Medical information on Osteoporosis

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency or advanced age. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density.

Osteoporosis makes your bones weak and more likely to break. Anyone can develop osteoporosis, but it is common in older women. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis.

Osteoporosis is a silent disease. You might not know you have it until you break a bone. A bone mineral density test is the best way to check your bone health. To keep bones strong, eat a diet rich in calcium and vitamin D, exercise and do not smoke. If needed, medicines can also help.

Can I Lower my Chances of Getting Osteoporosis?

Get enough calcium
Women under 50 years old need at least 1,000 mg of calcium each day
Women over 50 need at least 1,200 mg of calcium
Get enough vitamin D
Women under 50 years old need at least 200 IU of vitamin D
Women over 50 need at least 400 IU of vitamin D
Get exercise everyday, like walking or biking
Don’t smoke
If you drink alcohol, don’t drink more than one glass per day

How can I Make Sure I have the Right Diet?

Read the food label to make sure you are eating the right foods
Eat foods that have calcium
Low-fat dairy products like milk, cheese, and yogurt
Green, leafy vegetables like kale and turnip greens
Tofu
Canned fish (eaten with bones)
Orange juice, cereal, and other foods that have calcium added

What Else Can I Do?

Talk to your doctor, nurse, or pharmacist about medicines you can take to build bones. You might also need calcium or vitamin D pills.

Medications to Prevent and Treat Osteoporosis

Although there is no cure for osteoporosis, several medications approved by the U.S. Food and Drug Administration (FDA) can help stop or slow bone loss, or help form new bone, and reduce the risk of fractures. Currently, alendronate, raloxifene, risedronate, and ibandronate are approved for preventing and treating postmenopausal osteoporosis. Teriparatide is approved for treating the disease in postmenopausal women and men at high risk for fracture. Estrogen/hormone therapy (ET/HT) is approved for preventing postmenopausal osteoporosis, and calcitonin is approved for treatment. In addition, alendronate is approved for treating osteoporosis in men, and both alendronate and risedronate are approved for use by men and women with glucocorticoid-induced osteoporosis. Alendronate plus vitamin D is approved for the treatment of osteoporosis in postmenopausal women and in men. Risedronate with calcium is approved for the prevention and treatment of osteoporosis in postmenopausal women.

Bisphosphonates

Alendronate (FosamaxI1), risedronate (Actonel), and ibandronate (Boniva) are medications from the class of drugs called bisphosphonates. Like estrogen and raloxifene, these bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis. Alendronate is also approved to treat bone loss that results from glucocorticoid medications like prednisone or cortisone and is approved for treating osteoporosis in men. Risedronate is also approved to prevent and treat glucocorticoid-induced osteoporosis. Alendronate plus vitamin D is approved for the treatment of osteoporosis in postmenopausal women and in men. Risedronate with calcium is approved for the prevention and treatment of osteoporosis in postmenopausal women.

Alendronate and risedronate have been shown to increase bone mass and reduce the incidence of spine, hip, and other fractures. Ibandronate has been shown to reduce the incidence of spine fractures.

Alendronate is available in daily and weekly doses, while alendronate plus vitamin D is available in a weekly dose. Risedronate is available in daily and weekly doses, while risedronate with calcium is available in a weekly dose with daily calcium. Ibandronate is available in a monthly dose and as an intravenous injection administered once every three months.

Oral bisphosphonates should be taken on an empty stomach and with a full glass of water first thing in the morning. It is important to remain in an upright position and refrain from eating or drinking for at least 30 minutes after taking a bisphosphonate.

Side effects for bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcer. There have been rare reports of osteonecrosis of the jaw and of visual disturbances in people taking bisphosphonates.

1 Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Raloxifene

Raloxifene (Evista) is approved for the prevention and treatment of postmenopausal osteoporosis. It is from a class of drugs called Selective Estrogen Receptor Modulators (SERMs) that appear to prevent bone loss in the spine, hip, and total body. Raloxifene has beneficial effects on bone mass and bone turnover and can reduce the risk of vertebral fractures. While side effects are not common with raloxifene, those reported include hot flashes and blood clots in the veins, the latter of which is also associated with estrogen therapy. Additional research studies on raloxifene will continue for several more years.

