and Sports Medicine  info@highlands-ortho.com
|
1 ARH Lane Suite 201 P.O Box 235 Low Moor, VA 24445
540-863-4444 (office) |
.........."How did this happen to me?
and Sports Medicine info@highlands-ortho.com
|
1 ARH Lane Suite 201 P.O Box 235 Low Moor, VA 24445
540-863-4444 (office) |
.........."How did this happen to me?
Prevention is the watchword in osteoporosisIf you've been told you have osteoporosis, you may be wondering, "How did this happen to me? I don't feel any different!" Up until ages 30 to 40, bone density increases naturally. After that, it tends to diminish slowly -- usually imperceptibly. As the density of bones decreases, so does their strength. Many people don't realize they have osteoporosis until they break a bone in a seemingly minor fall or accident, most often a wrist, arm, or hip.
Osteoporosis literally means "porous bone" and is extremely common, especially for women after menopause and both men and women over age 65. But there are several ways to keep it at bay, including regular exercise, a diet high in calcium and other minerals, and estrogen replacement therapy for women.Pronunciation .................. os-tee-o-pur-O-sis
Synonyms
- Osteopenia
- Type I postmenopausal osteoporosis
- Type I spinal osteoporosis
- Type II senile osteoporosis
Detailed Description (What's going on)
Osteoporosis is a progressive loss of bone density. Maintaining bone strength is more difficult for women than men because sex hormones help keep bones strong. While women stop producing estrogen naturally after menopause, men continue to produce their sex hormone, testosterone, as they get older.
As bone density decreases, people are not just more vulnerable to fractures, but the spine actually begins to compress. This is one reason people tend to shrink or develop curves in their spine as they get older.
While osteoporosis is usually tied to the aging process, about 5% of all cases are caused by other medical conditions or drug therapies. Medications that can contribute to this "secondary osteoporosis" include corticosteroids, barbiturates, anticonvulsants, and high levels of thyroid hormone. A rare type of osteoporosis, called idiopathic juvenile osteoporosis, sometimes weakens the bones of children and young adults; the cause of juvenile osteoporosis is not yet known. Also heparin, a blood thinner, can cause osteoporosis.How Common Is Osteoporosis?
Osteoporosis affects approximately 25 million Americans and is responsible for an estimated 1.5 million fractures each year. Estimates vary about just how much more common osteoporosis is for women -- some are as low as three times as likely while others say women are eight times more likely than men to have osteoporosis. No matter the exact number, osteoporosis is significantly more common in women.
Established Causes
Osteoporosis is linked to normal aging, but it tends to develop more quickly in the following types of people: Those who didn't experience optimum bone growth during development Those who lose bone density at an accelerated rate, including people who experience: Accelerated postmenopausal bone loss Certain medical conditions that accelerate bone loss Risk factors that serve to increase the rate of bone density loss
Risk Factors
Many factors hasten the loss of bone density:
- Sedentary lifestyle
- Cigarette smoking
- Alcoholism
- Dietary calcium deficiency
- Hyperthyroidism
- Premature menopause (before the age of 40)
- Cushing's disease
- Reduced postmenopausal estrogen levels
- Chronic lung disease
- Long-term corticosteroid use
- Body weight below the normal range
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.Symptoms
The most common signs of osteoporosis are:
- Lower back pain
- Fractures of the hip, back, wrist, or vertebrae
- Gradual loss of posture and/or height
- Gradual deformation of the spine
How Osteoporosis Is Diagnosed
It can be difficult to diagnose osteoporosis because skeletal mass in general decreases with age. However, your physician may use imaging or lab tests to estimate the rate of change in your bone density.Imaging Radiographic images (X-rays, CT scans) are one of the best ways to see if you have osteoporosis. Your doctor might use any of the following tests:
Laboratory Work
- Quantitative CT (computed tomography)
- X-ray based dual-energy densitometry
- Neutron-activated analysis of systemic calcium
- Photon absorptiometry
- Bone scans
- Bone mineral density (BMD)
Chemical measurements can be taken to determine the rate of cell turnover in your bones. Based on these measurements, your doctor can assess the rate at which you're losing bone density. Your doctor might measure any of the following chemicals in your body:
- Serum levels of osteocalcin
- Systemic uptake of 99MTc-methylene diphosphonate
- Hydroxyproline in urinary excreted peptides
Treatment Overview
Technically, osteoporosis cannot be cured. However, with proper diet, exercise, and -- sometimes -- hormone replacement or other therapies, prospects for maintaining a sufficient bone density are very good. Treatment for osteoporosis focuses on prolonging its onset or slowing its progression.Hormone replacement therapy
Postmenopausal osteoporosis is routinely treated with hormone replacement therapy. Because bone density loss is greatest in the years right after menopause, many physicians are now prescribing hormones for women right around the time of menopause. Estrogen is usually given in combination with progesterone, which imitates a woman's hormonal balance prior to menopause.
