Osteoporosis Definition Osteoporosis, which means "porous bones," causes bones to become weak and brittle so brittle that

at even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. A common result of osteoporosis is fractures most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects many men. And aside from people who have osteoporosis, many more have low bone density. It's never too late or too early to do something about osteoporosis. take steps to keep bones strong and healthy throughout life. Symptom In the early stages of bone loss, you usually have no pain or other symptoms. !ut once bones have been weakened by osteoporosis, you may have osteoporosis symptoms that include"

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!ack pain, which can be severe if you have a fractured or collapsed vertebra #oss of height over time, with an accompanying stooped posture $racture of the vertebrae, wrists, hips or other bones Causes %he strength of your bones depends on their si&e and density' bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. (hen your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure. The process of bone remodeling )cientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. !one is continuously changing new bone is made and old bone is broken down a process called remodeling, or bone turnover. A full cycle of bone remodeling takes about two to three months. (hen you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. ou reach your peak bone mass in your mid*+,s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases

dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause. our risk of developing osteoporosis depends on how much bone mass you attained between ages -. and +. /peak bone mass0 and how rapidly you lose it later. %he higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. 1ot getting enough vitamin 2 and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later. What keeps bones healthy %hree factors that you can influence are essential for keeping your bones healthy throughout your life"

3egular e4ercise Ade5uate amounts of calcium Ade5uate amounts of vitamin 2, which is essential for absorbing calcium Risk Factor A number of factors can increase the likelihood that you'll develop osteoporosis, including"

Your sex $ractures from osteoporosis are about twice as common in women as they are in men. %hat's because women start out with lower bone mass and tend to live longer. %hey also e4perience a sudden drop in estrogen at menopause that accelerates bone loss. )lender, small*framed women are particularly at risk. 6en who have low levels of the male hormone testosterone also are at increased risk. %he risk of osteoporosis in men is greatest from age 7. on. !ge %he older you get, the higher your risk of osteoporosis. our bones become weaker as you age. Race ou're at greatest risk of osteoporosis if you're white or of )outheast Asian descent. !lack and 8ispanic men and women have a lower, but still significant, risk. Family history Osteoporosis runs in families. $or that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures. Frame si"e 6en and women who are e4ceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age. Tobacco use %he e4act role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.

#ifetime exposure to estrogen %he greater a woman's lifetime e4posure to estrogen, the lower her risk of osteoporosis. $or e4ample, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. !ut your risk of osteoporosis is increased if your lifetime e4posure to estrogen has been deficient, such as from infre5uent menstrual periods or menopause before age 9.. $ating disorders (omen and men with anore4ia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips. Corticosteroid medications #ong*term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and de4amethasone, is damaging to bone. %hese medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss. Thyroid hormone %oo much thyroid hormone also can cause bone loss. %his can occur either because your thyroid is overactive /hyperthyroidism0 or because you take e4cess amounts of thyroid hormone medication to treat an underactive thyroid /hypothyroidism0. Selecti%e serotonin reuptake inhibitors &SSR's( 3esearch published in -,,7 showed lower bone mineral density among both men and women currently using ))3Is compared with study participants not taking these antidepressants. 8owever, these results don't necessarily mean that ))3Is cause bone loss or osteoporosis. 6ore research is needed to fully understand the association between ))3I use and low bone density. :vidence does not currently indicate that you should stop using ))3Is because of concerns about bone loss. Other medications #ong*term use of the blood*thinning medication heparin, the cancer treatment drug methotre4ate, some anti*sei&ure medications, diuretics and aluminum*containing antacids also can cause bone loss. )reast cancer ;ostmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastro&ole and letro&ole, which suppress estrogen. %his isn't true for women treated with tamo4ifen, which may reduce the risk of fractures. #o* calcium intake A lifelong lack of calcium plays a ma<or role in the development of osteoporosis. #ow calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures. +edical conditions and procedures that decrease calcium absorption )tomach surgery /gastrectomy0 can affect your body's ability to absorb calcium. )o can conditions such as =rohn's disease, celiac disease, vitamin 2 deficiency, anore4ia nervosa and =ushing's disease a rare disorder in which your adrenal glands produce e4cessive corticosteroid hormones. Sedentary lifestyle !one health begins in childhood. =hildren who are physically active and consume ade5uate amounts of calcium*containing foods have the greatest bone density. Any weight*bearing e4ercise is beneficial, but <umping and hopping seem particularly helpful for creating healthy bones. :4ercise throughout life is important, but you can increase your bone density at any age.

