Ten Commonly Asked Questions About Osteoporosis
Published April 3, 2008
by Stacey Fornarotto, MS, PA-C
Hunterdon Family Medicine, a family health center of Hunterdon Medical Center
With normal age progression we start to notice many changes in our bodies. Our skin may not feel as soft. Our hair may be graying and not be as bouncy. Our figures may no longer look like they used to. We try to fight these signs of aging by changing our skin and hair care products, going on a diet, and maybe picking up a new exercise routine. But what about our bones, our structural supports that we do not see on a day to day basis? They too are changing. We are no longer continuing to build bone as we did when we were younger, but are instead starting to break them down. Our bones are gradually becoming weaker without us even realizing it. As our bones weaken they may literally become porous - a condition known as osteoporosis. Eventually they may become so fragile that a cough, a sneeze, or even a hug from a loved one may break a bone. And forget about a fall. We may wind up in a nursing home with a hip replacement if this happens, or possibly even die from complications. So shouldn't we try to take care of our body parts that we cannot see as well as the ones that we can? Many people still have several questions that stand between them and the prevention of their bone loss. Hopefully some answers will help those individuals to make more educated decisions.
1. Which bones are affected by osteoporosis?
Unfortunately all bones can be affected by osteoporosis. Generally the first bones that we notice that are affected are the hips, the wrists, and the vertebrae of the spine. Yet all bones are vulnerable to weakening including our arms, legs, pelvis, and teeth.
2. What are risk factors for developing osteoporosis?
There are several risks for developing osteoporosis that include:
. Aging
. being a woman
. having a small stature
. having a family history of fractures or bone loss
. having low estrogen or testosterone levels
. having a diet low in calcium and vitamin D
. chronic diseases that affect our lungs, kidneys, stomach and intestines
. the use of certain medications such as steroids, anticonvulsants, immunosuppressants, thyroid medications, and Depo-ProveraT
. having an inactive lifestyle
. cigarette smoking
. excessive alcohol use
Even though some of these risk factors are out of our control, several can be controlled and precautions can still be taken. For instance, if you take any of the previously mentioned medications, it is recommended that you discuss the possibility of future bone loss with your healthcare practitioner. If you smoke or drink excessive alcohol, the increased risk of bone loss, fractures (broken bones), and possibly the loss of your independence is another reason why you need to quit.
3. Wouldn't I already know if I had bone loss?
Not necessarily. Often times the first sign of weakened bones is a fracture. Bone mineral density (BMD) tests, or dexascans, are the tests that are most commonly used to screen individuals before they have a dilemma. These tests measure the densities or thickness of the bones in the spine and hip which is reflective of other similar types of bones in the body. The values that are obtained determine if there is any bone loss present and if you are at an increased risk of breaking your bones in the future. If you have any of the previously reviewed risk factors, you should ask your healthcare provider when you should start getting tested, and how often you need to get future testing for comparison.
4. I do not have any family history of osteoporosis or any risk factors, so why should I be concerned?
Simply stated, because osteoporosis can affect anybody. People are tending to live longer and be more active in their communities. It is inevitable that bones will weaken as they age. Granted, if you have no risk factors, you are probably less likely to develop severe bone loss problems, but there are certainly no guarantees. Everyone should at least be screened for bone loss, or discuss with a healthcare provider any precautions he or she should be taking to prevent any future problems.
5. Are there any other ways to prevent bone loss?
Yes, there are many things that are very preventive. In addition to avoiding smoking and excessive alcohol intake, weight- bearing exercises such as walking and weight lifting are very beneficial to strengthen bones. Calcium is critical and you should make sure that you have adequate daily intake. Current recommendations are based on age.
Age Daily recommended Intake
1-3 500mg
4-8 800mg
9-18 1300mg
19-50 1000mg
51 and older 1200mg
Many foods are rich in calcium such as low-fat dairy products, broccoli, salmon, and kale. Many other foods are also now fortified with calcium such as breakfast cereals and fruit juices. If you are still unable to get enough calcium through foods and drinks, you should also take calcium supplements daily.
6. There are so many different calcium supplements available. How do I decide which one to buy?
The two most commonly used calcium supplements are calcium carbonate and calcium citrate products. Calcium carbonate supplements are generally less expensive, but may have more constipating side effects. Calcium citrate is generally better absorbed by the body and has fewer side effects. Coral calcium has recently received a lot of attention from the media. Coral calcium is generally at least 3 times more expensive than both calcium carbonate and calcium citrate, and at this time, there have been no studies to indicate that it is any more beneficial than the other supplements that are currently on the market. No matter which type of calcium supplement you decide to purchase, it is always best to take them with meals for better absorption. The body is generally only able to absorb between 500-600mg of calcium at a time. Therefore it is better to take supplements multiple times per day. It is also essential to get between 400 and 800 IU of vitamin D daily to help absorb calcium. By getting 5 to 10 minutes of sunlight on your face and arms just 3 times per week, you will be getting the majority of this requirement, and the vitamin D will stay stored in your body for several days.
It is always best to check with your healthcare provider before starting any supplement.
7. There is a history of kidney stones in my family, so shouldn't I avoid taking calcium?
On the contrary. Studies have shown that people who have less calcium in their diet are at greater risk of forming kidney stones than those who have more. The most common type of kidney stones are made of calcium oxalate. When you have adequate amounts of calcium in your diet, the calcium is able to bind to the oxalate that is in your gut and can be excreted naturally. If you do not have an adequate amount of calcium intake, the oxalate can be absorbed into the blood and contribute to stone formation. Therefore, taking calcium will most likely help prevent both osteoporosis and kidney stone formation.
8. What about men? Do they get osteoporosis?
They certainly do! Currently there are 2 million men who have osteoporosis, and it is estimated that at least 12 million men are at risk. That is why men also need to take the same measures to prevent bone loss. Guidelines are still being devised to determine at what age men should start being screened for bone loss with bone mineral densities. Therefore men should ask their healthcare provider when they should start having bone mineral density tests done based on their individual risk factors.
9. There are many different medications advertised for osteoporosis. Do they really make a difference?
There are currently several different classes of prescription medications on the market and many have excellent results. Bisphosphonates (FosamaxT, ActonelT, and BonivaT), calcitonin (MiacalcinT), estrogens, raloxifene(EvistaT) and parathyroid hormone (ForteoT) are all approved by the US Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis. These medications work differently, but may be very beneficial. You should make an appointment with your healthcare professional to discuss the current options that are available and any potential risks and benefits of medications.
10. I was on hormone replacement therapy (HRT) for many years, so aren't I protected?
Unfortunately, once HRT is stopped, there is no longer any protective effect. Since the alarming information that was reported by the Women's Health Initiative study about the possible increased risk of cancer and heart disease with HRT, many women have discontinued it's use. You will need to discuss what your next option is with your healthcare practitioner.
Prevention is the most important tool that can be used to try and decrease your risk of developing osteoporosis. In order to strengthen our bones, we need to have a diet that is rich in calcium, and we need to maintain an active lifestyle through exercise. It is also critical to avoid smoking and excessive alcohol intake to try to minimize our risk of future bone loss.
You should follow up with your healthcare provider to discuss any questions that you may have.
Stacey Fornarotto, MS, PA-C is a Physician Assistant at Hunterdon Family Medicine, a family health center of Hunterdon Medical Center. Hunterdon Family Medicine is located at 190 Rt. 31, Ste. 500 in Flemington (across the street from Hunterdon Medical Center,). To schedule an appointment with Stacey call Hunterdon Family Medicine at 908-788-6161.