As you read Part I of this article on osteoporosis yesterday, I hope you took this condition seriously. I’m sure you’ve all heard about “seniors” being affected by osteoporosis, however, were you aware that young women in their 30’s start losing bone mass? Also, men with small frames and slightly built (thin) are just as prone to osteoporosis as “thin” women, therefore, I encourage all of you to take this information seriously.

This topic is very close to my heart because my bones are osteoporotic. As I alluded to yesterday, my knees were affected by this condition. This is an unusual occurrence because osteoporosis is usually found in the spine and hips; however, if the wrist can easily be broken during a fall due to this condition, then the knee and ankle joints can be affected as well.

Part II of this article also comes from The Mayo Clinic website and is written by the Clinic Staff. In order to bring you all the facts and keep all the information in context, I have copied the information as it was written. At the end of the article, I will provide the bibliography if you are interested in additional reading on this topic. Let’s start with “Preparing For Your Appointment.”

Preparing for your appointment

By Mayo Clinic staff

Your family doctor or general practitioner may be the first doctor to bring up bone density testing. However, you may then be referred to a doctor who specializes in metabolic disorders (endocrinologist).

Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you’ve noticed, though it’s possible you may not have any.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you’re currently taking or have taken in the past. It’s especially helpful if you record the type and dose of calcium and vitamin D supplements, because there are many different preparations available. If you’re not sure what information your doctor might need, you can bring the bottles with you.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For osteoporosis, some basic questions to ask your doctor include:

• Do I have osteoporosis?
• What kinds of tests do I need to confirm the diagnosis?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Is there a generic alternative to the medicine you’re prescribing me?
• Are there any alternatives to the primary approach that you’re suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any activity restrictions that I need to follow?
• Do I need to make changes in my diet?
• Do I need to take supplements?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
• Is there a physical therapy program that would benefit me?
• What can I do to prevent falls?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Have you experienced any fractures or broken bones?
• Have you noticed a loss of height?
• How is your diet? Do you think you get enough calcium? Vitamin D?
• Do you take any vitamins or supplements?
• How often do you exercise?
• Did you exercise more or less in the past?
• Does anyone in your family have osteoporosis?
• Has anyone in your family had bone fractures?
• Have you ever had stomach or intestinal surgery?
• Do you have chronic diarrhea?
• Have you taken corticosteroid medications (prednisone, cortisone) as pills, injections, suppositories or creams?

Tests and diagnosis

Doctors commonly diagnose osteoporosis by measuring bone density.

Dual energy X-ray absorptiometry
The best screening test is dual energy X-ray absorptiometry (DXA). This procedure is quick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis — and it’s used to accurately follow changes in these bones over time.

Other tests that can accurately measure bone density include:

• Ultrasound
• Quantitative computerized tomography (CT) scanning
• Single-photon absorptiometry

Treatments and drugs

Medications
A number of medications are available to help slow bone loss and maintain bone mass, including:

• Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures. Examples of these medications include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel) and zoledronic acid (Reclast).

  Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They’re also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.

  Side effects, which can be severe, include nausea, abdominal pain, difficulty swallowing and the risk of an inflamed esophagus or esophageal ulcers. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can’t tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

  There have also been reports of serious side effects with bisphosphonates, such as osteonecrosis of the jaw, irregular heartbeats and visual disturbances. Discuss the potentials risks and benefits of these medications with your doctor, and let your dentist know if you’re taking any medications prior to any dental surgery.

• Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn’t use this drug if you have a history of blood clots. This drug isn’t currently recommended for use in men, though a small study found that it may also be helpful for preserving bone density in men.
• Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It’s usually administered as a nasal spray and may cause nasal irritation in some people who use it, but it’s also available as an injection. Because calcitonin isn’t as potent as bisphosphonates, it’s normally reserved for people who can’t take other drugs.
• Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. It works by stimulating new bone growth, while other medications prevent further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so therapy is recommended for two years or less.

Hormone therapy
Estrogen, especially when started soon after menopause, can help maintain bone density. However, the use of hormone therapy can increase your risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Because of concerns about its safety and because other treatments are available, hormone therapy is generally not a first-choice treatment anymore.

Physical therapy
In addition to medications or hormones, physical therapy programs may help you build bone strength and improve your posture, balance and muscle strength, making falls less likely.

Lifestyle and home remedies

These suggestions may help relieve symptoms and maintain your independence if you have osteoporosis:

• Maintain good posture. Good posture — which involves keeping your head held high, chin in, shoulders back, upper back flat and lower spine arched — helps you avoid stress on your spine. When you sit or drive, place a rolled towel in the small of your back. Don’t lean over while reading or doing handwork. When lifting, bend at your knees, not your waist, and lift with your legs, keeping your upper back straight.
• Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get in and out of your bed easily.
• Manage pain. Discuss pain management strategies with your doctor. Don’t ignore chronic pain. Left untreated, it can limit your mobility and cause even more pain.

Coping and support

The idea that your bones aren’t as strong as they used to be can be frightening. You may find that talking to other people who also have osteoporosis can be encouraging and helpful. Ask your doctor if he or she knows of any support groups in your area. Or, contact the National Osteoporosis Foundation (NOF) at 800-231-4222 for a list of local support groups. If there isn’t a group in your area, the NOF support group coordinator can give you information on starting a support group. The NOF also has an online support community at www.inspire.com.

Prevention

Three factors essential for keeping your bones healthy throughout your life are:

• Adequate amounts of calcium
• Adequate amounts of vitamin D
• Regular exercise

Calcium
The amount of calcium you need to stay healthy changes over your lifetime. The Institute of Medicine (IOM) recommends the following amounts of daily calcium from food and supplements:

• Up to 1 year old — 210 to 270 milligrams (mg)
• Age 1 to 3 years — 500 mg
• Age 4 to 8 years — 800 mg
• Age 9 to 18 years — 1,300 mg
• Age 19 to 50 years — 1,000 mg
• Age 51 and older — 1,200 mg

Dairy products are one, but by no means the only, source of calcium. Almonds, broccoli, spinach, cooked kale, canned salmon with the bones, sardines and soy products, such as tofu, also are rich in calcium.

If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. The IOM recommends taking no more than 2,500 mg of calcium daily.

Vitamin D
Getting enough vitamin D is just as important to your bone health as getting adequate amounts of calcium. Scientists don’t yet know the optimal daily dose of vitamin D, but it’s safe for anyone older than 1 year to take up to 2,000 international units (IU) a day.

Experts generally recommend that adults get between 400 and 1,000 IUs daily.

Although many people get adequate amounts of vitamin D from sunlight, this may not be a good source if you live in high latitudes, if you’re housebound, or if you regularly use sunscreen or you avoid the sun entirely because of the risk of skin cancer. Although vitamin D is present in oily fish, such as tuna and sardines, and in egg yolks, you probably don’t eat these on a daily basis. Vitamin D supplements or calcium supplements with added vitamin D are a good alternative.

Exercise
Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life. Combine strength training exercises with weight-bearing exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — mainly affect the bones in your legs, hips and lower spine. Swimming, cycling and exercising on machines such as elliptical trainers can provide a good cardiovascular workout, but because such exercises are low impact, they’re not as helpful for improving bone health as weight-bearing exercises are.

Other tips for prevention
These measures also may help you prevent bone loss:

• Don’t smoke. Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman’s body makes and by reducing the absorption of calcium in your intestine.
• Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body’s ability to absorb calcium.

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