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OSTEOPOROSIS

DEFINITION:

Osteoporosis is a condition in which bones become thin, weak and brittle. As a result of osteoporosis, bones may fracture more easily, leading to disability and increased risk of death. Post-menopausal women are at higher risk of developing osteoporosis and women are at fives times greater risk than men.

MENOPAUSE AND OSTEOPOROSIS:

Throughout a woman’s life the hormone, estrogen, protects against bone loss. After menopause occurs, the ovaries don’t make as much estrogen and estrogen levels in the body drop. The loss in estrogen can lead to bone loss, putting women at risk of fractures.

WHAT ARE THE RISK FACTORS FOR OSTEOPOROSIS?

  • Low calcium in diet
  • Vitamin D deficiency
  • Excess vitamin A
  • High caffeine and salt intake
  • Aluminum (antacids)
  • More than 3 drinks of alcohol per day
  • Physical inactivity or being immobile
  • Smoking
  • Frequent falling/poor balance
  • Being thin
  • Certain medical conditions (Lupus, Rheumatoid arthritis, Inflammatory bowel disease)
  • Medications (prednisone, heparin and certain antiepileptics are a few examples)

WHAT ARE THE SIGNS AND SYMPTOMS OF OSTEOPOROSIS?

Usually there are no symptoms for decades. As the disease progresses signs and symptoms may occur:

  • Fracture to the spinal bones can lead to loss of height, curving of spine, or pain traveling from the back to the sides.

HOW IS OSTEOPOROSIS DIAGNOSED?

  • Bone mineral density (BMD) test: Measures bone density in certain areas such as heel, spine, hip, hand or wrist. All women 65 and older are recommended to have the test. If you are a woman younger than 65 and past menopause, consider having a BMD if you have risk factors for osteoporosis (listed above) or if you have had fractures.
  • Dual-energy X-ray absorptiometry (DEXA) scan- is the most accurate way to test for osteoporosis. It is a machine that takes a scan of your body while you lie down.

CAN I PREVENT OSTEOPOROSIS?

The best ways to prevent osteoporosis are to exercise, eat a healthy diet with calcium and Vitamin D, and quit smoking if you smoke.

  • Weight-bearing exercises are especially important to keep bones strong (i.e. brisk walking).
  • Strength training is also good for bones.
  • Calcium helps build healthy bones and Vitamin D helps the body absorb calcium.
    • Good sources of calcium in food are: leafy greens (spinach, kale, collards), dairy foods (yogurt, milk, cheese) and canned fish (salmon, sardines).
    • Sunlight is a good source for Vitamin D and so are fortified milk, cereal and orange juice.
    • Women who don’t get enough calcium or Vitamin D in their diets may need to take supplements.

WHAT ARE THE TREATMENT OPTIONS FOR OSTEOPOROSIS?

Treatment of osteoporosis is important to prevent bone fractures. The following is a brief overview of some treatment options. Your doctor will speak with you about them in more detail and if you should consider using them.

  • Bisphosphonates: A class of medications that slow bone break down. Some examples are alendronate, ibandronate and risedronate).
  • “Estrogen-like” medications (called selective estrogen receptor modulators [SERMS])- these produce estrogen like effects on bones and protect against bone loss. Some examples include Tamoxifen and Raloxifene
  • Estrogen/progestin therapy had previously been considered a treatment option, but is no longer not recommended.
  • Calcitonin: A hormone that regulates calcium levels. It is not first line treatment but has been used for intense onset of pain from vertebral fractures
  • Denosumab: A medicine that improves bone mineral density and reduces the risk of fractures.  Side effects may include skin infections and eczema.
  • Parathyroid hormone: This hormone stimulates bone formation.  It is effective in prevention and treatment of osteoporosis.

|    © 2014-2018 copyright Taraneh Shirazian, MD

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Joan H. Tisch Center for Women's Health

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New York, NY 10028

Phone: 646-754-3300

 

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