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Osteoporosis
Am I at Risk?
TABLE OF CONTENTS
What is osteoporosis?................................................................................................................ 1
Who gets osteoporosis?.............................................................................................................. 2
How can I prevent osteoporosis?. . .................................................................................................. 3
How do I know if I have osteoporosis?............................................................................................. 4
What is a bone mineral density (BMD) test?....................................................................................... 5
What treatments are available?...................................................................................................... 6
Osteoporosis in men................................................................................................................. 8
Bone Health Clinic................................................................................................................... 9
WHAT IS OSTEOPOROSIS?
Normal bone
Osteoporosis is a disease in which bones become thin.
As a result, the bones are more likely to break. Bones
most often affected are in the hip, spine, and wrist, but
the ribs and other bones are also at risk. The incidence
of these fractures increases with age in both men and
women.
Nearly 25 million Americans have osteoporosis and
most of them are women above the age of 60. Men are
also vulnerable to the disease. In the early stages of
disease, there are no signs or symptoms, which is why
it has been given the nickname “the silent disease.”
The loss of bone progresses gradually until a bone
breaks. Other signs include loss of height and bad
posture. Breaking a bone is a serious complication. It
can cause severe pain and keep you from getting around
and doing the things you enjoy. It can also lead to other
health problems. Twenty percent of seniors who break a
bone die within one year from problems related to their
broken bone or from surgery to repair the broken bone.
Many of those who do survive are not able to go back to
independent living and may require long-term nursing
care.
The occurrence of osteoporosis is expected to rise as
more and more people are living longer and leading
more sedentary lives. It is, therefore, important to
understand the factors that put one at risk for osteoporosis,
as well as how to prevent it.
Normal bone—Microscopic view showing strong, dense, and
compact bone
osteoporosis
Osteoporotic bone—Microscopic view showing thin, weak, and
disconnected bone at risk for fracture
Figures courtesy of Synthes, Inc.
1
WHO GETS OSTEOPOROSIS?
Patients who take the following medicines may
be prone to osteoporosis:
Anyone can get osteoporosis, but certain people
are more likely to develop it than others.
Common osteoporosis risk factors include:
• Oral glucocorticoids (steroids)
• Being older than 65 years of age
• Antiepileptic medicine
• Having broken a bone after age 50
• Gonadal hormone suppression
• Having a close relative that has osteoporosis or has
broken a bone
• Immunosuppressive agents
• Being in “fair” or “poor” health
•Smoking
• Being underweight for height
• Starting menopause before age 45
• Having low levels of testosterone in men
• Lacking calcium intake
• Having two or more ounces of alcohol per day
• Having poor vision, even with eye glasses
• History of falling
• Physically inactive
Patients who have one of the following medical
conditions may be prone to osteoporosis:
• Hyperthyroidism
• Chronic lung disease
• Cancer
• Inflammatory bowel disease
• Chronic hepatitis or renal disease
• Hyperparathyroidism
• Vitamin D deficiency
•Cushing’s disease
•Multiple sclerosis
•Rheumatoid arthritis
2
• Cancer treatment (chemotherapy, radiation)
• Thyroid medicine
HOW CAN I PREVENT
OSTEOPOROSIS?
You are never too old or too young to improve your
bone health. Maintaining a healthy lifestyle can help
prevent osteoporosis. Here are some things you can do
to keep your bones strong and healthy:
get enough Calcium and Vitamin D
Getting enough calcium helps build strong bones when
you are younger and keeps them strong later in life.
Your body needs vitamin D to absorb calcium. Sunlight
is a great source of vitamin D though many people may
not get enough, especially those that are house-bound,
live in high altitudes, or regularly use sunscreen.
The National Osteoporosis Foundation makes the
following recommendations:
• Adults under age 50 need a total of 1,000 mg of
calcium and 400-800 IU of vitamin D daily.
• Adults age 50 and older need a total of 1,200 mg of
calcium and 800-1,000 IU of vitamin D daily.