$xcess soda consumption %he link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in your blood. If you do drink caffeinated soda, be sure to get ade5uate calcium and vitamin 2 from other sources in your diet or from supplements. Chronic alcoholism $or men, alcoholism is one of the leading risk factors for osteoporosis. :4cess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium. Depression ;eople who e4perience serious depression have When to seek medical ad%ice :arly detection is important in osteoporosis. =onsider your risk factors, then discuss your prevention strategy with your doctor. If you're a woman, it's best to do this well before menopause. Tests and diagnosis Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. 2octors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density. Dual energy ,-ray absorptiometry %he best screening test is dual energy >*ray absorptiometry /2:>A0. %his procedure is 5uick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist the areas most likely to be affected by osteoporosis and it's used to accurately follow changes in these bones over time. Other tests that can accurately measure bone density include"

?ltrasound @uantitative computeri&ed tomography /=%0 scanning Should you ha%e a test. If you're a woman, the 1ational Osteoporosis $oundation recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you"

ou're older than age A., regardless of risk factors. ou're postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone. ou have a vertebral abnormality.

ou use medications, such as prednisone, that can cause osteoporosis. ou have type B diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis. ou e4perienced early menopause. 2octors don't generally recommend osteoporosis screening for men because the disease is less common in men than it is in women.

Complication $ractures are the most fre5uent and serious complication of osteoporosis. %hey often occur in your spine or hips bones that directly support your weight. 8ip fractures usually result from a fall. Although most people do relatively well with modern surgical treatment, hip fractures can result in disability and even death from postoperative complications, especially in older adults. (rist fractures from falls also are common. In some cases, spinal fractures can occur without any fall or in<ury simply because the bones in your back /vertebrae0 become so weakened that they begin to compress. =ompression fractures can cause severe pain and re5uire a long recovery. If you have many such fractures, you can lose several inches of height as your posture becomes stooped.

Treatments and drugs /ormone therapy 8ormone therapy /8%0 was once the mainstay of treatment for osteoporosis. !ut because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. 6ost problems have been linked to certain oral types of 8%, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring. 2iscuss the various options with your doctor to determine which might be best for you. 0rescription medications If 8% isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. %hey include"

)isphosphonates 6uch like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures. !isphosphonates may be especially beneficial for men, young adults and people with steroid*induced osteoporosis. %hey're also used to prevent osteoporosis in people who re5uire long*term steroid treatment for a disease such as asthma or arthritis. )ide effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you've had acid reflu4 or ulcers in the past. !isphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations. In -,,7, the $ood and 2rug Administration /$2A0 approved the first once*yearly drug for postmenopausal women with osteoporosis. %he medication, &oledronic acid /3eclast0, is given intravenously at your doctor's office. It takes about B. minutes to get your annual dose. One published study found that &oledronic acid reduces the risk of spine fracture by 7, percent and of hip fracture by 9B percent. A small number of cases of osteonecrosis of the <aw have been reported in people taking bisphosphonates for osteoporosis. %hese cases have primarily occurred after trauma to the <aw, such as a tooth e4traction, or cancer treatment. 3isk appears to be higher in people who have received bisphosphonates intravenously. (hile there is currently no clear evidence that you should stop taking bisphosphonates before dental surgery, let your dentist know what medications you're taking and discuss your concerns.

Raloxifene &$%ista( %his medication belongs to a class of drugs called selective estrogen receptor modulators /):36s0. 3alo4ifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. 8ot flashes are a common side effect of ralo4ifene, and you shouldn't use this drug if you have a history of blood clots. %his drug is approved only for women with osteoporosis and is not currently approved for use in men. Calcitonin A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an in<ection. !ecause calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs. Teriparatide &Forteo( %his powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high

risk of fractures. ?nlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. %eriparatide is given once a day by in<ection under the skin on the thigh or abdomen. #ong*term effects are still being studied, so the $2A recommends restricting therapy to two years or less. Tamoxifen %his synthetic hormone is used to treat breast cancer and is given to certain high*risk women to help reduce their chances of developing breast cancer. Although tamo4ifen blocks estrogen's effect on breast tissue, it has an estrogen*like effect on other cells in your body, including your bone cells. As a result, tamo4ifen appears to reduce the risk of fractures, especially in women older than .,. ;ossible side effects of tamo4ifen include hot flashes, stomach upset, and vaginal dryness or discharge. $merging therapies A new physical therapy program has been shown to significantly reduce back pain, improve posture and reduce the risk of falls in women with osteoporosis who also have curvature of the spine. %he program combines the use of a device called a spinal weighted kypho*orthosis /(CO0 a harness with a light weight attached and specific back e4tension e4ercises. %he (CO is worn daily for +, minutes in the morning and +, minutes in the afternoon and while performing B, repetitions of back e4tension e4ercises.