For some women, though, there are complicating factors that make estrogen treatment less desirable. These include a high risk of breast cancer, active liver disease, or certain cardiovascular conditions.Common drug therapies:
- Estrogen conjugates
- Calcium preparations
- Vitamin D analogs
- Calcitonin
- Alendronate
- Other bisphosphonates that inhibit bone reabsorption
Fosamax (alendronate), a bisphosphonate hormone that works to prevent your bones from weakening, is another treatment for osteoporosis. Your doctor might also try Calcitonin, a hormone that inhibits bone reabsorption. While Calcitonin is generally considered less effective than hormone replacement therapy or alendronate, it is a good option for people for whom those treatments aren't effective.Other drug therapies:
- Parathyroid hormone analogues
- Estrogen receptor modulators (tamoxifen, raloxifene)
- Androgens (in men) and anabolic steroids (in women)
- Fluorides
Surgery
The most unnerving characteristic of osteoporosis is that a fracture can occur while a person is performing simple tasks, such as rising from a chair or bending over to pick up the phone. When fractures due to osteoporosis occur, they are sometimes treated surgically.
- Hip fractures: Most often this surgery replaces part of the hip joint or the entire joint.
- Wrist fractures: Sometimes wrist fractures are surgically reset; sometimes the bone is set in a cast.
- Vertebrae: Vertebrae can also collapse, and in the case of osteoporosis, are not treated surgically. Instead, a supportive back brace, physical therapy, and exercise are recommended.
Monitoring the Condition
Because osteoporosis causes bone mass to constantly decrease, you'll have follow-up visits with your doctor to keep tabs on your bone density. If pain develops, X-rays should be taken to assess the possibilities of bone fractures that have gone untreated.Activity and Diet Recommendations
Weight-bearing exercises like walking, climbing, bicycling, and aerobics are one of the most effective measures you can take to prevent or slow osteoporosis. Note that swimming, while an excellent exercise, isn't useful for treating osteoporosis because you don't put any pressure on your bones, which is what helps strengthen them.
Diet is also very important in preventing and controlling osteoporosis. Your doctor will probably recommend you increase your calcium intake, either through supplements or diet. You may also want to ask your doctor about your vitamin D intake, since it works with calcium to increase bone density.
Dairy products are a well-known source of calcium, but it can also be found in leafy green vegetables, sardines, and salmon. Other nutrients important to bone-building include vitamin K-1 and boron. K-1 is a form of vitamin K found only in plants, especially broccoli, cabbage, lettuce, spinach, and green tea. Boron is found in many fruits and vegetables.
Other minerals and vitamins important for maintaining bone density include the following:Dietary no-no's
- Fluoride
- Magnesium
- Manganese
- Zinc
For those with osteoporosis, certain foods and beverages are best kept to a minimum:
- Soft drinks: Not recommended, since their ingredients routinely include caffeine, plus high levels of sugar and phosphates, which contribute to calcium loss.
- Sodium (salt).
- Caffeine: Eliminating it would be optimal, but at the very least, reduce your consumption.
- Alcohol: Again, elimination is best, but at the very least, limit your consumption.
- Antacids: Avoid the kind that contain aluminum salts, which block calcium absorption. Use those that include calcium carbonate.
Quality of Life
If you have been diagnosed with osteoporosis, consult your doctor about what activities are best suited for your condition. In general, you'll want to avoid situations that are more likely to cause a bone break.Considerations for Women
Because women are much more likely than men to develop osteoporosis, it is important to be particularly vigilant about a preventative diet, exercise, and drug therapies.Herbs &nbps&nbps&nbps&nbps&nbps; Good quality data is still lacking on phytoestrogens and osteoporosis. At this point, patients with osteoporosis or at risk should consult their physicians before considering herbal therapies for this condition. Phytoestrogens. These naturally occurring plant estrogens are found in the following herbs:
- Calcium. For a good source of supplemental calcium, take Rolaids or Tums. These over-the-counter antacids contain about 200 mg of calcium per tablet. But stay away from calcium supplements containing bone meal, dolomite, or oyster shells. They may contain lead, a toxic heavy metal. Sometimes calcium carbonate can cause bloating and constipation, so consider trying calcium citrate preparations.