Exercise
Exercise makes bones and muscles stronger and helps
prevent bone loss. Recommended exercises include
weight-bearing exercises (walking, jogging, aerobics,
dancing), resistance or muscle-strengthening exercises
(weights, stretch bands), and balance exercises (yoga,
Pilates). Swimming, cycling, and other machines such
as elliptical trainers provide a great source of
cardiovascular exercise, but are not as helpful for
improving bone health as weight bearing exercises.
eat Fruits and Vegetables
Eating healthy is important for building strong bones
and food remains the best source of calcium. Foods rich
in calcium include milk, cheese, yogurt, pudding, ice
cream, fish, and shellfish (sardines, salmon, shrimp).
Dark, leafy vegetables such as bok choy, broccoli, spinach,
kale, and collard greens, as well as fruits such as oranges,
rhubarb, and dried figs are also high in calcium. Some
foods are fortified with calcium (calcium has been added
to the food) and include some brands of juices, soy milk,
rice milk, tofu, cereals, breads, breakfast bars, and
snacks. Look at the food label to see if calcium has been
added.
A simple way to add calcium to your food is to add
non-fat powdered milk to puddings, homemade cookies,
breads, muffins, soups, gravy, or casseroles. A single
tablespoon of non-fat powdered milk contains about
50 mg of calcium.
quit Smoking
Smoking is harmful to your bones in many ways.
The chemicals in cigarettes are bad for your bone cells.
Smoking also might make it harder to absorb calcium.
For women, smoking can prevent estrogen from
protecting the bones.
limit alcohol consumption
It is recommended that you do not drink more than two
ounces of alcohol per day. Too much alcohol reduces
bone formation and many people who drink too much
do not get enough calcium in their diet.
prevent Falls
Fall prevention is important to reduce fractures. Many
factors can lead to falls including poor balance, weak
muscles, vision problems, certain diseases or medications,
and alcohol use, as well as tripping hazards in your
home. Make your home safe by keeping rooms free
of clutter and having plenty of light. Be careful both
indoors and outdoors.
3
HOW DO I KNOW IF I HAVE
OSTEOPOROSIS?
do you have any of these risks factors?
I am a woman older than 65 years or a man older
than 70 years
I am Caucasian or Asian
I have broken a bone after age 50
I have a close relative with osteoporosis
I smoke
I am underweight for my height (petite and thin)
I started menopause before age 45
I am a man with low levels of testosterone
It is recommended that you speak with your health care
provider about your overall bone health and risks for
osteoporosis. A review of your medical history, as well
as a physical exam can help your health care provider
determine your risks for osteoporosis. A bone mineral
density (BMD) test may be recommended and can help
diagnose whether you have low bone density
(osteopenia) or osteoporosis. Osteopenia is the beginning
stage of osteoporosis.
Medical History
Your health care provider may ask you questions about
your health, medicines you take, and the health of your
close relatives. Questions may be asked about your diet
and exercise habits and whether your smoke or drink.
This information helps your health care provider learn if
you have risk factors for osteoporosis.
I am calcium or vitamin D deficient
I drink two or more ounces of alcohol per day
I have a history of falling
I am not physically active
I have one of the following medical conditions:
hyperthyroidism, chronic lung disease, cancer,
inflammatory bowel disease, chronic hepatitis or
renal disease, hyperparathyroidism, Cushing’s disease,
multiple sclerosis, or rheumatoid arthritis
I have taken one of these medications: oral steroids,
aluminum-containing antacids, antiseizure
medication, radiation or chemotherapy, thyroid
medication, gonadal hormone suppression, or
immunosuppressive medication
If you answered “yes” to any of the factors listed above,
you could be at increased risk for osteoporosis.
4
Physical Exam
Your health care provider may measure your height to
determine if you are losing height. Your spine may be
evaluated to see if it is curving forward. Losing height
and curvature of the spine may indicate that you have
already broken bones in the spine, likely due to
osteoporosis.
Bone Mineral Density (BMD) Test
The National Osteoporosis Foundation recommends
BMD testing for the following groups: women age 65
years or older, postmenopausal women younger than
65 years who have at least one additional risk factor,
all postmenopausal women with a new fracture, and all
women who have used estrogen replacement therapy for
several years. Your health care provider will determine
based on your medical history and physical exam if a
BMD is necessary.
