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What is osteoporosis?
Osteoporosis is a condition characterized by progressive
loss of bone density, thinning of bone tissue and increased
vulnerability to fractures. Osteoporosis may result from disease,
dietary or hormonal deficiency or advanced age. Regular exercise
and vitamin and mineral supplements can reduce and even reverse
loss of bone density.
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How can I lower my chances of getting osteoporosis?
- Get enough calcium
- Women under 50 years old need at least 1,000 mg of calcium
each day
- Women over 50 need at least 1,200 mg of calcium
- Get enough vitamin D
- Women under 50 years old need at least 200 IU of vitamin
D
- Women over 50 need at least 400 IU of vitamin D
- Get exercise everyday, like walking or biking
- Don’t smoke
- If you drink alcohol, don’t drink more than one
glass per day
How can I make sure I have the right diet?
- Read the food label to make sure you are eating the right
foods
- Eat foods that have calcium
- Low-fat dairy products like milk, cheese, and yogurt
- Green, leafy vegetables like kale and turnip greens
- Tofu
- Canned fish (eaten with bones)
- Orange juice, cereal, and other foods that have calcium
added
What else can I do?
Talk to your doctor, nurse, or pharmacist about medicines
you can take to build bones. You might also need calcium or
vitamin D pills.
Medications to Prevent and Treat Osteoporosis
Although there is no cure for osteoporosis, several medications
approved by the U.S. Food and Drug Administration (FDA) can
help stop or slow bone loss, or help form new bone, and reduce
the risk of fractures. Currently, alendronate, raloxifene,
risedronate, and ibandronate are approved for preventing and
treating postmenopausal osteoporosis. Teriparatide is approved
for treating the disease in postmenopausal women and men at
high risk for fracture. Estrogen/hormone therapy (ET/HT) is
approved for preventing postmenopausal osteoporosis, and calcitonin
is approved for treatment. In addition, alendronate is approved
for treating osteoporosis in men, and both alendronate and
risedronate are approved for use by men and women with glucocorticoid-induced
osteoporosis. Alendronate plus vitamin D is approved for the
treatment of osteoporosis in postmenopausal women and in men.
Risedronate with calcium is approved for the prevention and
treatment of osteoporosis in postmenopausal women.
Bisphosphonates
Alendronate (FosamaxI1), risedronate (Actonel), and ibandronate
(Boniva) are medications from the class of drugs called bisphosphonates.
Like estrogen and raloxifene, these bisphosphonates are approved
for both prevention and treatment of postmenopausal osteoporosis.
Alendronate is also approved to treat bone loss that results
from glucocorticoid medications like prednisone or cortisone
and is approved for treating osteoporosis in men. Risedronate
is also approved to prevent and treat glucocorticoid-induced
osteoporosis. Alendronate plus vitamin D is approved for the
treatment of osteoporosis in postmenopausal women and in men.
Risedronate with calcium is approved for the prevention and
treatment of osteoporosis in postmenopausal women.
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Alendronate and risedronate have been shown to increase bone
mass and reduce the incidence of spine, hip, and other fractures.
Ibandronate has been shown to reduce the incidence of spine
fractures.
Alendronate is available in daily and weekly doses, while
alendronate plus vitamin D is available in a weekly dose.
Risedronate is available in daily and weekly doses, while
risedronate with calcium is available in a weekly dose with
daily calcium. Ibandronate is available in a monthly dose
and as an intravenous injection administered once every three
months.
Oral bisphosphonates should be taken on an empty stomach
and with a full glass of water first thing in the morning.
It is important to remain in an upright position and refrain
from eating or drinking for at least 30 minutes after taking
a bisphosphonate.
Side effects for bisphosphonates include gastrointestinal
problems such as difficulty swallowing, inflammation of the
esophagus, and gastric ulcer. There have been rare reports
of osteonecrosis of the jaw and of visual disturbances in
people taking bisphosphonates.
1 Brand names included in this publication are provided as
examples only, and their inclusion does not mean that these
products are endorsed by the National Institutes of Health
or any other Government agency. Also, if a particular brand
name is not mentioned, this does not mean or imply that the
product is unsatisfactory.
