What is it?
Osteoporosis is a disease of bone loss. Simply put, it means that the
tissue in your bones has deteriorated, making them weak, brittle and
more likely to fracture. A diagnosis of osteoporosis means you have
at least 25-percent less bone mass than a healthy adult your age.
Osteoporosis occurs when more of your bone tissue is being taken
away from your bones (a process called resorption) than is being
created (formation). Bone formation usually peaks at age 30; after
that, resorption happens slightly more quickly than formation,
but has few ill effects in most people. However, in some people
this process happens much more quickly than normal, causing
osteoporosis. What is often not realized is that, untreated, osteo-
porosis is a crippling, painful and debilitating disease that can lead to
other serious health complications and even death. Fortunately, it is
• Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the
• In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million
more are estimated to have low bone mass, placing them at increased risk for osteoporosis.
• While osteoporosis is often thought of as an older person’s disease, it can strike at any age.
• Of the 10 million Americans estimated to have osteoporosis, eight million (80%) are women and two
A diagnosis of osteoporosis is usually made based on the following:
• When a hip or vertebral fracture or any “fragility fracture” has occurred. This is a broken bone that
has happened with no trauma or minimal trauma, such as if you were to cough or fall to the floor from a
standing position. The diagnosis in this case would be after you have experienced a fracture. Clearly the
better choice is to find out if you have osteoporosis by measuring your bone density BEFORE a fracture
occurs. If you have had a fracture in adulthood that you are not sure is fully explained by its
circumstances, get a bone density scan.
• A bone density T-score ≤ -2.5 at the femoral neck or spine after appropriate evaluation to exclude
Bone mineral density -
The gold standard for osteoporosis screening is the dual energy X-ray
absorptiometry (DXA or DEXA). This painless and quick procedure assesses the bone density of your hip
and spine and will provide a T-score for each that tells you about your bone mineral density (BMD) relative
to the bone density of a young adult female:
• If your T-score is between +1 and -1, your bone density is normal
• If your T-score is between -1.0 and -2.5, you have begun to experience bone loss, or osteopenia
• If your T-score is equal to or less than -2.5, you have osteoporosis
Each drop in bone mineral density by one point represents the loss of 10 to 15 percent of bone mass.
For example, if you move from -1 to -2 between screenings, you have lost approximately 10 percent of
your bone mass. Normal bone loss is about 1 to 2 percent a year as you age.
T-scores are based on the
NHANES reference values for women aged 20-29 years. The same absolute values are used in men.
You can take the DXA test every two years to monitor the effectiveness of medication or any changes in
your bone density. Some doctors will prescribe annual screenings for patients whose bone loss should be
In general, bone density testing is strongly recommended if you:
• are a post-menopausal woman and not taking estrogen.
• have a personal or parental history of hip fracture or smoking.
• are a post-menopausal woman who is tall (over 5 feet 7 inches) or thin (less than 125 pounds).
• are a man with clinical conditions associated with bone loss.
• use medications that are known to cause bone loss; these include glucocorticoids (steroidal anti-
inflammatories) such as Prednisone, taken for more than 3 months at a dose of 5mg daily or
more; various anti-seizure medications such as Dilantin and certain barbiturates, or high-dose
• have type 1 (formerly called juvenile or insulin-dependent) diabetes, rheumatoid arthritis, liver
disease, kidney disease, osteogenesis imperfecta in adults, untreated long-standing hyper-
thyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition or
malabsorption, chronic liver disease or a family history of osteoporosis. Osteoarthritis is not
• have high bone turnover, which shows up in the form of excessive collagen in urine samples.
• have a parathyroid condition, such as hyperparathyroidism.
• have experienced a fracture after only mild trauma.
• have had x-ray evidence of vertebral fracture or other signs of osteoporosis.
The Lateral Vertebral Assessment (LVA), a low-dose x-ray examination of the spine to screen for vertebral
fractures that is performed on the DXA machine, may be recommended for older patients, especially if:
• they have lost more than an inch of height.
• if a DXA scan gives borderline readings.
- You may be at increased risk if you have 3 or drinks/day. One drink of alcohol varies slightly in
different countries from 8-10g. This is equivalent to a standard glass of beer (285ml), a single measure of
spirits (30ml), a medium-sized glass of wine (120ml), or 1 measure of an aperitif (60ml).
Previous fracture -
A special situation pertains to a prior history of vertebral fracture. A fracture
detected as a radiographic observation alone (a morphometric vertebral fracture) counts as a previous
fracture. A prior clinical vertebral fracture from which the patient suffers consequences, is an especially
strong risk factor. The probability of fracture computed may therefore be underestimated. Fracture
probability is also underestimated with multiple fractures.
