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I'm healthy and I take good care of myself. Am I at risk for osteoporosis?
Osteoporosis is called a "silent disease" because it can occur gradually over many years without any symptoms. Often, the very first sign of osteoporosis is a broken bone, usually occurring at the hip, spine, or wrist. Unfortunately, osteoporosis affects people with no particular risk factors or symptoms. The proper way to diagnose osteoporosis is with a bone density test. One in two women and one in eight men have a lifetime risk of developing fractures from osteoporosis. Ensuring that you receive adequate calcium throughout your life is the best preventative measure to avoid osteoporosis.
I'm too young to worry about osteoporosis now, aren't I?
No one is too young to take preventive action to avoid osteoporosis. Young people, especially adolescents, need to have an adequate dietary calcium intake and start good lifetime exercise habits to build optimal bone mass. Other preventive behaviors for osteoporosis are health habits that prevent many other diseases as well, such as a healthy calcium rich diet, avoiding smoking and avoiding excessive alcohol consumption.
Osteoporosis is not a "real" disease is it?
Osteoporosis is a serious disease because it weakens the bones progressively to the point that almost any movement can cause a painful, debilitating fracture of the hip, spine, or other bones. In fact, osteoporosis causes one fracture every 20 seconds in the U.S. Of those with hip fractures from osteoporosis, one in four will die prematurely within one year and many others, especially women, unnecessarily suffer. It can also lead to loss of teeth.
Osteoporosis was once considered simply a natural consequence of aging or a cosmetic problem for older women rather than the disease that it is. With all the current patient attention on osteoporosis, patients should be reassured that this serious disease now can be effectively prevented, diagnosed, and treated before it is too late. Once osteoporosis is diagnosed, medications can be prescribed to halt further bone loss and further degeneration.
Is there a satisfactory treatment for osteoporosis once you have it?
There are effective treatments for osteoporosis. However, as with most conditions, early diagnosis is key to the good outcomes. Current therapies for prevention and treatment of osteoporosis include supplementing dietary calcium and vitamin D to help to slow the rate of bone loss. Menopausal women should have a total dietary intake of calcium of 1,500 mg per day and vitamin D supplementation is important in women who experience less than 20 minutes of exposure to the sun per day. Other therapies include estrogen replacement therapy in postmenopausal women, calcitonin-salmon (Miacalcin®), bisphosphonates (Actonel®* and Fosamax®*), selective estrogen-receptor modulators or "SERMs" (Evista®*). These therapies can prevent further bone loss by inhibiting bone resorption and have been shown to reduce the incidence of fracture. For these drugs to work effectively, you must have adequate calcium intake.
I am taking a prescription medication for osteoporosis, but my doctor didn't tell me to take calcium supplements.
Patients taking medications such as bisphosphonates must have adequate calcium intake for these drugs to work effectively. Calcium and all other medications should be taken at least 2 hours AFTER a bisphosphonate. Regardless of the therapy prescribed by a physician for treatment of osteoporosis, a patient should continue to take a calcium supplement while taking the medications.
Can't I worry about osteoporosis after I get through menopause?
You should start preventive measures long before the symptoms of osteoporosis begin. This means maintaining an adequate calcium intake and performing sufficient weight-bearing exercises in the premenopausal years. Exercise in the peri-menopausal time has the added benefit of reducing menopause-related symptoms, as well as protecting against osteoporosis. Women can lose up to one fifth of their bone mass in the five to seven years following menopause, putting them at an even greater risk. It is extremely important to ensure adequate calcium intake at this phase of life.
Am I too old to do anything about osteoporosis now?
Just as one is never too young to start osteoporosis prevention strategies, one is never too old to take action to slow it down from getting worse. It is never too late to improve lifestyle habits—make sure that you are getting adequate calcium. Further, it is never too late to begin treatment with one of the several effective medications available.
What causes the back pain associated with osteoporosis?
Back pain associated with osteoporosis is the result of weaken vertebral spine that can no longer withstand normal stress (such as a sneeze) or a minor trauma (such as a fall). The result is a fracture. Unfortunately, a fracture is typically the first outward sign of the disease. Advanced osteoporosis can be extremely painful and potentially disabling.
Don't only "little old ladies" get osteoporosis?
Most patients with visible symptoms of osteoporosis are postmenopausal women, generally over age 55, and hardly considered old in today's world. Interestingly, osteoporosis at any age makes its patients appear older than others the same age with better posture. Contrary to myth, osteoporosis also affects men—approximately one in five people with osteoporosis is male. It also affects younger women who have had their ovaries removed, younger patients with various diseases such as anorexia, patients who take chronic steroids, and astronauts who have experienced a weightless environment for an extended period of time.
When should I start getting screened for osteoporosis?
Osteoporosis is a serious disease. The U.S. Preventive Services Task Force (USPSTF) recommends that women age 65 and older be screened routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures. In women, the lifetime risk of death from a hip fracture is almost 3 in 100, the same as breast cancer.
Women of color aren't at risk for osteoporosis. So, I don't have to worry, right?
This mistaken belief comes from a misreading of the common risk factors associated with osteoporosis which states that Caucasian and Asian women are at increased risk. African Americans are still at risk when they go through menopause, just at a slightly lower percentage rate. Recent research indicates that Hispanic women, depending on their ethnic background, may even be more at risk than Caucasian women. Everyone needs to be concerned about osteoporosis and other diseases of calcium deficiency.
I always drank milk as a child. Do I have anything to worry about?
Four eight-ounce glasses of milk per day in childhood and adolescence is worth more than 32 ounces of prevention, but it is not the only factor. Keep drinking milk, but explore other preventive measures one should take, such as weight bearing exercise. The U.S. Preventive Services Task Force (USPSTF) recommends that women age 65 and older be screened routinely for osteoporosis. For women at increased risk for osteoporotic fractures, the USPSTF recommends that routine screening begin at age 60.
If my mother didn't have osteoporosis, am I at risk?
While you would be at an increased risk if your mother had osteoporosis, it does not automatically follow that you will not. In addition, your mother may have had osteoporosis without being diagnosed. The screening and diagnostic tools today are more sophisticated than those available even 10 years ago. Further, you will probably live longer than your mother, thus increasing the odds that you may be affected by osteoporosis. You may also have additional risks that your mother did not, such as relatives from your father's side of the family with the disease. Importantly, if you have an adolescent daughter, take measures to ensure that she is getting adequate calcium in her diet or through supplementation.
How can I learn more about calcium?
Women should always consult with their health care providers concerning their need for calcium. Several good resources are available, such as The National Osteoporosis Foundation (www.nof.org) and Related Bone Diseases National Resource Center (NCR). The NRC is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the NIH. This nonprofit organization seeks to support research on and an awareness of osteoporosis, Paget's disease, and osteogenesis imperfecta. It offers many educational materials and programs (many in Spanish and some in large-type print).
A branch of the NIH, The National Institute on Aging Information Center (www.nih.gov/nia), provides reliable and free information. They can be contacted at PO Box 8057 Gaithersburg, MD 20898-8057, or(800)222-2225.
What is osteopenia?
Osteopenia is a reduction in bone mineral density. Bone mineral density is rated with a "T-score". A "normal" T-score is -1.0 or higher. Osteoporosis is defined as a T-score of -2.5 or lower, and osteopenia is a T-score between -1.0 and -2.5.
