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Osteoporosis in Women Osteoporosis is thinning of the bones. It is a Once a woman reaches menopause (no common disease especially among women periods for one year), she loses a greater that can sometimes be prevented. It is often amount of bone mass in the first 5 to 7 called a silent disease because it occurs years. over time and may not be diagnosed until a fracture (break) occurs. Fractures occur most often in the spine (vertebrae), hip, and Age – Bone loss occurs with age. Race – Caucasian, Hispanic, and Asian women are at increased risk. Fair wrist. skinned, thin women seem to be at the greatest risk. About 9 million women have osteoporosis and one in two women will have a fracture Family History – Women with a family after age 50. Osteoporosis is a serious history of osteoporosis are more likely condition with complications, including to develop the disease. death. More women die each year from osteoporosis-related fractures than from cancer of the breast, cervix, or uterus combined. Low levels of estrogen in women. Risk factors that you can manage are: Smoking – Smoking increases bone loss Bone is living tissue and is in a constant and may result in menopause occurring state of change. Cells break down and new sooner. cells are built. All of the bones in the body are replaced over a lifetime by this process. decrease the rebuilding of bone. Heavy If bone breaks down faster than it rebuilds, use of alcohol can also increase the risk the bone weakens and the risk of fracture of falls. rises. There are two types of bones cells: Osteoclasts - act on the bone surface to of calcium loss from the body. leads to bone breakdown. Osteoblasts - produce collagen and people often have greater muscle strength and are less likely to fall. Risk Factors others are beyond your control. Factors that you cannot change are: Gender - Women are at increased risk because their bones are smaller and thinner than those of men. Lack of exercise – Women who are not active tend to lose bone strength. Active rebuild bone. Some risk factors can be managed and Large amounts of caffeine, protein, and sodium – These all increase the amount dissolve collagen and proteins, which Heavy alcohol use – Alcohol can Low dietary intake of calcium or Vitamin D and/or limited sun exposure - Vitamin D and calcium are needed for building bone. Medical problems – osteoporosis can be T-score Results seen with: density. Endocrine or hormonal disorders such as diabetes, excess thyroid hormone, excess parathyroid hormone Digestive conditions like celiac Autoimmune disorders such as rheumatoid arthritis, lupus and multiple sclerosis Cancer The National Osteoporosis Foundation identifies indicators for testing for: Women age 65 and older. Younger postmenopausal women with one or more risk factors (other than being white, postmenopausal, and Eating disorders, such as anorexia or female). Women after age 50 who have fractures. Women who have a medical condition Chronic kidney disease Long term use of some medications or who are taking a medication that may such as diuretics, seizure medication, cause bone loss. glucocorticoids (Hydrocortisone and Prednisone), antacids that contain Diagnosing Osteoporosis Osteoporosis is diagnosed by measuring bone density. Standard X-rays are not used because only a 40% or greater bone loss will show up on a standard X-ray. Heel Ultrasound An ultrasound of the heel is a test used to screen women for bone loss. DEXA Scan The DEXA Scan is a simple X-ray and is the best method for measuring bone density. The density is measured in the lower spine, hip and/or wrist. The test takes only a few minutes. Calcium supplements should not be taken within 48 hours before Women being considered for treatment or are being treated with medication. aluminum, blood thinners and some diabetes medications. T-score of -2.5 or lower shows more bone loss, called osteoporosis. Lactose intolerance bulimia T-score of -1.0 to -2.5 shows some bone loss, called osteopenia. disease, IBS (inflammatory bowel disease), gastric bypass surgery T-score above -1.0 means normal bone If you have a family history of osteoporosis or other risk factors, talk with your doctor about testing before menopause. Treating Osteoporosis Exercise – Women need to perform weight- bearing exercise 30 minutes on most days of the week to help increase bone density. The best weight bearing exercises are walking or jogging. This also helps build the muscle around the bones and prevent fractures if falls occur. Working out with light weights or exercise bands may also be helpful. Medication – Some medications can help reduce bone loss and some can even help to build bone. Hormone replacement therapy (HRT) - the exam. Clothing with metal zippers, HRT has been used to prevent snaps, or under-wires must not be worn. osteoporosis, but recent findings have The results of the DEXA scan are reported brought this into question. Talk with as a T-score. your doctor about the risks and benefits of HRT. Bisphosphonates – Bisphosphonates Calcium Supplements – Take supplements such as Risedronate (Actonel®), that contain calcium carbonate or calcium Actonel® with Calcium (Atekvia™), citrate. Check the labels or ask your Alendronate (Fosamax®), Ibandronate pharmacist or doctor about the best product (Boniva®) and Zoledronic Acid for you. (Reclast®) help prevent bone loss, rebuild bone, and prevent fracture. Vitamin D – Vitamin D is needed for Carefully follow instructions on how building bone. Being in the sun for 15 much water to drink when taking and how long you need to sit upright after taking. Reclast® is an injection given IV (intravenously) once a year. Estrogen Agonist/Antagonist – Raloxifene (EVISTA®). In women who have had breast cancer, this may be helpful in preventing bone loss and reducing fractures. minutes a day provides enough vitamin D for the body. Vitamin D can also come from milk, other foods, and supplements. The recommended daily amount of vitamin D is: 400 – 800 I.U. for women under age 50 800 – 1000 IU for women age 50 and over Exercise – Women need to perform weight- bearing exercise 30 minutes on most days of the week to help increase bone density. Calcitonin (Miacalcin®, Fortical®) are Working out with light weights is also helpful. nasal sprays that may be helpful in These types of exercise help to build muscle reducing bone loss and the risk of around bones and prevent fractures from falls. fracture. Balance exercises such a Tai Chi can also Teriparatide (Forteo®) is a parathyroid decrease your risk of falls. hormone medication that seems to be helpful in improving bone strength in women with a high risk of fracture due to glucocorticoid therapy. Preventing Osteoporosis Proper Calcium Intake – The best source of calcium is the diet. Eat a wide variety of food to ensure that you get enough calcium. The most common calcium-rich foods are dairy products, fish, dark green vegetables, and beans. The National Osteoporosis Foundation recommends these amounts of daily calcium: Limiting tobacco, alcohol, caffeine, and carbonated drinks – Smoking or using tobacco products cause loss of bone mass. Too much intake of alcohol, caffeine or carbonated drinks daily can lead to an increased loss of calcium. Take an active part in preventing and treating osteoporosis. Talk with your doctor about any questions or concerns. Resources National Osteoporosis Foundation 800-231-4222 www.nof.org 1000 mg. daily for women under age 50 National Institutes of Health 1200 mg. daily for women age 50 and over Osteoporosis and Related Bone Diseases 800-624-2663 www.osteo.org Rev. 6/08, 10/11, 12/14 © Mount Carmel 2014