Risk of Osteoporosis is Preventable

Published by Contra Costa Times

Posted on Wed, Jun. 07, 2006

By Dr. Annie Cherayil

RECENTLY, I cared for an 81-year-old lady who was admitted to the hospital with back pain so severe she was no longer able to live by herself.

In the hospital, X-rays showed severe osteoporosis and compression fractures of her spine. Her vertebrae had collapsed on themselves, causing her pain.

Osteoporosis is the loss of bone structure and strength, so the bones become weak and brittle. This means they can break more easily, especially in the hip, spine and wrist.

In the United States today, nearly 10 million people already have osteoporosis, and another 80 million have low bone mass, meaning they are at increased risk for developing it. Osteoporosis affects women much more than men.

How do we treat osteoporosis?

Non-drug therapies are especially important. They include calcium and vitamin D. Adults 50 and older need 1,200 milligrams of calcium daily, and 400-600 IU of Vitamin D. These are needed whether or not you are taking medicines for osteoporosis.
Weight-bearing exercise (walking, jogging, etc.) helps strengthen the hips and spine, as do resistance exercises such as lifting weights. Sixty minutes four times a week is best, but do what you can.
Stop smoking, because tobacco smoke weakens bones.

Drug therapy for osteoporosis includes the following:

Biphosphonate drugs like Fosamax (alendronate) and Actonel (risedronate) are usually tried first. They can be taken daily, weekly or monthly, as directed by your doctor. They help prevent both hip and spine fractures.

Biphosphonates can irritate the esophagus (the tube connecting the mouth and stomach), so it is important to take the pill with plenty of water so it won't get stuck. Sit or stand a full 30 minutes after taking it, avoid meals for 30 minutes before or after, and do not lie down for a few hours after. Rarely biphosphonates can cause severe bone loss in the jaw.

Calcitonin (Cibacalcin, Calcimar, Miacalcin) can be taken as a nasal spray or an injection. Calcitonin is generally less effective than biphosphonates, but helps strengthen spinal bones, and can help reduce back pain.
Evista (raloxifene) is a daily pill that works like female hormones to strengthen bones, but doesn't increase the risk of cancer. Evista can cause hot flashes and leg cramps, though, and increases the risk of blood clots.
Premarin and Menest (conjugated estrogens) are female hormones that work well to strengthen bones. Estrogen alone increases the risk of uterine (womb) cancer, but adding progestin pills can reduce this risk.

A few years ago, however, research showed that female hormone therapy increases the risk of blood clots, strokes, heart attacks, dementia, and some cancers. The estrogens were shown to increase the risks of stroke, dementia, and blood clots, not breast cancer and heart attacks.

Women should understand the benefits and risks of these hormones before taking them. Female hormones and biphosphonates together (but not at the same time) give added benefit for severe osteoporosis.

How do you know if therapy is working? Talk to your doctor. In some cases, further tests may be indicated.

The elderly woman I cared for hadn't been aware of her osteoporosis until it was too late. Talk to your doctor about your risks for osteoporosis, and how you can prevent or treat it.

Dr. Cherayil practices family medicine at the Concord Health Center.