About Your Diagnosis
Osteoporosis is a metabolic bone disease in which bones become brittle,
predisposing them to fractures.
Decreased estrogen levels in postmenopausal women is one of the most
common causes of osteoporosis. Oral steroids taken for asthma or arthritis
may also cause osteoporosis. Osteoporosis may be caused by poor nutritional
intake of vitamins and minerals, such as calcium and vitamin D.
smoking, alcohol consumption, and a sedentary lifestyle predispose individuals
to osteoporosis. Small Caucasian women with a positive family history
of osteoporosis are at high risk. Hyperthyroidism, hyperparathyroidism,
or Cushing's syndrome can also lead to osteoporosis.
Osteoporosis has been diagnosed in 46 million individuals in the
United States. It is four times more common in women than men. Risk
increases with age. There are at least 275,000 osteoporotic fractures
of the hip every year.
Osteoporosis may be detected on an x-ray of a bone.
osteoporosis must be advanced to be noticeable on x-ray. Dual- energy
x-ray absorptiometry (DEXA) is a more sensitive measure of bone density
and can be used to follow bone density over time. Osteoporosis is defined
as a bone density of 2.5 standard deviations below the peak mean bone
density of the general population. Patients with bone densities below
this level are at high risk for having fractures. Patients with intermediate
bone densities and a previous history of fracture also have osteoporosis.
Osteoporosis may be prevented or cured with proper medical therapy.
Living With Your Diagnosis
Many individuals with osteoporosis have no symptoms. Some have a loss
of height and curvature of the spine. Others may have pain from a hip,
spine, or wrist fracture.
Regular weight-bearing exercise such as walking is excellent preventive
therapy. Dietary calcium intake should be between 1,000 and 1,500 mg
of elemental calcium a day. Vitamin D is necessary for the absorption
of calcium from the diet; 400800 international units (IU) of vitamin
D is recommended daily. Postmenopausal women should also consider estrogen
replacement therapy with 0.625 mg of conjugated equine estrogen per
day. Alendronate, an oral bisphosphonate, in a dosage of 510 mg
once a day has been approved for the prevention of osteoporosis. All
of these preventive therapies may also be used in patients with established
osteoporosis. In addition, calcitonin, available as a nasal spray or
as an injection, is indicated for women who cannot take estrogen and
who are postmenopausal by more than 5 years. Surgery is often required
to repair fractured bones.
Side effects of treatment may include kidney stones caused by excess
calcium replacement, vitamin D toxicity, or esophageal ulcers caused
by alendronate therapy. Estrogen therapy has been associated in some
studies with a mild increase in the risk for breast cancer, and a marked
increase in endometrial uterine cancers. Women who have not had a hysterectomy
must take estrogen in combination with a progestin to minimize the risk
of endometrial cancer. Estrogen may also lead to breast tenderness and
resumption of menses in postmenopausal women. Benefits of estrogen therapy
include a markedly decreased risk of coronary artery disease and increased
vaginal lubrication. Each woman with osteoporosis should discuss individual
concerns about estrogen replacement therapy with a knowledgeable physician
before beginning this therapy. Raloxifene (Evista) is a newer product
recently approved for the prevention of osteoporosis. It shares some
of the benefits of estrogens such as increased bone density and lowering
of lipids and is without significant adverse effects on the endometrium
and breasts. It can, however, cause hot flashes and increase the risk
* Minimize any risk factors for osteoporosis by quitting cigarette smoking,
decreasing alcohol or caffeine intake, increasing exercise, and taking
adequate calcium and vitamin D.
* Have a vitamin D level measured in your blood, especially if you live
in a northern climate and have low sun exposure.
* Have regular breast examinations and mammograms if you take estrogen.
* Don't take alendronate with food; it will not be absorbed.
* Don't take alendronate when you lay down; it may cause esophageal
ulcers. Instead, stand up and take it with a full glass of water.
* Don't take calcium without consulting your doctor if you have a history
of kidney stones or hyperparathyroidism.
* Don't take more vitamin D than recommended by your physician.
* Don't take estrogen alone if you are postmenopausal and you have a
uterus. Instead, take estrogen with a progestin.
When to Call Your Doctor
* You wish to have a bone density measured.
* You would like an assessment of your current calcium intake.
* You notice any new hip, back, wrist, or rib pain, especially if it
occurs after falling, coughing, or sneezing.
* You wish to discuss the risks and benefits of estrogen replacement.
* You notice a new lump on your breast.
* You have heartburn while taking alendronate.
For More Information
National Osteoporosis Foundation
1150 17th Street, Suite 500 NW
Washington, DC 20036-4603
The Endocrine Society
4350 East West Highway, Suite 500
Bethesda, MD 20814-4410