercises – free weights, weight machines, stretch bands
• Balance exercises – tai chi, yoga

Avoid any exercises that present a risk of falling.

DIET
Get at least 1,200 milligrams per day of calcium, and 800-1,000 international units of Vitamin D3. Vitamin D is needed to help absorb calcium in the stomach.

High-calcium foods include:
• Cheese
• Ice cream
• Leafy green vegetables, such as spinach and collard greens
• Salmon
• Sardines (with the bones)
• Tofu
• Yogurt

STOP UNHEALTHY HABITS
Stop smoking. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALLS
It is critical to prevent falls. Avoid sedating medication and remove household hazards. Make sure your vision is good. Other ways to prevent falling include:
• Avoiding walking alone on icy days
• Using bars in the bathtub, when needed
• Wearing well-fitting shoes

TESTS & DIAGNOSIS
Bone mineral density testing (specifically a densitometry or DEXA scan) measure how dense your bones are and assess the risk of fracture.

PREVENTION
Calcium is essential for building and maintaining healthy bone. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy, well-balanced diet can help you get these and other important nutrients throughout life.

If you are post menopausal or have other risk factors for osteoporosis, talk to your primary care physician, GYN doctor, or your rheumatologist regarding the need to test for bone density and Vitamin D levels.

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