Over 50% of your bone density is obtained in puberty. By 30 you should have obtained your peak bone mass. After that, bone is lost. Children must have adequate calcium, vitamin D, exercise, and proper diet to have strong bones for life!!
Osteoporosis causes the body to remove more bone than it replaces. This means that bones get weaker. Weak bones are more likely to break. Osteoporosis is a bone disease that is quite common, especially in older women. However, young people and men can develop osteoporosis, too. Osteoporosis can be prevented, and with proper therapy it can be treated.
"Osteopenia" is thin bones that are not as badly affected as osteoporotic ones. Bone mineral density (BMD) can be measured and is an excellent predictor of fractures. The test is painless, with minimal radiation exposure. The DEXA (dual -energy x-ray absorptiometry) or BDT (bone density test) will show: T score value of -1.5 to -2.5 (this is your score compared to a healthy young adult) if you have osteopenia. More than -2.5 is osteoporosis. Many clinicians will not treat you until there is osteoporosis. Osteopenia is a warning sign much like prehypertension or borderline cholesterol. Determining the cause of osteopenia and treating such things as low calcium intake or Vitamin D may be important to prevent osteoporosis. Getting exercise, decreasing alcohol to <2 drinks/day, quitting smoking and treating estrogen deficiency are other important measures. A vertebral fracture may be also noted on your bone density test. If so, treatment of osteopenia is warranted.
How can osteoporosis affect me?
Who is at risk for osteoporosis?
Many things put people at risk for osteoporosis. The following people have a higher chance of getting osteoporosis.
Desirable Blood Tests:
Evaluate patients for risk factors for the following: i.e. neuromuscular diseases, nocturia (having to urinate at night), orthostatic hypotension (low blood pressure upon standing). Patients prone to falls might fracture something. With severe osteoporosis, just rolling over in bed or reaching for something can cause a fracture. To prevent falls-- pick things up off the floor and leave plenty of space to move around the house without tripping. A spinal X-ray may be indicated if there is back pain (suspected fracture).
Who gets a bone density?
Any woman who is 40 or greater who may be at risk for osteoporosis. Younger women with indications will also generally be approved by insurance. Medicare will cover it every 2 years for screening and, like other insurances, yearly if there is medication being given for treatment of osteoporosis.
Treatment of Osteoporosis:
Things that inhibit bone resorption:
Things that build bone:
Interesting Facts About Calcium:
Has 40% elemental calcium in a 500 milligram pill; may cause constipation.
Has 20% elemental calcium; you need 4 pills a day, but it gives less constipation and can be taken with or without meals. For older patients who may have problems with decreased acid production in the stomach (pernicius anemia), Calcium Citrate is the way to go!!
For older women; 400-800 units daily. 20 minutes in the sun with exposed skin will provide this amount of vitamin D.
You need 200 IU per day via nasal spray. Nasal irritation may be a problem. This is excellent for the pain associated with spinal fractures.
Bisphosphonates - Fosamax, Actonel, Boniva: Decrease fractures;
Taken weekly or monthly for at least one to three years to show effect, must be taken with water. Patient cannot lie down for at least thirty minutes, as it directly irritates the esophageal mucosa. Wait thirty minutes before any food or drink other that water is ingested.
There are some intravenous medications now such as Boniva or Reclast that you do not have to take orally. These are injected.
Selective Estrogen Receptor Modulator: The newest hottest area of interest. This refers to a medication which would be agonist on the cardiovascular system and bone, while being an antagonist on breast and uterus. One such drug, Evista (Raloxifene), decreases LDL, protects bones, and does not stimulate breast or endometrial cancer. Rx - Evista 60mg daily. This drug also decreases your risk of breast cancer!!
There a 1-3% bone loss per year in women during early menopause. Estrogen is a preventive treatment and needs to be taken over a lifetime. Don't forget to exercise and maintain a healthy lifestyle.
NEJM 5/2007 p2293
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