Download Osteoporosis General Information

Osteoporosis and Bone Health Services
Mercy Health – Kenwood Endocrinology and
Osteoporosis
4760 E. Galbraith Road, Suite 212
Cincinnati, OH 45236
Ph. 513-686-2663 | Fax 513-686-3637
GENERAL INFORMATION ABOUT OSTEOPOROSIS
This material is intended to provide an introduction to the issues relevant to the diagnosis,
prevention and treatment of osteoporosis. This information is important for everyone,
especially for patients who have osteoporosis or are concerned about it.
Osteoporosis is defined as reduced bone strength leading to an increased risk of fracture. The
tendency to fracture is partly the result of weakening of the bones, but other factors, such as
falling or exerting force on the spinal column by lifting, pulling, pushing and bending are also
important. The most common sites for osteoporosis-related fractures are the spine, hip and
wrist. Consequences of osteoporotic fractures include disability (pain and loss of mobility) and
even death. Anxiety and depression may follow as independence is lost.
Men and women begin losing bone in their early to mid-forties and continue losing bone for the
rest of their lives. Factors that may increase the rate of bone loss include a low calcium diet,
excessive elimination of calcium in the urine, a sedentary life style, cigarette smoking, low
body weight, early menopause, treatment with medications such as cortisone-like drugs, etc.
There are no symptoms of low bone density or of bone loss – this is a “silent” condition. The
only way for someone to know if they have osteoporosis before they start having fractures is to
have a bone density test. Bone density can be measured by several techniques. The most
widely accepted is dual-energy x-ray absorptiometry, also known as DXA or DEXA. This is a
safe, painless test that takes just a few minutes to measure bone density in the spine and the
hip and determine how an individual compares with desirable levels. A bone density test is
essential for diagnosing osteoporosis and also useful for monitoring the response to treatment.
Calcium, vitamin D and the right kinds of physical activity are important for optimal bone
health. For patients at increased risk of fracture, medications are available that can partially
reverse bone loss, improve bone strength and reduce the risk of fractures.
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CALCIUM
Calcium is the “raw material” for bone. Although some people get all the calcium they need from their
diet, the average person’s diet provides only half the desirable amount. Before you start taking calcium
supplements, you need to know your dietary calcium intake.
To estimate your daily calcium intake, fill in the following as best you can. A serving of milk, yogurt or
calcium-fortified orange juice is 8 ounces. A serving of cheese is one ounce. A serving of dark green
vegetables is 1 cup (8 ounces).
Everyone gets some calcium from his or her diet. For non-dairy sources, add
__300
mg
8 oz of milk, calcium-fortified OJ or 6oz yogurt daily
_____ x 300 mg = ________mg
4 oz of cottage cheese daily (2% fat)
_____ x 85 mg = ________mg
1 oz (1 slice) of cheese daily
_____ x 200 mg = ________mg
8 oz of dark green vegetables daily
_____ x 200 mg = ________mg
4 oz of almonds daily
_____ x 300 mg= ________mg
Calcium in multivitamin
________mg
TOTAL CALCIUM = ________mg
Subtract your daily calcium intake from the desired daily intake (the target is 1,000 mg daily for men up
to age 70 and women to age 50, and 1,200 mg daily for women 50 and older and men 70 and older).
The remainder is the amount of calcium you need as a supplement. It is rarely necessary to take more
than 1,000 mg calcium supplement daily.
Examples:
Patient A is a 45-year-old woman who gets 400 mg of calcium from her diet. To reach her target of 1,000 mg daily
she should take 600 mg of supplemental calcium daily (300 mg twice a day).
Patient B is a 65-year-old woman who gets 700 mg of calcium from her diet. To reach her target of 1,200 mg daily
she should take 500 mg of supplemental calcium daily (500 mg once a day or 250 mg twice a day).
CALCIUM SUPPLEMENTS
Calcium supplements are just as good for your bones as calcium in milk and other foods. Calcium
supplements come in various forms (calcium carbonate, calcium lactate, calcium citrate, etc.). Your
pharmacist can help you select the right kind. Often, store brands or generics are as good as national
brands and less expensive. Calcium carbonate is usually the cheapest supplement and is worth trying
first because most people do very well with it. However, calcium carbonate causes gas or constipation
in about 20% of people, problems that are less likely with calcium citrate. Calcium supplements are
best absorbed when taken with food and best taken no more than 500-600 mg per dose (for example,
someone who needs 1,000 mg of calcium supplement daily should take 500 mg twice a day with
meals).
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VITAMIN D
Vitamin D is important for the absorption of calcium from the digestive tract and also for the
assimilation of calcium into bone. Deficiency of vitamin D results in bone loss and also
causes muscle weakness and an increased tendency to fall.