Raloxifene
Raloxifene (Evista) is approved for the prevention and treatment
of postmenopausal osteoporosis. It is from a class of drugs
called Selective Estrogen Receptor Modulators (SERMs) that
appear to prevent bone loss in the spine, hip, and total body.
Raloxifene has beneficial effects on bone mass and bone turnover
and can reduce the risk of vertebral fractures. While side
effects are not common with raloxifene, those reported include
hot flashes and blood clots in the veins, the latter of which
is also associated with estrogen therapy. Additional research
studies on raloxifene will continue for several more years.
Calcitonin
Calcitonin is a naturally occurring hormone involved in calcium
regulation and bone metabolism. In women who are at least
5 years past menopause, calcitonin slows bone loss, increases
spinal bone density, and according to anecdotal reports, relieves
the pain associated with bone fractures. Calcitonin reduces
the risk of spinal fractures and may reduce hip fracture risk
as well. Studies on fracture reduction are ongoing. Calcitonin
is currently available as an injection or nasal spray. While
it does not affect other organs or systems in the body, injectable
calcitonin may cause an allergic reaction and unpleasant side
effects including flushing of the face and hands, frequent
urination, nausea, and skin rash. The only side effect reported
with nasal calcitonin is a runny nose.
Teriparatide
Teriparatide (Forteo) is an injectable form of human parathyroid
hormone. It is approved for postmenopausal women and men with
osteoporosis who are at high risk for having a fracture. Teriparatide
stimulates new bone formation in both the spine and the hip.
It also reduces the risk of vertebral and nonvertebral fractures
in postmenopausal women. In men, teriparatide reduces the
risk of vertebral fractures. However, it is not known whether
teriparatide reduces the risk of nonvertebral fractures. Side
effects include nausea, dizziness, and leg cramps. Teriparatide
is approved for use for up to 24 months.
Estrogen/Hormone Therapy
Estrogen/hormone therapy (ET/HT) has been shown to reduce
bone loss, increase bone density in both the spine and hip,
and reduce the risk of hip and spine fractures in postmenopausal
women. ET/HT is approved for preventing postmenopausal osteoporosis
and is most commonly administered in the form of a pill or
skin patch. When estrogen – also known as estrogen therapy
or ET – is taken alone, it can increase a woman’s
risk of developing cancer of the uterine lining (endometrial
cancer). To eliminate this risk, physicians prescribe the
hormone progestin – also known as hormone therapy or
HT – in combination with estrogen for those women who
have not had a hysterectomy. Side effects of ET/HT include
vaginal bleeding, breast tenderness, mood disturbances, blood
clots in the veins, and gallbladder disease.
The Women’s Health Initiative (WHI), a large Government-funded
research study, recently demonstrated that the drug Prempro,
which is used in hormone therapy, is associated with a modest
increase in the risk of breast cancer, stroke, and heart attack.
The WHI also demonstrated that estrogen therapy is associated
with an increase in the risk of stroke. It is unclear whether
estrogen therapy is associated with an increased risk of breast
cancer or cardiovascular events. A large study from the National
Cancer Institute indicated that long-term use of estrogen
therapy may be associated with an increased risk of ovarian
cancer. It is unclear whether hormone therapy carries a similar
risk.
Any estrogen therapy should be prescribed for the shortest
period of time possible. When used solely for the prevention
of postmenopausal osteoporosis, any ET/HT regimen should only
be considered for women at significant risk of osteoporosis,
and nonestrogen medications should be carefully considered
first.
Prevention By about age 20, the average woman has acquired
98 percent of her skeletal mass. Building strong bones during
childhood and adolescence can be the best defense against
developing osteoporosis later. There are five steps, which
together can optimize bone health and help prevent osteoporosis.
They are:
- A balanced diet rich in calcium and vitamin D
- Weight-bearing and resistance-training exercises
- A healthy lifestyle with no smoking or excessive alcohol
- Talking to healthcare professional about bone health
- Bone density testing and medication when appropriate
A study of disease management in a rural healthcare population
demonstrated that a preventive program was able to reduce
hip fractures and save money.
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