Called the 'silent disease' because it steals from your skeleton, osteoporosis has few warning signs--until suddenly you break a bone. Now, thanks to new targeted medications, you can slow your bone erosion and even reverse your losses.
One in two women and one in three men over 60 will have a fracture due to osteoporosis, and many more are at risk of one. Put simply, osteoporosis is an extension of the natural ageing process. When you're young, your bones get longer and denser until you reach your full height. Even as you grow, your bone tissue is constantly being broken down and rebuilt. Then, in your early 30s if you're a woman, and at about age 40 if you're a man, your skeleton normally begins to slowly lose bone faster than your body can replace it.
From this point on, the skeleton very gradually thins as you age. But if you have osteoporosis, it's a different story. By the time you're diagnosed, your bones will already have lost significant density, making them fragile and easy to break--often after a very minor accident or even spontaneously. In particular, you'll have a higher risk for fracturing wrists or suffering painful compression fractures of the spine, causing your upper back to curve forwards. The real danger, however, is hip fractures, which can cause permanent disability; even worse, studies show that 20 percent of people over age 50 who break a hip die of complications within a year.
Bone less is mainly a depletion of the mineral calcium. It affects more women than men because the hormone oestrogen plays a crucial role in the female body's ability to use dietary calcium to build new bone. As a result, when you approach or are in menopause, the reduction in your body's oestrogen production deprives your bones of the calcium they need. Indeed, some 20 to 30 percent of bone loss in women occurs in the first five years after menopause, a critical time when a precondition called osteopenia often develops.
Bone loss can also occur in younger women whose oestrogen levels fall after a hysterectomy, or in athletes whose ability to produce oestrogen may be hindered by low body fat. Hormonal changes can also contribute to osteoporosis in men (see on shortly), as can long-term use of medications, such as anticonvulsants and corticosteroids.
LIKELY FIRST STEPS
To begin, treatment for your osteoporosis will focus on medications to slow your bone loss and reduce the risk of fractures, as well as lifestyle changes to improve your general health and feelings of well being. Your doctor may recommend the same approach if you've got osteopenia, to keep your bone loss in check. For severe cases and fractures, surgery may be an option.
Treatment Options
MEDICATIONS
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Calcium & vitamin D Supplements to build and strengthen bones.
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Bisphosphonates Fosamax and Actonel, first-line treatments.
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Hormone replacement Short-term at menopause can be beneficial.
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SERMs Promising drugs Evista, Livial.
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Calcitonin Hormone that decreases bone loss.
LIFESTYLE CHANGES
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Dairy products Rich sources of calcium.
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Weight-bearing exercise Strength-building helps calcium work.
----------------------------------------------------------------------------------------------------------------------------------------------
Safety measures Practical precautions prevent injury.
PROCEDURES
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Joint replacement For severe injuries, especially fractured hips.
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Kyphoplasty Restorative therapy for collapsed vertebrae.
NATURAL METHODS
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Therapies Acupuncture, chiropractic, massage for pain.
TAKING CONTROL
What is happening
One in two women and one in three men over 60 will have a fracture due to osteoporosis, and many more are at risk of one. Put simply, osteoporosis is an extension of the natural ageing process. When you're young, your bones get longer and denser until you reach your full height. Even as you grow, your bone tissue is constantly being broken down and rebuilt. Then, in your early 30s if you're a woman, and at about age 40 if you're a man, your skeleton normally begins to slowly lose bone faster than your body can replace it.
From this point on, the skeleton very gradually thins as you age. But if you have osteoporosis, it's a different story. By the time you're diagnosed, your bones will already have lost significant density, making them fragile and easy to break--often after a very minor accident or even spontaneously. In particular, you'll have a higher risk for fracturing wrists or suffering painful compression fractures of the spine, causing your upper back to curve forwards. The real danger, however, is hip fractures, which can cause permanent disability; even worse, studies show that 20 percent of people over age 50 who break a hip die of complications within a year.
Bone less is mainly a depletion of the mineral calcium. It affects more women than men because the hormone oestrogen plays a crucial role in the female body's ability to use dietary calcium to build new bone. As a result, when you approach or are in menopause, the reduction in your body's oestrogen production deprives your bones of the calcium they need. Indeed, some 20 to 30 percent of bone loss in women occurs in the first five years after menopause, a critical time when a precondition called osteopenia often develops.
Bone loss can also occur in younger women whose oestrogen levels fall after a hysterectomy, or in athletes whose ability to produce oestrogen may be hindered by low body fat. Hormonal changes can also contribute to osteoporosis in men (see on shortly), as can long-term use of medications, such as anticonvulsants and corticosteroids.
- Adequate intake of calcium and vitamin D to build bone.
- Medication prescribed to strengthen your bones and reduce your risk of fractures.
- Weight-bearing experience to increase your bone density.
- Alterations in home and office to prevent falls.
QUESTIONS TO ASK
- How severe is my condition?
