Osteoporosis in Women

What is osteoporosis?

Osteoporosis is a disease that thins and weakens bones to the point where they may break easily. This disease most often causes fractures of the bones of the hip, spine, and wrist.

How does it occur?

Studies indicate that bones keep their strength by being used, supporting the body’s weight. Bone-forming cells called osteoblasts make new bone all the time. Bone-absorbing cells called osteoclasts dissolve away older bone, making room for new bone. This goes on all the time – the bones are always being remodeled. For unknown reasons, the balance of formation and reabsorption of bones tips slightly in favor of reabsorption as people get older. Too much bone reabsorption leads to osteoporosis.

Bones reach their greatest strength between ages 20 and 35. After 35, your bones slowly get weaker as you get older.

The risk of osteoporosis goes up with age. Osteoporosis starts to develop in women after menopause, between the ages of 45 and 55. After menopause a woman’s body makes much less estrogen, a female hormone. Estrogen helps women's bones stay strong. The bones weaken when estrogen levels are low.

Women have less bone mass than men, and they lose bone mass sooner and faster than men. Osteoporosis is most common in white and Asian women, especially slim women, but it can occur in women of any race.

In addition to aging, other causes of osteoporosis are:

• lifestyle habits such as:
  • smoking
  • having more than 1 drink of alcohol a day
  • too little calcium in the diet
  • not enough weight-bearing exercise such as walking, dancing, or lifting weights
• surgical removal of the ovaries, which lowers estrogen levels
• long-term use of some medicines, such as steroids used to treat asthma or arthritis, thyroid medicines, anticonvulsants, aluminum-containing antacids, and some cancer treatments
• chronic disease, such as diabetes, hyperthyroidism, and heart failure
• too much exercise (such as marathon running), which lowers estrogen levels
• long periods of bed rest during serious illness (Medical scientists think this comes from not having enough weight on the bones of the body. For example, astronauts in space a long time show signs of osteoporosis.)
• eating disorders or too much dieting.

You have a higher risk of osteoporosis if you have a family history of the disease.

What are the symptoms?

Usually, there are no symptoms until a bone breaks. Broken bones are the most common problem for people with osteoporosis. Often it's the hip, arm, or wrist that breaks.

The bones of the spine are also a common area of thinning. Often, over time, the bones of the spine (vertebrae) collapse on themselves. This can cause a loss of height, back pain, and a stooping posture (dowager's hump).

How is it diagnosed?

Your healthcare provider will review your medical history, ask about symptoms, and examine you.

The main test used to look for osteoporosis is a bone mineral density test, such as a DEXA scan. This test is a special X-ray exam of the spine, hip, and/or wrist. A DEXA scan is recommended for all women age 65 and older. Women who have a higher risk should have the test by age 60. Repeat testing depends on the results of the first test.

Sometimes, osteoporosis can be measured using ultrasound scans.

How is it treated?

Treatment can slow down the loss of bone and rebuild some bone. It does not restore bone strength all the way back to normal.

The 3 essentials of basic treatment for osteoporosis are:

• Weight-bearing exercise. Weight-bearing exercise, such as walking or stair climbing, helps keep your bones strong. Doing this kind of physical activity every day may help keep your bones from getting weaker.
• Plenty of calcium in the diet. Adult women 19 to 50 years old should have 1000 milligrams (mg) of calcium a day. Women over 50 need at least 1200 mg a day. Calcium is found naturally in foods such as milk, yogurt, and cheese. It can also be taken as a supplement.
• Good levels of vitamin D in the blood. If your blood levels of vitamin D aren’t high enough, you may need to take supplements. Vitamin D helps your body absorb and use calcium. The current US recommendations for vitamin D are 800 international units (IU) a day if you over 70 years old. You should get 600 IU a day if you are 70 or younger.

Several medicines slow bone loss and help reduce fractures. These include:

• bisphosphonates such as risedronate and alendronate
• calcitonin-salmon hormone (nasal spray
• selective estrogen receptor modulators (SERMs) such as raloxifene and tamoxifen.

These medicines are prescribed if your bone mineral density tests show that you have osteoporosis even though you are getting enough exercise and calcium and are not smoking. They may also be prescribed if you have had a broken bone because of osteoporosis.

Treatment with the female hormones estrogen and progestin can help prevent bone loss as well as relieve some of the symptoms of menopause. Discuss the risks and benefits of hormone therapy with your healthcare provider. Depending on your age, treatment with estrogen and progestin may increase the risk for heart disease. It may also increase your risk for stroke, breast cancer, blood clots, some gallbladder problems, and possibly dementia. Also, estrogen taken without progestin increases the risk of uterine cancer if you still have your uterus.

Other medicines and therapies have been or are being developed. Check with your healthcare provider about your current choices for treatment.

How long will the effects last?

The risk of a broken bone resulting from osteoporosis gets higher as you get older. Compression fractures in the spine are the most common type of fracture caused by osteoporosis. Treatment can help reduce your risk of broken bones, especially compression fractures and broken hips. However, no treatment has eliminated the risk of these types of fractures.

Once menopause starts, most women, especially Caucasian and Asian women, need to take precautions for the rest of their lives to prevent osteoporosis.

How can I take care of myself and help prevent osteoporosis?

• Follow the treatment prescribed by your healthcare provider.
• If you are taking medicine to treat osteoporosis, be sure to take it as prescribed. For example, medicines such as alendronate must usually be taken with a full glass of water in the morning on an empty stomach. Don’t lie down for at least a half hour after taking it.
• Eat healthy foods, especially low-fat milk and dairy products, green leafy vegetables, citrus fruits, sardines, and shellfish.
• Take a daily calcium and vitamin D supplement if your healthcare provider recommends it.
• Get regular weight-bearing exercise. Walking is especially good. Weight-bearing exercise helps prevent bone loss and strengthens muscles, which can help prevent falls. Be sure to exercise your upper body also. Ask your healthcare provider if there are any limits on your exercising.
• Don’t smoke. Smokers may absorb less calcium from their diet.
• Do not have more than 1 drink of alcohol a day. One drink is 1 ounce of hard liquor, one 12-oz serving of beer, or one 4-oz glass of wine.
• Avoid antacids that contain aluminum hydroxide, such as Amphojel, Gaviscon, or Mylanta.
• Talk with your healthcare provider about hormone therapy or other medicines when you reach menopause.

What can I do to reduce my risk of injury?

If you have osteoporosis, you can reduce the risk of injury and broken bones if you:

• Avoid lifting heavy objects.
• Avoid unusually vigorous physical activity. Build up your activity level gradually. Take exercise classes that fit your age, strength, and fitness.
• Wear shoes that provide good support (such as running or walking shoes).
• Use support for walking, such as a cane, if you need it.
• Keep areas where you will be walking well lit and uncluttered. When you walk outside, avoid graveled areas or other uneven surfaces that could cause a fall.
• Avoid putting throw rugs on your floors at home.
• Be cautious about going outdoors when roads and sidewalks are icy.

If you have had problems with falling, be sure to let your healthcare provider know. Some medicines increase the risk of falling. You may need physical therapy to improve your balance and walking. In some cases, a nurse or physical therapist may need to do a home safety evaluation.

For more information, call or write:

• National Osteoporosis Foundation
  Phone: 1-800-223-9994
  Web site: http://www.nof.org