Osteoporosis or thinning of the bones, is the most common metabolic bone disease in the Western world. Osteoporosis is twice as common in women as it is in men. One out of two women will experience at least one fractured bone due to osteoporosis by age 70. The most common fractures resulting from osteoporosis are fractures of the wrist, the hip and the spine. Of the women who experience hip fractures, up to 20% will die within one year. Fifty percent of those who survive hip fractures will never walk independently again.

The best treatment for osteoporosis is prevention. The risk of  developing osteoporosis can be decreased by consuming adequate amounts of calcium and vitamin D, by taking Estrogens or estrogen related drugs after menopause and by performing at least 20 minutes of weight bearing exercise, i.e. walking, at least three times a week. There are several medications which may also help to reverse osteoporosis.

The vast amount of attention that has been devoted to breast cancer awareness in recent years has convinced many women that breast cancer is the greatest threat to their survival and well being. The fact is that, starting at age 50, heart disease is the number one killer of women. The life time risk a woman developing heart disease is 66% and the risk of her developing osteoporosis related fractures is 50% but a woman's lifetime risk of developing breast cancer is only 9% and her risk of dying from breast cancer is 2.8%. In the last decade, more American women have died each year as a result of hip fractures than have died of breast cancer.

 Factors that increase the risk of developing osteoporosis include:  Female gender, slight build, early menopause or surgical removal of the ovaries, lack of exercise, inadequate  dietary calcium, smoking, long term use of corticosteroids (i.e. prednisone), excessive thyroid hormone and the presence of any chronic, debilitating disease.

 Osteoporosis is a severely under diagnosed condition. All too often, the diagnosis of osteoporosis is not made until after a person has suffered an osteoporotic fracture. It has been recommended that bone density testing become a part of routine health maintenance in women over age 60. The prevention of osteoporosis with calcium, exercise and medication as well as early diagnosis give us the opportunity to help prevent broken bones, long term disability and death that may result from osteoporosis.

PREVENTION AND TREATMENT OF OSTEOPOROSIS IN WOMEN

During the course of our lives, the minerals from our bones are constantly being reabsorbed into our blood stream and redeposited  back into bone matrix. Women begin to lose more minerals from their bones than they put back starting at age 35. From that time on, the loss of bone mineral density continues at a slow, constant rate until menopause when, in the absence of the hormone estrogen, the bones suddenly begin losing mineral density at a dramatically more rapid rate.  Loss of bone mineral continues throughout the rest of a woman's life at a rate of 1% to 1.5% per year.  As the amount of mineral in bones decreases, the risk of bones fracturing from the stresses of the normal activities of daily living increases. 

Once bone density has declined to the point where a woman's fracture risk has reached five times the fracture risk of a normal, healthy 30 year old woman, then we give the condition the name Osteoporosis.  Ideally, we would like to prevent this condition from occurring or, at the very least, to diagnose and treat it before a woman suffers from fractured bones.

Factors that increase the risk of developing osteoporosis include:  Female gender, white race, slight build, early menopause or surgical removal of the ovaries, lack of exercise, inadequate dietary calcium and vitamin D, smoking, excessive alcohol consumption, long term use of corticosteroids (i.e. prednisone), excessive thyroid hormone and the presence of any chronic, debilitating disease.

Various steps can be taken by all women to help minimize bone loss.  Those women at particularly high risk for developing osteoporosis can have their bone density measured with various tests.  Treatments are available that both slow down the loss of existing bone and actually help to rebuild bone.  The best time for diagnosis is before fractures have occurred.

CALCIUM  The minimum daily requirement of calcium in postmenopausal women is 1500 mg. per day.  Calcium in combination with Magnesium is optimal since both minerals are needed to create bone matrix.  Absorption will be better if calcium is  taken in several small servings instead of one large one.  There are many good calcium supplements available.  Calcium citrate and chelated calcium supplements are the best.  Oyster shell is the most POORLY absorbed calcium.

One test to see if your calcium is going to be available to be absorbed from your  intestinal tract is to drop one pill into a glass of vinegar. If a Calcium pill won't dissolve in vinegar, it probably won't dissolve in your stomach either! 

The consumption of caffeine causes increased loss of calcium through the kidneys thus increasing the daily requirement for calcium.

 VITAMIN D  Vitamin D is essential for the absorption of  calcium from the intestinal tract.  Fifteen percent of postmenopausal women lose the ability to turn sunlight  into Vitamin D.  It is recommended that all postmenopausal women consume 800 units of  Vitamin D each day.

WEIGHT BEARING EXERCISE  A minimum of 20 minutes of continuous weight bearing exercise (walking) three times a week will help to keep bones strong and healthy.

ESTROGEN  The use of estrogens in postmenopausal women has been shown to slow down bone loss and to increase bone density slightly.  The use of estrogens has been shown to decrease the risk of osteoporotic fractures by 50%.  Estrogens also lower the risk of cardiovascular disease, slow down the onset of Alzheimer's disease, lower the risk of colon cancer, help to relieve hot flashes and vaginal dryness and keep skin younger and more pliable.

On the minus side, in women who still have a uterus, estrogens may cause post menopausal bleeding and increase the risk of endometrial cancer if taken without a progesterone.  Estrogens also slightly increase the risk of thromboembolism (blood clots).  A few studies have demonstrated a small increase in the lifetime risk of developing breast cancer in women who take estrogens.

TESTOSTERONE  The addition of small amounts of testosterone to estrogen replacement therapy has been shown to further increase bone density.  Testosterone has also been shown to increase the female sex drive and to increase energy levels and general sense of well being.  Testosterone, at low doses, has not been shown to have a negative impact on the lipid profile.

Excessive use of testosterone may cause acne, deepening of the voice and growth of unwanted facial and body hair.

PROGESTERONE  The use of progesterone has been shown to help improve bone density.  Progesterone decreases the risk of uterine cancer associated with estrogen replacement.  Progesterone has a somewhat negative effect on the lipid profile.  It slightly lowers HDL (good cholesterol) and increases LDL (bad cholesterol).  The use of progesterones has also been associated with breast tenderness and mood swings.

EVISTA  Evista is a synthetic compound that acts like an estrogen in some ways but not in others.  It lowers the fracture risk as estrogen does.  It also helps to improve the lipid profile but not quite as well as estrogens.  It may actually lower the risk of developing breast cancer.

On the minus side, Evista has not been shown to prevent Alzheimer's symptoms. It does not help to reverse vaginal dryness and it can actually cause hot flashes in up to 25% of the women who take it.  Like estrogens, Evista also increases the risk of blood clots.  Evista may be a good choice for women with a strong family history of breast cancer or in those who have had breast cancer and have completed a course of Tamoxifen.

CALCITONIN  Calcitonin is the hormone that comes from the parathyroid glands.  Its purpose is to slow down the reabsorbtion  of bone.  It is available in a nasal spray. Used daily, it has been shown to increase bone density and to reduce fracture risk.  Its main side effects are local irritation in the nose and occasionally, headaches.

ACTONEL and FOSAMAX  are the "gold standard" of the drugs that improve bone density.  Unfortunately, these drugs can be quite irritating to the stomach and gastrointestinal tract.  To minimize these side effects, they must be taken first thing in the morning on an empty stomach with a full 8 ounce glass of water.  The person must remain upright and refrain from eating or taking any other medications for a full 30 minutes after the pill is ingested.

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