- Vitamin D. In one study, 348 postmenopausal women took either a placebo or a vitamin D supplement (400 IU/day). All the women consumed about the same amount of calcium. After two years, the placebo group had lost bone mass, but the vitamin D group had stronger bones. [1] Just don't take more than 1,000 IU/day, as larger doses may be hazardous.
- Chinese angelica (dong quai)
- Fennel
- Licorice
- Black cohosh
Self-Care Measures
The best treatment for osteoporosis is prevention. And the best prevention seems to be a combination of diet, dietary supplements, and exercise. For many postmenopausal women, hormone replacement therapy is also a successful preventive tactic.
The following self-care measures may reduce osteoporosis, or prevent it from developing in the first place. Eat foods high in calcium. The National Institutes of Health and the American Medical Association recommend 1,500 mg of calcium per day for postmenopausal women, slightly less for other adults. Start with high-calcium foods, such as yogurt (350 mg/serving), milk (300 mg), spinach (245 mg), cheeses (200 mg to 275 mg), beans (150 mg to 200 mg), and tofu (150 mg).
Take a calcium supplement. Calcium supplements repeatedly have been shown to slow bone loss in postmenopausal women. The suggested dose is 1,000 mg (1 gram) per day. Vitamin D, vitamin K, and magnesium also help your body use calcium. It's recommended that you get half as much magnesium as calcium, so if you're getting 1,000 mg of calcium per day, balance it with 500 mg of magnesium. Calcium and vitamin D work together to keep your blood level of calcium normal.
Calcium supplements are available in many forms. Chewable antacids are not the best way to get calcium since your body does not absorb most of the calcium contained in them. Calcium carbonate tablets are a better form of the supplement, and calcium citrate may be even better tolerated.
Eat more fruits and vegetables. They're high in several nutrients that play important supporting roles in bone health, including magnesium, manganese, vitamin K, and boron.
Exercise regularly. Every authority on osteoporosis recommends regular weight-bearing exercise, including walking, dancing, aerobics, and even gardening. (Note that swimming, while a very beneficial exercise for many people, is not recommended for the treatment of osteoporosis, as it offers no weight-bearing potential.) In one study, 42 sedentary women over age 60 remained inactive, while 42 others took daily 20- to 50-minute walks. After a year, the sedentary group had more severe osteoporosis, but the walkers showed very little bone loss.
Spend some time in the sun. When sunlight strikes your skin, your body makes vitamin D, which is crucial to strong bones. Without it, your bones can't absorb calcium. You can also get vitamin D from a few foods, notably tuna and vitamin D-fortified milk and dairy products.
Eat more beans. Doctors often prescribe estrogen to menopausal women, in part to prevent osteoporosis. But there's a natural way to get estrogen: beans, especially soybeans and soybean products, such as tofu, contain plant estrogen (phytoestrogens). Naturopaths and nutrition experts recommend phytoestrogens to prevent bone loss.
If you smoke, quit. Smoking accelerates osteoporosis.
Keep your home safe. For those at risk for -- or diagnosed with -- osteoporosis, a safe environment is important. Keep your home well lit, and eliminate any unnecessary obstacles and dangerous cables or wires that you might trip over. If possible, get someone else to do tasks that would require you to apply pressure with or on your joints and bones. When you go out for a walk, watch the road for cracks and potholes.
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AAOS Research 6300 North River Road Rosemont, IL 60018-4262 Phone: 847-823-7186 or 800-346-AAOS (2267) Fax: 847-823-8125 http://www.aaos.org
Dr. Carmichael
Merck & Co., Inc.
National Institute of Arthritis and |
National Institutes of Health http://isis.nlm.nih.gov/
National Osteoporosis Foundation
Osteoporosis and Related Bone Diseases
U.S. National Library of Medicine
Wheeless' Textbook of Orthopedics |
General Orthopaedic Information and Additional Websites
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and Sports Medicine info@highlands-ortho.com
|
1 ARH Lane Suite 201 P.O Box 235 Low Moor, VA 24445
540-863-4444 (office) |
Thank you for your time
Created Nov. 13,, 1999
Last update Dec. 2, 1999