Vitamin D is made in the skin during exposure to sunlight. Some foods are “fortified” with
added vitamin D (such as milk and orange juice), but because few foods contain vitamin D
naturally – examples are liver and oily fish – there is little vitamin D in the average diet.
The official recommendation for vitamin D intake is 600 IU daily for men and women ages 19
to 70 and 800 IU daily for those over the age of 70. Recent evidence suggests that higher
intakes are desirable.
If you are 50 years or older, you would probably benefit from taking standard supplemental
multi-vitamin such as One-A-Day®, Theragran®, Centrum®, etc. There are also many good
store brands and generics. The least expensive ones are as good as the more expensive
brands. Most multivitamins contain 400-500 IU of vitamin D. However, most people would
benefit from 1,000-2,000 IU per day, doses that would be safe for most people.
Another way to get more vitamin D is to take a combination tablet with calcium, plus
vitamin D (typically 500-600 mg of calcium plus 200 IU vitamin D). Another is to add a
supplement of vitamin D. Pharmacies, health foods stores, groceries and buyer’s clubs
(Sam’s, Costco) now have vitamin D available in 1,000 IU and 2,000 IU tablets for pennies
a tablet.
PHYSICAL ACTIVITY AND EXERCISE
Daily walking and other exercises can improve muscle strength and balance. Patients with a
history of heart or circulatory problems should with their physician before increasing their
activity. People who have not been active on a regular basis should start slowly and build up
over 4 – 6 weeks to walking at least 40 minutes per session, four or more sessions per week.
Walking improves bone density, coordination, lung capacity, and balance. Try to develop a
regular exercise program. Walk to shops, walk to finish your errands, or walk a few times
around the mall. Go with a friend. Wear headphones and listen to your favorite music or radio
station. Some people like treadmills or elliptical trainers (you can walk and watch TV!); these
can be purchased from sporting goods stores and other suppliers. Your medical insurance
may cover the cost the cost of exercise equipment if you have a doctor’s order; be sure to
check with your insurance company before you purchase. Consider exercise as a prescription,
as important as any medication you take. Set aside a regular time each day for exercise.
Resistance exercises can improve muscle strength. These are exercises that can be
accomplished at home with small hand or ankle weights or with a device called a Theraband®.
The local gym or athletic club can offer more sophisticated resistance exercises such as
Nautilus®. Using this equipment requires instruction. Ask for a demonstration before you
begin. If you are not able to do regular walking or other weight-bearing activity, consider water
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aerobics. This form of exercise helps cardiovascular fitness, muscle tone and flexibility, but is
not weight-bearing; therefore is not effective for improving bone density, but still it is better than
no exercise at all. Whatever activities you choose, be careful not to injure yourself.
BE CAREFUL
If you have osteoporosis your bones are more prone to fracture. There are no hard and fast
rules about what you can or can’t do, but certain activities are risky. You should avoid highimpact activities (such as riding in bumpy vehicles) and anything that increases your risk of
falling (such as walking on uneven ground). Spine fractures, the most common type of fracture
associated with osteoporosis can be caused by compressive forces that are produced by such
activities as pushing, pulling, bending, and lifting. Try to avoid lifting or pushing objects
weighing more than 20 pounds. If you must pick up something from the ground, do not bend at
the waist; instead, bend at your knees and hips and keep your back as straight as you can.
Fractures are usually painful. Although the pain of a fracture will go away when the fracture
has healed, it may last for 2 – 3 months. Once a vertebra is damaged, it cannot be
straightened. It is far better to prevent fractures than to treat the consequences. Use good
judgment to avoid activities that might lead to fractures.
PRESCRIPTION MEDICATIONS TO INCREASE BONE STRENGTH
For most patients with osteoporosis, a healthful life style is important but not sufficient. The
following prescription medications have been shown to reduce the risk of fracture. There are
also non-approved medications that are sometimes used “off label.” FDA-approved treatments
are listed below in alphabetical order by brand name, with the generic name in parentheses:
• Actonel® (risedronate)
• Atelvia® (delayed-release risedronate)
• Boniva® (ibandronate)
• Evista® (raloxifene)
• Forteo® (teriparatide)
• Fosamax® (alendronate), also available as generic alendronate
• Miacalcin® and Fortical ® (nasal spray calcitonin)
• Reclast® (zoledronic acid)
• Prolia™ (denosumab)
There are pros and cons to each. The choice of medication depends on a number of factors
and should be based on individual circumstances.
Additional information is available from the
National Osteoporosis Foundation
1232 22nd Street NW
Washington DC 20037-1292
www.nof.org
202-223-2226
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