WHAT IS A BONE MINERAL
DENSITY (BMD) TEST?
A bone mineral density (BMD) test measures how much
calcium and other types of minerals are in an area of
your bone using a special X-ray exam or computed
tomography (CT) scan. It helps your health care provider
detect osteoporosis and predict your risk of fractures.
Standard X-rays are not used for BMD testing because
they don’t show osteoporosis until 25 to 40 percent of
bone density has been lost. BMD tests can find the
disease earlier. Types of BMD tests include:
• Central dual energy X-ray absorptiometry (DXA)—
This uses low-dose X-rays and measures the bone
mineral density at the hip, upper thigh bone (femoral
neck), and spine.
• Quantitative computed tomography (QCT) – This test
is typically done when a DXA machine is not available.
It is more expensive and not as reliable at measuring
changes in bone density over time.
• Peripheral screening tests—These tests are helpful as
a screening tool. They predict the chance of breaking
a bone when a DXA test is not available. These tests
typically measure bone density in the lower arm,
wrist, finger, or heel. They cannot accurately diagnosis
osteoporosis, and they should not be used to see how
well an osteoporosis medicine is working. Screening
tests can help identify people who may benefit from
further osteoporosis evaluation. You will commonly
find them used at health fairs.
BMD tests are safe, accurate, and noninvasive. There are
no needles or instruments and are relatively quick (similar
to having an X-ray done). In most states, you need to
get a prescription from your health care provider to have
a BMD test done. Your health care provider can assist in
finding an appropriate location for testing.
The results of your test are usually reported as a “T
score” and “Z score.” The T score compares your bone
density with that of healthy younger adults of the same
gender. The Z score compares your bone density with
that of other people your age, gender, and race.
The World Health Organization has defined the following
categories based on bone density in Caucasian women:
•Normal bone density •Osteopenia •Osteoporosis T-score greater than -1.0
T-score -1.0 to -2.5
T-score less than -2.5
5
WHAT TREATMENTS
ARE AVAILABLE?
The goal of osteoporosis treatment is the prevention of
bone fractures. This is done by either reducing bone loss
or, preferably, by increasing bone density and strength.
There is no cure for osteoporosis so prevention is the
key to treatment.
Osteoporosis treatment combines lifestyle changes
(nutrition, exercise, and safety) and medications, if
needed. Lifestyle changes include maintaining a healthy
diet rich in calcium and vitamin D, quitting smoking,
limiting alcohol, and exercising regularly. Your health
care provider may also recommend you take calcium
and vitamin D supplements.
The Food and Drug Administration (FDA) has approved
medicines to reduce the risk of broken bones. These
medicines either slow or stop bone loss or rebuild bone.
People with osteoporosis (T-scores of -2.5 and below)
should consider taking an osteoporosis medicine. People
with osteopenia (T-scores between -1 and -2.5) should
consider taking medication if they have certain risk
factors that may increase their chances for fracture.
People with a broken hip or broken bones in the spine
should also consider taking osteoporosis medicine.
Medications approved for the treatment of
osteoporosis include:
Class and Drug
Brand Name
Form
Frequency
Bisphosphonates
Alendronate
Generic Alendronate and Fosamax®Oral (tablet)
daily/weekly
Alendronate
Fosamax Plus D™Oral (tablet)
weekly
(with 2,800 IU or 5,600 IU of Vitamin D3)
IbandronateBoniva®Oral (tablet)
monthly
IbandronateBoniva®Intravenous (IV) injection
four times per year
RisedronateActonel®Oral (tablet)
daily/weekly/twice monthly/
monthly
RisedronateActonel® with CalciumOral (tablet)
weekly
RisedronateAtelvia™ Oral (tablet)
weekly
Zoledronic Acid
Reclast®Intravenous (IV) infusion
one time per year/
once every two years
Calcitonin
CalcitoninFortical®Nasal spray
daily
CalcitoninMiacalcin®Nasal spray
daily
CalcitoninMiacalcin®Injectionvaries
6
Medications approved for the treatment of
osteoporosis include (continued):
Class and Drug
Brand Name
Form
Frequency
Estrogen*
Estrogen
Multiple brandsOral (tablet)
daily
Estrogen
Multiple brandsTransdermal (skin patch)
twice weekly/weekly
Estrogen Agonists/Antagonists Also called Selective Estrogen Receptor Modulators (SERMs)
RaloxifeneEvista®Oral (tablet)
daily
Parathyroid Hormone
TeriparatideForteo®Injectiondaily
RANK ligand (RANKL) inhibitor
DenosumabProlia®Injection
every six months
*Estrogen is also available in other preparations including a vaginal ring, as a cream, by injection, and as an oral tablet taken sublingually (under
the tongue). The vaginal preparations do not provide as much bone protection as the other forms offered.
