| Osteoporosis
The information provided by Advanced
Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes
only. As each woman is unique, do not rely on this information for diagnosis and
treatment. We cannot guarantee the accuracy of the content and advise that you see a
qualified Health Care Professional for individual needs and care.
Osteoporosis is a condition in which bone
becomes brittle, weak, and more likely to fracture. Decreased bone mass is termed osteopenia
and puts a patient at increased risk to develop osteoporosis. These conditions occur more
frequently in women after menopause. But they can be seen in both men and women, even at
much younger ages.
- Approximately 23 million American women have osteopenia or
osteoporosis.
- This leads to about 1.2 million fractures in women each year.
- Up to 50% of women over the age of 50 will break a bone due to
osteoporosis during their lifetime. The bones at greatest risk for fracture include your
hip, spine, and wrist.
Women more prone to osteoporosis include:
- those with a family history of osteoporosis or fractures that
may have been due to osteoporosis
- Caucasian and Asian women
- women who are thin or petite
- those with decreased hormones during or after menopause or
surgery to remove the ovaries
- women who use medroxyprogesterone acetate (Depo-Provera ā )
injections for birth control – this is new information. Discuss this with your
physician if you use or are contemplating using this method of birth control.
- Women who consume 3000 mg or more per day of vitamin A
(retinol, not beta- carotene) - this is information published in the Journal of the
American Medical Association January 2, 2002
Other risk factors are:
- lack of physical activity
- cigarette smoking
- excess alcohol intake
- excess caffeine consumption
- inadequate calcium (little or no dairy products or calcium
supplements)
- medications such as steroids or excessive thyroid hormone
Signs of osteoporosis are frequently not
seen until significant damage has occurred. These may include:
- loss of height
- certain types of back pain
- a broken bone from minimal trauma in the hip, wrist, or spine
- an upper back that is curved forward.
Certain clinical risk factors increase the chance of fracture
in women with decreased bone density (those who have osteopenia – see below). These
include a prior history of fracture, a bone density of –1.8 or less, fair or poor
general health status, and poor mobility (women confined to a wheel chair and those who
are bed ridden).
Detection of osteoporosis is accomplished
with a bone density test. Some techniques evaluate the wrist or heel. The
best information is obtained by evaluating the spine and hip with a Dexa Scan.
The dexa scan is a painless, very low dose x-ray that takes about 15 minutes to complete.
It is recommended (by the National Osteoporosis Foundation) that all women over age 65 be
tested and women under age 65 who have risk factors be tested. The test results will be
reported as T-scores.
T-score |
Interpretation |
> -1.0 |
normal |
-1.0 to -2.49 |
osteopenia |
< -2.5 |
osteoporosis |
Prevention or treatment of osteoporosis requires all
of the following.
Estrogen or an estrogen substitute
Adequate calcium absorption (vitamin D is need for calcium
absorption)
Weight-bearing exercise.
Lifestyle change to address the above risk factors (smoking,
excess alcohol, lack of physical activity, and excess caffeine intake)
Prior to the menopause, most women should have adequate
estrogen. Exceptions to this include some women with eating disorders such as anorexia and
bulimia, and some athletes including some gymnasts and dancers. When the total-body fat
content falls below a certain level, deficient estrogen production may be a result.
Estrogen therapy is indicated to prevent osteoporosis but not to treat it. Estrogen
replacement is a complex decision that should be discussed with your physician (see Hormone Replacement Therapy and the
Menopause under Patient Health Information). Alternatives to estrogen replacement
include Fosamax, Actonel, Evista, and Miacalcin. Estrogen and the alternatives listed
above work by decreasing absorption of bone. Teriparatide (Forteo®) is a new medication
approved by the FDA to stimulate new bone formation. Finally, dietary soy consumption may
reduce osteoporosis and cardiovascular disease.
The best source of calcium is from your diet (see Calcium and Other Vitamins and Minerals under Patient Health
Information). If you are relying on a calcium supplement, it is very important that it
be taken in divided doses. The digestive system can only absorb a certain amount at a
time. Also, do not take calcium within one hour of drinking caffeine-containing liquids.
The caffeine will bind with the calcium, and it will be excreted in the stool. The
recommended daily consumption of calcium is 1200 mg, or for women with decreased bone
density and/or over 65 years of age 1500 mg. Along with calcium, you need vitamin D
600-800 IU daily to improve absorption of the calcium. Other nutrients that may help
reduce osteoporosis include vitamin B6 (1.5mg/day), vitamin B12 (2.4 micrograms/day),
folic acid (.4 mg/day), and moderate alcohol (one drink - 14 grams alcohol).
Weight-bearing exercise is another important component to
prevent and treat osteoporosis. The best forms of exercise are walking and jogging.
Ideally this is going to be done for 30 minutes a day, seven days a week. Although
swimming is an excellent exercise to reduce cardiovascular risk, it does not qualify as a
weight-bearing exercise. Weight lifting is also an excellent exercise to help prevent and
treat osteoporosis. It also provides increased strength, range-of-motion, and balance. If
you have never lifted weights before, it is advisable to have a certified trainer help you
get started to minimize risk and maximize benefit.
Lifestyle change should address the risk factors of smoking,
excess alcohol, lack of physical activity, and excess caffeine intake. |