- Taking into account my general health and family history, is hormone replacement therapy the right choice for me?
- Are there specific physical activities I should avoid?
- Can I escape getting the hunched back that my grandmother had?
Treatments
To begin, treatment for your osteoporosis will focus on medications to slow your bone loss and reduce the risk of fractures, as well as lifestyle changes to improve your general health and feelings of well being. Your doctor may recommend the same approach if you've got osteopenia, to keep your bone loss in check. For severe cases and fractures, surgery may be an option.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Calcium & vitamin D Supplements to build and strengthen bones.
------------------------------------------------------------------------------------------------------------------------------------------
Bisphosphonates Fosamax and Actonel, first-line treatments.
-------------------------------------------------------------------------------------------------------------------------------------------
Hormone replacement Short-term at menopause can be beneficial.
-------------------------------------------------------------------------------------------------------------------------------------------
SERMs Promising drugs Evista, Livial.
--------------------------------------------------------------------------------------------------------------------------------------------
Calcitonin Hormone that decreases bone loss.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Dairy products Rich sources of calcium.
----------------------------------------------------------------------------------------------------------------------------------------------
Weight-bearing exercise Strength-building helps calcium work.
----------------------------------------------------------------------------------------------------------------------------------------------
Safety measures Practical precautions prevent injury.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Joint replacement For severe injuries, especially fractured hips.
---------------------------------------------------------------------------------------------------------------------------------------------
Kyphoplasty Restorative therapy for collapsed vertebrae.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Therapies Acupuncture, chiropractic, massage for pain.
TAKING CONTROL
- If a physical activity feels too strenuous or unsafe, stop immediately. Tuning into the signals your body is sending may help prevent a serious injury. If the activity is something you still wish to pursue, talk it over with your doctor beforehand.
- Take tea and see. A study in Taiwan completed in 2002 found that longtime tea drinkers had the highest overall bone density. Researchers determined that drinking two cups a day of black, ganreen or oolong tea for at least six years protected the bones. This may be because tea contains flavonoids, oestrogen-like substances that may keep bones strong.
- Bone up on nondairy sources of calcium. Even if you drink plenty of milk, make sure your diet also includes such calcium-rich foods as canned salmon and sardines (eaten with the bones), dark-green leafy vegetables and white beans. A variety of processed foods are now fortified with calicum, including juices and cereals.
Is it possible to get too much calcium?
Yes. Most adults can safely consume up to 2000 mg of calcium a day, but large amounts can lead to a variety of problems, including nausea, vomiting and kidney stones. In two studies, men who consumed very high levels of calcium appeared to have an increased risk of developing prostate cancer.
Medications
Yes. Most adults can safely consume up to 2000 mg of calcium a day, but large amounts can lead to a variety of problems, including nausea, vomiting and kidney stones. In two studies, men who consumed very high levels of calcium appeared to have an increased risk of developing prostate cancer.
Medications
You already know that calcium is important for helping your body make bone tissue, but how much do you need? Adults up to age 50 require 100 mg of calcium daily; postmenopausal women (and men over age 65) should get 1200 to 1500 mg a day. If dietary sources aren't enough, add calcium supplements. You'll find a variety of calcium compounds on your pharmacy's shelves; the two with the highest levels of calicum supplements. You'll find a variety of calcium compounds on your pharmacy's shelves; the two with the highest levels of calcium are calcium carbonate (take it with food) and calcium citrate (which can be taken without food). For best absorption, don't take more than 500 to 600 mg at a time. Calcium needs a partner in its bone-protection work: vitamin D. Most adults need 400 IU of vitamin D daily; with osteoporosis, you may require 600 to 800 IU daily. Or your doctor may suggest a prescription form of the vitamin called calcitriol (Rocaltrol). Rocaltrol is commonly used if a trial of HRT has failed. It is also very useful for osteoporosis induced by corticosteroid use.
You'll also need medication to slow bone loss and increase bone mass. The first choice for many patients are drugs called biphosphonates: alendronate (Fosamax) and risedronate (Actonel). These drugs are available on the PBS on authority prescription for those men and women with established osteoporosis who have had a fracture following minimal trauma. And both drugs have been shown to lower the incidence of fractures. Each morning you must take the medication on an empty stomach with plain water and stay upright without eating or drinking for at least 30 minutes to prevent irritation of the oesophagus. For this reason, some people prefer the new once-a-week forms.
You'll also need medication to slow bone loss and increase bone mass. The first choice for many patients are drugs called biphosphonates: alendronate (Fosamax) and risedronate (Actonel). These drugs are available on the PBS on authority prescription for those men and women with established osteoporosis who have had a fracture following minimal trauma. And both drugs have been shown to lower the incidence of fractures. Each morning you must take the medication on an empty stomach with plain water and stay upright without eating or drinking for at least 30 minutes to prevent irritation of the oesophagus. For this reason, some people prefer the new once-a-week forms.
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