What is osteoporosis?
Osteoporosis is the loss of bone that can occur as you get older. As the bones get thinner, they become weaker. There is a much greater risk they will break if you fall or have an otherwise minor injury. Medical complications of these injuries can result in longer stays at the hospital, disability, and even death.

Osteoporosis is most common in white and Asian women, especially slender women.

How does it occur?
Osteoporosis occurs as women get older. Sex hormones help keep bones strong. The hormone estrogen helps women's bones stay strong. For example, it helps deposit calcium in the bones. While men continue to produce testosterone, their sex hormone, as they get older, women produce much less estrogen after menopause. Surgical removal of the ovaries and intense exercise (such as marathon running) can also reduce estrogen levels. The lower levels of estrogen cause a weakening of the bones.

Osteoporosis can also occur as a result of hormone disorders or prolonged bed rest during serious illness. It may appear with osteomalacia, a condition in which the bones soften and weaken from lack of vitamin D.

Other possible causes include an imbalance in the body's natural acidity or a loss of phosphate. Too much aluminum hydroxide, a chemical used to treat ulcers, in the body can also be a cause.

Women who smoke or are physically inactive are at a greater risk of developing osteoporosis. Too little calcium in the diet or a family history of osteoporosis are other risk factors.

What are the symptoms?
You may have no clear symptoms until a bone breaks. Broken bones are the most common problem for people with osteoporosis. The hip, arm, and wrist are common places for breaks. The bones of the spine are also a common area of thinning. Often, over time, the bones of the spine (vertebrae) collapse on themselves, one at a time, causing loss of height, back pain, and changes in posture.

How is it diagnosed?
Your physician may discover you have osteoporosis from an x-ray taken for some other problem. It is much better to make the diagnosis before a fracture occurs so that treatment can be started to decrease the risk of fracture. The best way to do this is with a measurement of “bone mineral density.”

How is it treated?
Treatment cannot eliminate osteoporosis, but it can slow down the loss of bone.
The single most effective prevention for osteoporosis is estrogen (hormone replacement therapy). Women begin to produce less estrogen before menopause. Without this hormone to help bones stay strong, women are more likely to have osteoporosis. Taking estrogen pills after menopause is the best way to slow calcium loss from the bones and keep your bones strong.

Estrogen has many other benefits of Evista, but also carries some risks. Estrogen taken alone, without the hormone progesterone, can cause uterine cancer. Also, you should not take estrogen if you have a history of breast cancer, blood clots, or stroke. You and your doctor need to discuss your specific circumstance and whether or not hormone therapy is wise in your situation. New estrogens (called SERM’s) are being developed that might be appropriate in patients who should avoid “natural” estrogens. One such SERM is Evista®.

Prevention also includes increasing the calcium your body gets, usually through diet and supplements. Generally, doctors recommend 1,000 milligrams of calcium for women taking estrogen and 1,500 milligrams for women who are not.

Weight-bearing exercise, such as walking or stair climbing, also helps keep your bones strong. Doing this kind of physical activity every day may help stop further weakening of your bones. Swimming, although very healthy, is not a weight-bearing exercise. It can be part of your overall fitness program, but for women at risk for osteoporosis, exercise should include walking.

Treatments for patients already demonstrating varying degrees of bone loss include calcitonin and bisphosphanates (Actonel® and Fosamax®). Both drugs help prevent bone thinning or weakening, but can cause mild digestive-system side effects. Adequate calcium and Vitamin D are important for optimal benefit from these drugs.

Should I get a bone mineral density (BMD) test?
Obtaining bone mineral density is the best way to evaluate high-risk women and identify those who will benefit from measures to treat any bone loss that has silently occurred. All women by age 65 should have this done, even if they have no risk factors, are taking estrogen, getting adequate calcium in their diets, and exercising.

Younger women who are estrogen deficient (post menopausal and on no hormone therapy), smoke, have a strong family history of osteoporosis or use steroids should also consider a BMD. This can be done in our office in about 15 minutes without removal of clothing, and is usually covered by insurance, including Medicare.

How can I take care of myself?
Follow the treatment prescribed by your doctor. In addition, you can:

• Eat healthy foods, especially low-fat milk and dairy products, green leafy vegetables, citrus fruits, sardines, and shellfish.
• Take a daily calcium supplement if your physician recommends it.
• Do weight-bearing physical activity, such as walking, regularly. Be sure to exercise your upper body also.

What can I do to help prevent osteoporosis?
You can help prevent osteoporosis with:

• hormone replacement therapy at menopause
• adequate calcium in your diet, even before menopause.
• regular exercise.

What can I do to reduce my risk of injury?
You can reduce the risk of injury and broken bones if you:

• Avoid lifting heavy objects.
• Avoid unusually vigorous physical activity; build your activity level gradually.
• Wear proper footwear: low-heeled shoes with nonslippery soles for walking and suitable shoes for sports and recreation. Make sure the soles of your shoes don't catch on carpeted surfaces.
• Use support for walking, such as a cane, if you need it.
• Maintain a safe, well-lit, and uncluttered home to help prevent falls.
• Avoid icy, wet, or slippery surfaces, especially in the bathroom. Use nonskid mats in the shower and bathtub.