Preventing osteoporosis

WEB EXCLUSIVE / OCTOBER 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in October 1998

Download this Patient Note in PDF format

Your bones are constantly changing. Old bone dissolves and is replaced with new, stronger bone. Before age 30, new bone appears faster than old bone disappears. But as you get older, the opposite occurs: bone breaks down faster than it is replaced. When this happens, the bones can become "spongy," weak, and more likely to break. Stooped posture and loss of height may also result. This condition is called osteoporosis, which means "porous bone" in Latin. In the United States, 10 million people are estimated to have osteoporosis, and about 34 million more are at risk for the disease.

Am I at risk?

Osteoporosis is about four times more common in women than in men. It tends to run in families and occurs more often in slender people whose bones might be somewhat weak to begin with.

Women are especially vulnerable to osteoporosis in the 5 to 7 years after menopause, when they can lose up to 20% of their bone mass. However, increased bone loss in women can also result from illness, advanced age, use of certain medications, or a sedentary lifestyle.

Cigarette smoking and excessive alcohol consumption weaken bones in both men and women. Smoking seems to block the body's ability to maintain bone strength, and alcohol affects calcium absorption and reduces bone growth.

What tests should I have?

If you have a family history of osteoporosis or if you have concerns, ask your doctor for advice. He or she may suggest that you have a bone mineral density test using dual-energy x-ray absorptiometry, or DXA. For the test, you lie on a table while an x-ray machine passes over your hips and spine and computes bone density. The test, which takes 10 to 15 minutes, uses less radiation than is needed for a standard chest x-ray. This simple procedure can detect even a very small bone loss.

What can I do to protect my bones?

One very important thing you can do for yourself is make sure you get enough calcium and vitamin D. Most of us need at least 1,000 mg of calcium each day, but men over age 65 and postmenopausal women need 1,500 mg. That's equal to five 8-oz glasses of milk or five cups of yogurt each day. High levels of calcium are also found in soybeans, cheese, and leafy green vegetables. However, even if you eat a balanced diet rich in calcium, you may still need calcium supplements. Ask your doctor if supplementation is right for you.

Vitamin D increases calcium absorption and is important for building bones. About 15 minutes of direct sunlight a day is one way to maintain a good vitamin D supply. Vitamin D is also found in sardines and salmon, fortified milk, eggs, and multivitamins.

Exercise is very important for strengthening bones. Weight-bearing exercises, such as walking, jogging, dancing, and stair climbing, are especially good. If you have health problems or are over age 40, be sure to check with your doctor before beginning a regular exercise program.

Finally, drug treatment can help. Alendronate, risedronate, and ibandronate are drugs of the bisphosphonate class that help prevent as well as treat osteoporosis. Another medication, raloxifene, from a class of drugs called selective estrogen receptor modulators, also appears to increase bone density, although not at the same rate as bisphosphonates.

For more information National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center 2 AMS Circle Bethesda, MD 20892 800-624-2663 http://www.osteo.org National Osteoporosis Foundation 1232 22nd St NW Washington, DC 20037 http://www.nof.org

What can I do to prevent falls? Each year, more than a million Americans fall and break bones weakened by osteoporosis. Here are some simple things you can do to prevent a fall. Fall-proof your home. Make sure all stairways have sturdy handrails. Install grab bars in bathrooms. Eliminate slippery floors, and eliminate or secure area rugs. Get rid of clutter, including electrical and phone cords and low tables, that can trip you. Make sure all rooms are well lit. Keep phones within reach to call for help in case you fall. Take good care of your eyes and ears. Have your sight and hearing checked and corrected regularly. Make sure clothing is short enough so it doesn't get underfoot or trip you when climbing stairs. Choose comfortable, sturdy shoes with nonskid soles. Use a cane, walking stick, or walker if you're unsteady on your feet. If you do fall, move slowly and avoid putting weight on an injured arm or leg. If you think a bone is broken, don't move and don't let anyone move you until medical help arrives.

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste