The American Geriatrics Society - Education

Osteoporosis
Todd P. Semla, PharmD

Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until a sudden strain, bump, or fall causes a fracture or a vertebra to collapse.

Q. What is osteoporosis?

A. Osteoporosis is a skeletal disease in which bones become thinner and more porous, and more prone to fracture. Osteoporotic fractures most commonly occur in the hip, spine, and wrist. The disease is usually painless until a bone breaks or fractures. In order to diagnose osteoporosis, a person's bone density, or bone mineral content, must be measured.

Q. How common is osteoporosis?

A. Osteoporosis is very common among older women. It is estimated that 9.4 million women in the United States have osteoporosis. Another 16.8 million women have a bone density that is below normal.

Q. How do I know if I am at risk for osteoporosis?

A. Although advanced age is a well-known risk factor for both men and women, the disease is far more prevalent in post-menopausal women due to the loss of the hormone estrogen. Other risk factors for women include an early or premature menopause, either naturally or by surgical removal of the ovaries, with no hormone replacement therapy; exercising so strenuously that one's menstrual period stops; having a small body frame; excessive use of alcohol; cigarette smoking; low dietary intake of calcium; and a high dietary intake of protein. For men, low levels of the male hormone testosterone increase risk. More often, however, the cause of osteoporosis in men is chronic alcoholism. Certain medications, such as glucocorticoids (e.g., prednisone), heparin, and phenytoin (Dilantin©); primary hyperparathyroidism; and a positive family history also increase the risk for osteoporosis in both men and women.

Q. How can my doctor determine if I have osteoporosis?

A. For persons with no obvious signs of osteoporosis, the only way to diagnosis the disease is to measure one's bone density using bone densitometry. This is a simple test, much like an x-ray, which uses a very low dose of radiation to measure bone density in the spine, hip, wrist, or heel. Your doctor may want to measure specific areas based on your age and history. You may also need to have the test repeated every two to four years, particularly if you are taking medications that can increase bone density. Your doctor should measure your bone density prior to starting you on medications that will preserve your bone density.

Q. How can I reduce my risk of osteoporosis?

A. Your risk for developing osteoporosis can be reduced by doing weight bearing exercise such as walking, jogging, weight lifting or playing a sport such as tennis; and making sure you get enough calcium and vitamin D through diet and supplements. Postmenopausal women should consume 1,200 mg of calcium each day. Persons 51 to 70 years should consume 400 IU of vitamin D daily, and those 71 and older should consume 600 IU daily. Hormone replacement therapy such as estrogen or other medications designed to prevent bone loss are also effective ways to reduce the risk of osteoporosis in postmenopausal women.

Q. Once diagnosed, can osteoporosis be treated?

A. Several medications are available that can either maintain or even increase bone density when taken in combination with calcium and vitamin D. These medications include hormone therapies such as conjugated estrogens (such as Premarin© or the combination estrogen/progesterone pill, Prempro©); raloxifene (Evista©); alendronate (Fosamax©); and calcitonin (Miacalcin©) which can be taken as a nasal spray or by subcutaneous injection. Other measures can be taken to prevent fractures or falls including gait and strength training to improve balance, and learning new ways to safely perform everyday activities.

Q. Where can I find out more information about osteoporosis?

A. Contact the following organizations:

National Osteoporosis Foundation
1232 22nd Street, N.W. Washington, DC 20037-1292
Telephone: (202) 223-2226
Website: www.nof.org

National Institutes of Health
Osteoporosis and Related Bone Diseases National Resource Center
1232 22nd Street
Washington, DC 20037-1292
Telephone: (202) 223-0344, (800) 624-BONE, or (202) 293-2356
Email: orbdnrc@nof.org
Website: www.osteo.org

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