Osteoporosis - The Silent Disease

What You Need to Know About Osteoporosis Prevention, Risks, Treatments

Teenage girls probably don't spend a lot of time thinking about their bones, but if they did, the payoff during middle age would be immeasurable. How so? Because the critical years for building bone mass are from early adolescence to about age 30. Much like putting money in the bank, a healthy deposit of calcium during those key developmental years can mean big savings for women as they reach their menopausal years.

For women (and men) who don't have healthy bone mass, the result is osteoporosis. According to the National Osteoporosis Foundation, osteoporosis is a preventable disease for most people, but it is currently a major health threat to almost 44 million Americans -- 80 percent of whom are women.

What is osteoporosis?

Osteoporosis means porous bones. Caused by low bone mass, it's a disease that makes bones fragile and more likely to break. Often, a woman might have osteoporosis and not even know it -- until a bone breaks, usually in the hip, spine, or wrist.

There are several ways to test your bone density. But the best idea is to make sure you don't become one of the statistics in the first place.

Preventing osteoporosis

To prevent osteoporosis, doctors recommend a healthy diet rich in calcium and vitamin D (to help with calcium absorption). Women in their bone-developing prime -- ages 9 to 18 -- need 1,300 mg. of calcium a day. From 19 to 50 years of age, the dosage drops to 1,000 mg. a day, then it increases again for women 51 and older to 1,200 mg. a day.

In addition, weight-bearing exercise helps build bone mass, so exercises like running, walking, resistance training and weight lifting are particularly beneficial.

Other parts of a healthy lifestyle include not smoking, and limiting alcohol consumption.

Measuring Your Risk

But some people can follow these guidelines and still end up with osteoporosis. These are people with genetic factors out of their control. They include:

• Being female -- since women are at greater risk than men;
• Having family members with osteoporosis;
• Being thin (because heavier women carry around more bone mass);
• Experiencing menopause early (because of the early interruption of estrogen).

In addition, just being older, or using certain medications like corticosteroids and anticonvulsants, can contribute to the development of osteoporosis.

The good news is that even with these risk factors, you can take medications to treat the disease.

Treating Osteoporosis

Many doctors still recommend hormone replacement therapy (HRT) as the number one choice for osteoporosis treatment. If you consider that the onset of menopause -- when most women become vulnerable to bone-mass loss -- marks the loss of estrogen, it makes sense to use HRT as a way to prevent further bone loss.

Common estrogen medicines available today include Premarin, Ogen, Estrace, and Prempro.

Estrogen Alternatives

Some studies have shown a link between HRT and an increased risk of breast cancer, so many women choose not take it. But there are still options available.

• Alendronate -- brand name Fosamax® -- has been proven to slow or stop bone loss, increase bone density, and reduce the risk of fractures. Side effects may include irritation to the esophagus. It is taken on an empty stomach with 8 ounces of water upon waking in the morning, and you must remain upright for at least 30 minutes after taking it.
• Risedronate -- brand name Actonel® -- has been shown to reverse bone loss and help reduce the risk of fractures by building bone mass. Side effects may include stomach pain or constipation. As with Fosomax, Actonel is taken on an empty stomach first thing in the morning, and patients must remain upright for 30 minutes.
• Calcitonin -- brand name Miacalcin® -- has been shown to slow bone loss and increase spinal bone density for women beyond menopause. Side effects may include nasal dryness or swelling of the nasal membranes. It is available as an injection or nasal spray.
• Raloxifene -- brand name Evista® -- is a new class of drug that mimics estrogen in some parts of the body, and may actually reduce the risk of breast cancer. Side effects are uncommon, but may include hot flashes. It is taken once a day with or without food or water.

Also, keep in mind that inexpensive over-the-counter products like Calcet and Tums contain bone-strengthening calcium.

The important thing to remember is that being diagnosed with osteoporosis is not the end of world. With a careful treatment program that may include doctor-supervised exercise, a healthy lifestyle, and possibly medication, even fragile bones have the chance to gain strength.

Robin Hoogshagen, RPH, is manager of Wal-Mart's Home Office Pharmacy in Bentonville, Ark. She joined Wal-Mart in 1993 as a staff pharmacist and was promoted to her current position in 1996. Her duties include training newly hired pharmacists and testing new pharmacy projects.

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