About 85-90% of adult bone mass is acquired by age 18 in girls and 20 in boys. Building strong bones
during childhood and adolescence can help to prevent osteoporosis later in life.
Together, the following five steps can optimize bone health and help prevent osteoporosis:
Get the daily recommended amounts of calcium and vitamin D
Age 19-50, each day you need 1000 mg of calcium & 200 IU of vitamin D.
Age 51-70, each day you need 1200 mg of calcium & 400 IU of vitamin D.
Age > 70, each day you need 1200 mg of calcium & 600 IU of vitamin D.
You can only absorb about 500 mg of calcium at a time. The best way to get it is in your food.
Engage in regular weight-bearing and muscle-strengthening exercise. Weight-bearing exercise,
like walking, dancing, or lifting even light weights, 30 minutes a day, which can be done in 10
Talk to your healthcare provider about bone health
Have a bone density test and take medication when appropriate
A study of disease management in a rural healthcare population demonstrated that a preventive program
was able to reduce hip fractures and save money.
Although there is no cure for osteoporosis, it can be treated. The following medications are approved by
the FDA to prevent and/or treat osteoporosis:
Antiresorptive Medications –Bisphosphonates
• Alendronate and alendronate plus vitamin D3 (brand names Fosamax® and Fosamax plus D™).
Alendronate is approved for the prevention and treatment of osteoporosis in postmenopausal women and
for the treatment of osteoporosis in men. It also is approved for the treatment of glucocorticoid-induced
osteoporosis in men and women as a result of long-term use of steroid medications.
• Ibandronate (brand name Boniva®).Ibandronate is approved for the prevention and treatment of
osteoporosis in postmenopausal women.
• Risedronate and risedronate with calcium (brand names Actonel® and Actonel® with Calcium).
Risedronate is approved for the prevention and treatment of osteoporosis in postmenopausal women
and for the treatment of osteoporosis in men. It also is approved for the prevention and treatment
of glucocorticoid-induced osteoporosis in men and women as a result of long-term use of steroid
• Zoledronic Acid (brand name Reclast® aka Zometa®). Zoledronic acid is approved for the treatment of
osteoporosis in postmenopausal women and men.
Other Antiresorptive Medications
• Calcitonin (brand names Fortical® and Miacalcin®). Calcitonin is approved for the treatment of
osteoporosis in postmenopausal women who are at least five years beyond menopause.
• Estrogen (multiple brand names available). Estrogen therapy (ET) and estrogen with progesterone
hormone therapy (HT) are approved for the prevention of osteoporosis in postmenopausal women.
According to the FDA, postmenopausal women should consider other medications before taking ET or HT
to prevent osteoporosis due to risks associated with these medications. They should also be used in the
lowest possible dose for the shortest period of time to meet treatment goals.
• Estrogen Agonists/Antagonists also known as Selective Estrogen Receptor Modulators (SERMs)
–Raloxifene (brand name Evista®). Raloxifene is approved for the prevention and treatment of
osteoporosis in postmenopausal women. Tamoxifen, a breast cancer preventative, is also a SERM.
Bone Forming (Anabolic) Medications
Parathyroid Hormone –Teriparatide (brand name - Forteo®). Teriparatide, a type of parathyroid hormone,
is approved for the treatment of osteoporosis in postmenopausal women and in men who have very low
BMD or are at high risk for a fracture. The FDA recommends that individuals take teriparatide for no more
Prescriptive Nutritional Supplements
Fosteum®, which is a prescription supplement containing genistein aglycone, a soy ingredient; citrated
zinc bisglycinate, a nutrient used by the body; and cholecalciferaol (vitamin D). When taken with
sufficient calcium and Vitamin D, it has been shown safely to build bone density in people with osteopenia
without causing increased risk of estrogen-positive breast cancer. Fosteum has also been shown to
decrease hot flashes & night sweats associated with menopause.
When you open this PDF file on your computer, you can click directly on the web links
included below to connect to these websites.
Internat’l Society for Clinical Densitometry, http://www.iscd.org/Visitors/patient/PatientInformation.cfm
National Health and Nutrition Examination Survey, http://www.cdc.gov/nchs/nhanes.htm
National Osteorporosis Foundation, www.nof.org
Radiology Info, http://www.radiologyinfo.org/en/info.cfm?pg=dexa
World Health Organization FRAX Risk Assessment Tool, www.shef.ac.uk/FRAX/index.htm
Food Sources of Calcium from http://www.healthlinkbc.ca/healthfiles/hfile68e.stm
This brochure was compiled by Kathi Kolb, M.S.P.T., who is a physical therapist and a certified
osteoporosis educator. She is also a breast cancer survivor and the daughter of a woman who
died of complications from osteoporosis.
Visit her blog at www.accidentalamazon.com.
Revised September 29, 2009
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