Reprinted with permission from the National Osteoporosis Foundation, Washington, DC 20036. Treatment with Osteoporosis Medication, October 19,
2012. All rights reserved.
7
OSTEOPOROSIS IN MEN
Many people think that osteoporosis only affects women.
However, one in four men will develop osteoporosis. It
affects nearly half of all people, women and men, over
the age of 75.
Even though bone loss in men usually occurs later in life
compared with women, men can still be at high risk for
osteoporosis. By age 65, men catch up to women and
lose bone mass at the same rate.
Osteoporosis often goes unrecognized in men. Emphasis
is typically placed on women and, therefore, men often
are undiagnosed until a fracture occurs. This makes it
even more important for men to discuss their risk factors
for osteoporosis with their health care provider, as well
as any changes in height or posture, a fracture, or
sudden back pain. Increasing awareness is essential for
prevention and early identification is critical as there is
no cure, only treatments.
Risk factors that have been linked to
osteoporosis in men include:
• Regular use of certain medications, such as steroids,
antacids, antiseizure medications, cancer therapy, and
thyroid hormones
• Unhealthy lifestyle habits, such as smoking, excessive
alcohol use, low calcium intake, and lack of regular
exercise
Consider the following steps to decrease your
risk for osteoporosis:
• Get enough calcium and vitamin D.
• Exercise—include weight bearing and muscle
strengthening exercises.
• Consider quitting smoking and limiting alcohol
consumption.
• Talk to your health care provider about your risk
factors and chances for getting osteoporosis.
Recommended daily allowances of calcium and
vitamin D in men include:
Under 50 years........... 1,000 mg of calcium and
400 to 800 IU of vitamin D
• Chronic diseases that affect the kidneys, lungs,
stomach, or intestines or alter hormone levels
50 to 69 years ............ 1,000 mg of calcium and
800 to 1,000 IU of vitamin D
• Low testosterone
70 years and older ..... 1,200 mg of calcium and
800 to 1,000 IU of vitamin D
• Immobilization or prolonged bed rest following
surgery, fracture, or illness that can result in significant
bone loss
• Age—the older you are, the greater your risk for
osteoporosis
• Race—Caucasian men appear to be at particularly
high risk, but all men can develop this disease
• Family history of osteoporosis or broken bones
8
Once osteoporosis has been diagnosed, your doctor
may prescribe medication. Your treatment plan may
also include nutrition, exercise, and lifestyle guidelines
to prevent further bone loss. Calcium and vitamin D
supplementation may be recommended. If osteoporosis
is the result of an underlying condition or medication,
your health care provider may plan to address these
causes.
Penn State Hershey Bone and Joint
Institute Bone Health Clinic
To schedule an appointment with Dr. Fox, please call
717-531-5638.
The Bone Health Clinic at Penn
State Hershey Bone and Joint
Institute provides treatment for
patients with metabolic bone
disorders and osteoporosis.
Edward J. Fox, M.D., director of
the bone health clinic, is a boardcertified orthopaedic surgeon with
clinical interests in osteoporosis,
edward J. fox, m.d.
orthopaedic oncologic surgery/
musculoskeletal oncologic surgery, metabolic bone disease
treatment, and orthopaedic trauma surgery.
Penn State Hershey Bone and Joint Institute
Penn State Milton S. Hershey Medical Center
East Health Campus
30 Hope Drive, Entrance B
P.O. Box 859
Hershey, PA 17033
PennStateHershey.org/osteoporosis
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