0re%ention Detting ade5uate calcium and vitamin 2 is an important factor in reducing your risk of osteoporosis. If you already have osteoporosis, getting ade5uate calcium and vitamin 2, as well as taking other measures, can help prevent your bones from becoming weaker. In some cases you may even be able to replace bone you've lost. %he amount of calcium you need to stay healthy changes over your lifetime. our body's demand for calcium is greatest during childhood and adolescence, when your skeleton is growing rapidly, and during pregnancy and breast*feeding. ;ostmenopausal women and older men also need to consume more calcium. As you age, your body becomes less efficient at absorbing calcium, and you're more likely to take medications that interfere with calcium absorption. /o* much calcium and %itamin D. ;remenopausal women and postmenopausal women who use 8% should consume at least B,,,, milligrams /mg0 of elemental calcium and a minimum of E,, international units /I?0 of vitamin 2 every day. ;ostmenopausal women not using 8%, anyone at risk of steroid*induced osteoporosis, and all men and women older

than A. should aim for B,.,, mg of elemental calcium and at least E,, I? of vitamin 2 daily. Detting enough vitamin 2 is <ust as important as getting ade5uate amounts of calcium. 1ot only does vitamin 2 improve bone health by helping calcium absorption, but it also may improve muscle strength. )cientists are continuing to study vitamin 2 which may also protect against certain types of cancer to determine the optimal daily dose, but it's safe to take up to -,,,, I? a day. Although many people get ade5uate amounts of vitamin 2 from sunlight, this may not be a good source if you live in high latitudes, if you're housebound, or if you regularly use sunscreen or you avoid the sun entirely because of the risk of skin cancer. Although vitamin 2 is present in oily fish such as tuna and sardines and in egg yolks, you probably don't eat these on a daily basis. =alcium supplements with added vitamin 2 are a good alternative. As for calcium, dairy products are one, but by no means the only, source. Almonds, broccoli, cooked kale, canned salmon with the bones, oats and soy products such as tofu also are rich in calcium. If you find it difficult to get enough calcium from your diet, consider calcium supplements. )upplements are ine4pensive and generally are well tolerated and well absorbed if taken properly. )ometimes calcium supplements can cause constipation. If this is a problem for you, drink more water and try using a fiber supplement. In addition, check the type of calcium you're using. =alcium phosphate and calcium citrate tend to be less constipating. =alcium and vitamin 2 supplements are most effective taken together in divided doses with food. Other tips for pre%ention %hese measures also may help you prevent bone loss"

$xercise :4ercise can help you build strong bones and slow bone loss. :4ercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start e4ercising regularly when you're young and continue to e4ercise throughout your life. =ombine strength training e4ercises with weight* bearing e4ercises. )trength training helps strengthen muscles and bones in your arms and upper spine, and weight*bearing e4ercises such as walking, <ogging, running, stair climbing, skipping rope, skiing and impact*producing sports mainly affect the bones in your legs, hips and lower spine. )wimming, cycling and machines such as elliptical trainers can provide a good cardiovascular workout, but because they're low impact, they're not as helpful for improving bone health as weight*bearing e4ercises are. !dd soy to your diet %he plant estrogens found in soy help maintain bone density and may reduce the risk of fractures.

Don1t smoke )moking increases bone loss, perhaps by decreasing the amount of estrogen a woman's body makes and by reducing the absorption of calcium in your intestine. %he effects on bone of secondhand smoke aren't yet known. Consider hormone therapy 8ormone therapy can reduce a woman's risk of osteoporosis during and after menopause. !ut because of the risk of side effects, discuss the options with your doctor and decide what's best for you. %estosterone replacement therapy works only for men with osteoporosis caused by low testosterone levels. %aking it when you have normal testosterone levels won't increase bone mass. !%oid excessi%e alcohol =onsuming more than two alcoholic drinks a day may decrease bone formation and reduce your body's ability to absorb calcium. %here's no clear link between moderate alcohol intake and osteoporosis. #imit caffeine 6oderate caffeine consumption about two to three cups of coffee a day won't harm you as long as your diet contains ade5uate calcium. #ife style and home remedies %hese suggestions may help relieve symptoms and maintain your independence if you have osteoporosis"

+aintain good posture Dood posture which involves keeping your head held high, chin in, shoulders back, upper back flat and lower spine arched helps you avoid stress on your spine. (hen you sit or drive, place a rolled towel in the small of your back. 2on't lean over while reading or doing handwork. (hen lifting, bend at your knees, not your waist, and lift with your legs, keeping your upper back straight. 0re%ent falls (ear low*heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Ceep rooms brightly lit, install grab bars <ust inside and outside your shower door, and make sure you can get in and out of your bed easily. +anage pain 2iscuss pain management strategies with your doctor. 2on't ignore chronic pain. #eft untreated, it can limit your mobility and cause even more pain.

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