Screening, testing, treatment, and prevention of osteoporosis are a part of comprehensive menopause care.
Osteoporosis is a common condition resulting in serious and painful fractures that can result in disability and death. Osteopenia is an earlier stage of osteoporosis that can only be diagnosed by bone densitometry testing. Women are far more likely than men to suffer from osteoporosis related fractures, and disability than men.
Your risk of osteoporosis depends on many factors including your age and menopausal status, family history, medications, alcohol use, smoking, exercise level, nutrition, and body weight. Women with multiple risk factors should receive bone density testing at an earlier age, perhaps as young as 45 or 50, while those with no risk factors also need testing, but it can be delayed to age 65. All women over 65 should be tested at least once every 10 years for osteoporosis.
Bone densitometry is an x-ray specifically designed to assess the quality of the bone in the hips and spine. The heel and wrist ultrasound tests are easier and cheaper to perform, but are not as accurate and should not be used as the basis for treatment.
The results of bone densitometry are expressed as statistical measures that compare your bone density with the expected bone density for a woman your age, and use that data to predict your likelihood of suffering a facture. Osteopenia is a bone density that is lower than normal for your age, while osteoporosis is a more severe degree of bone loss that has a high likelihood of causing a fracture.
Treatment and prevention of osteoporosis overlap to a great degree. Medications and interventions that are known to treat osteoporosis are often used for those with osteopenia – the lower degree of bone loss – to prevent progression to more severe disease. Once a fracture has occurred, the options are more narrowed, since weight bearing exercise may no longer be possible, and the effectiveness of medications is limited.
Weight bearing exercise is the cornerstone of prevention and treatment. “Use it or lose it” applies to your bones and muscles as well as to your brain. Walking is the most practical form of weight bearing exercise, along with aerobics, dance, resistance training (weight lifting) and jogging. We recommend 30-60 minutes sessions at least 3 times per week for prevention of osteoporosis. Exercise is always more enjoyable if set to music. Your ipod is your most enjoyable piece of exercise equipment.
Alcohol intake and smoking are also strongly linked to osteoporosis and you can reduce your risk significantly by avoiding excess alcohol intake and / or quitting a smoking habit. The additional health benefits of both of these measures are compelling, and we can help you kick your habit.
Vitamin D, both D2 and D3, and calcium are also essential to bone health. Your diet should include dairy products, lactose free if necessary, and green leafy vegetables since nutritional sources of calcium are better absorbed and have additional nutrients that you need. Supplements are available over the counter, and are quite inexpensive. 1200 total mg of calcium, including dietary calcium and supplementation are recommended. Calcium is best absorbed in an acid environment and so products containing vitamin C (ascorbic acid) improve absorption, while stomach acid reducers like Prilosec and Tagamet reduce absorption. Women with a history of kidney stones should avoid overdosing on calcium supplements; dietary intake is less likely to provoke stone formation.
Vitamin D is found in daily products and is produced in your skin with sun exposure. At least some of your exercise should occur outdoors to facilitate vitamin D formation. Dietary supplements for Vitamin D are also available over the counter, and 800 UI per day is the recommended dose for women over 50.
Hormone replacement is another tool we have to reduce the risk of osteoporosis. Estrogen enhances the absorption of calcium and vitamin D, and directs the mobilization of calcium from the blood stream into the bones. If hormone replacement is needed for other reasons, for example hot flashes, it is an effective treatment for osteoporosis. Of course there are risks associated with the use of hormone replacement including breast cancer and blood clots.
A related medication called Evista (raloxifene) is also available; it is an estrogen receptor stimulator that mobilizes calcium into the bones. Evista does not increase the risk of breast cancer, in fact it reduces the risk of breast cancer. Evista can cause hot flashes to get worse, and it can cause blood clots in people who are predisposed to them.
The largest class of medications for the treatment and prevention of osteoporosis are the bisphosphonates, including Fosomax and Actonel. Some of these medications are taken by mouth, but are associated with side effects like gastric upset and esophagitis. Other bisphosphonates are available in injectable forms, with an injection every 6 months, or an IV infusion once a year. Bisphosphonates can cause rare complications including osteonecrosis of the jaw, and you should alert your dentist if you are taking these medications. Blood tests for calcium and magnesium levels as well as kidney function may be necessary while using these medications.
A FRAX analysis is a computerized analysis that can be done using data from your bone density test results, age and other risk factors, to calculate your fracture risk. This information can be used to help you decide whether to take medications for osteoporosis taking into consideration costs, side effects, and your other conditions and medications.
Dr. Holley can help you navigate the ins and outs of osteoporosis so that you can enjoy a long and healthy life without the pain and disability associated with osteoporosis.