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Osteoporosis
Description and Risk Factors

Osteoporosis involves abnormally brittle bones or not enough bone, leading to fractures. There are many risk factors.

  • Premature menopause
  • Daily consumption of alcohol
  • Weight of less than 127 pounds
  • Smoking
  • Family history of osteoporosis (e.g., if women in your family got shorter as aged and/or had hip fractures)
  • Overactive thyroid
  • Problems with calcium metabolism
  • Kidney stones
  • Use of steroids by mouth or inhalation
  • Lifelong low intake of calcium
  • Malignancy: bone tumors and multiple myeloma can cause breaks in the bone.

Adolescents are at risk if they have had anorexia nervosa, bulimia, or six months without a period (Seen in competitive athletes with low body fat). Osteoporosis in these young women begins as a disease of malnutrition, and they will never regain the bone mass they lost.

Diagnostic Tests
A test called a DEXA scan indicates whether you have less bone mass than your peers and thus whether you are at risk for fractures. The test is painless and involves minimal radiation. You should consider getting a DEXA scan if you have the following risk factors.

  • Stress fractures when you run
  • Breaking a wrist when you fall
  • Smoking
  • Daily intake of alcohol
  • Your weight is less than 127 pounds
  • Strong family history

Treatment Options: Lifestyle Changes
The first set of options involves lifestyle changes.

  • Stop smoking.
  • Increase your exercise so that you get 20 to 30 minutes of anti-gravity activity per day. Try to walk six miles a week. The contribution of exercise is underscored by the fact that when the astronauts circle the atmosphere and become weightless, one of their biggest problems is stress fractures.

Treatment Options: Vitamins and Medications
Women with osteoporosis have treatment options that can help maintain bone or even build it back.

  • Calcium: take 1500 mg a day in divided doses. You cannot absorb more than 600 mg at once. Do not exceed 2000 mg a day. Viactiv®, Citracal®, and Tums® are good sources (i.e., calcium carbonate and calcium citrate), among other brands.
  • Vitamin D: is critical to assist in the absorption of calcium. Many articles have shown that older women are at risk of being Vitamin D deficient, and this can also lead to aching bones.
  • Estrogen: can help prevent fractures. Discuss the use of estrogen with your doctor because of its risks for clots and high blood pressure.
  • Evista (Raloxifene): an estrogen-receptorant agonist that is good for some women.
  • Fosamax (Alendronate) and Actonel (Risedronate) are the strongest medications for strengthening the bones. They must be taken on an empty stomach before breakfast once a week. Women typically take these chronically. For ninety percent of women, these medications succeed in stabilizing bones and preventing fracture and shrinking.
  • Forteo (Teriparatide): new medication that strengthens bones and helps growth of new bone. Given by injection at home daily for 2 years; shown to provide improvement in bone density.
  • Progesterone: is important in preparation of endometrium for implantation of the egg during pregnancy and the maintenance of pregnancy. Progesterone has characteristics that balance and counteract the adverse effects of estrogen. For example, some women produce too much estrogen, thus standing a risk of cancer of the uterus and breast. Supplemental progesterone has been known to aid in managing abnormal uterine bleeding as well as recurrent pregnancy loss or premature labor.

Summary
It is wise to seek counsel from your doctor on whether you are at risk for osteoporosis and what steps you can take to prevent or alleviate the symptoms. Although genes cannot be changed, other elements of lifestyle, diet, and medication can be adopted for best results in the menopausal years.

Bulletin
The estrogen only arm of the Women's Health Initiative study was stopped early last year. This arm included women without a uterus who were on either estrogen alone or placebo. The recommendation to close it early was due to the finding of an increase in strokes among the estrogen users.

The recommendation on hormone use remains the same; estrogen, with or without progestin, should be used only for hot flashes. The dose should be the lowest effective dose and used for the shortest amount of time.

For more information, please call toll-free, 1-888-876-8764, email: whs@mlhs.org

Main Line Health: Women’s Health -- Bryn Mawr Hospital, Lankenau Hospital, Paoli Hospital WH.05/04.DL

Citation: http://www.mainlinehealth.org/files/myosteoarthritisandosteoporosis
Women’s Health news source from Main Line Health System

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