Calcitonin

Calcitonin is a naturally occurring hormone involved in calcium regulation and bone metabolism. In women who are at least 5 years past menopause, calcitonin slows bone loss, increases spinal bone density, and according to anecdotal reports, relieves the pain associated with bone fractures. Calcitonin reduces the risk of spinal fractures and may reduce hip fracture risk as well. Studies on fracture reduction are ongoing. Calcitonin is currently available as an injection or nasal spray. While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, frequent urination, nausea, and skin rash. The only side effect reported with nasal calcitonin is a runny nose.

Teriparatide

Teriparatide (Forteo) is an injectable form of human parathyroid hormone. It is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Teriparatide stimulates new bone formation in both the spine and the hip. It also reduces the risk of vertebral and nonvertebral fractures in postmenopausal women. In men, teriparatide reduces the risk of vertebral fractures. However, it is not known whether teriparatide reduces the risk of nonvertebral fractures. Side effects include nausea, dizziness, and leg cramps. Teriparatide is approved for use for up to 24 months.

Estrogen/Hormone Therapy

Estrogen/hormone therapy (ET/HT) has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spine fractures in postmenopausal women. ET/HT is approved for preventing postmenopausal osteoporosis and is most commonly administered in the form of a pill or skin patch. When estrogen – also known as estrogen therapy or ET – is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin – also known as hormone therapy or HT – in combination with estrogen for those women who have not had a hysterectomy. Side effects of ET/HT include vaginal bleeding, breast tenderness, mood disturbances, blood clots in the veins, and gallbladder disease.

The Women’s Health Initiative (WHI), a large Government-funded research study, recently demonstrated that the drug Prempro, which is used in hormone therapy, is associated with a modest increase in the risk of breast cancer, stroke, and heart attack. The WHI also demonstrated that estrogen therapy is associated with an increase in the risk of stroke. It is unclear whether estrogen therapy is associated with an increased risk of breast cancer or cardiovascular events. A large study from the National Cancer Institute indicated that long-term use of estrogen therapy may be associated with an increased risk of ovarian cancer. It is unclear whether hormone therapy carries a similar risk.

Any estrogen therapy should be prescribed for the shortest period of time possible. When used solely for the prevention of postmenopausal osteoporosis, any ET/HT regimen should only be considered for women at significant risk of osteoporosis, and nonestrogen medications should be carefully considered first.

Prevention by about age 20, the average woman has acquired 98 percent of her skeletal mass. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. There are five steps, which together can optimize bone health and help prevent osteoporosis. They are:

A balanced diet rich in calcium and vitamin D
Weight-bearing and resistance-training exercises
A healthy lifestyle with no smoking or excessive alcohol
Talking to healthcare professional about bone health
Bone density testing and medication when appropriate

Low Impact Exercise

The advantages of low-impact exercises are different and sometimes unexpected to those experienced with high-impact training. Workouts are considered to be low-impact when intensity is reduced, but the technical definition relies on whether or not both feet leave the ground during training. No-impact exercise entails motions in which neither foot leaves the ground and is often relegated to water-based routines that provide extra joint support. In this case, training is particularly gentle and is ideal for those who need to stay away from stressful motions. Low-impact workouts raise the heart rate but do not tone the muscles. Those who have been inactive for long periods of time often use these techniques to build a level of fitness so that they can comfortably begin a more intensive regimen. There are also those who use low-impact training to avoid injuries, but this low level of intensity is often not enough to achieve ambitious heart rate goals. Those who wish to improve their fitness levels while managing joint injuries sometimes use cross training, which combines low- and high-impact movements in a measured way.

Unfit individuals often enjoy low-impact aerobic routines because they are rewarding both in terms of fitness improvements and calorie burning. All cardio workouts keep the heart fit, leading to a lower, healthier pulse and better circulation at rest. Because low-impact routines produce results more slowly, it`s important to maintain a minimum of half an hour of daily exercise.

One of the biggest advantages of low-impact exercises is the fact that they don`t jar the joints. Those with arthritis, osteoporosis, or injuries turn to less intensive workouts as a way to help their bodies to heal at a gentle pace. Walking is an excellent low-impact technique, but there are more entertaining ways to improve fitness. Trampolining is often understood to be a particularly jarring exercise, but it offers enough variation and fun to keep trainers motivated while they tone. Rebounding has much to do with balance, which ensures that oft-ignored muscle groups are strengthened together with those that commonly receive focus. Trampolining allows a higher intensity workout while simultaneously reducing the strain that would result from performing the same routine on the ground. It also improves coordination and motor skills by involving the brain in the action. Those who exercise on the ground often develop noticeably on only one side of the body; a consequence that rebounding omits through maintaining an upright position.

Many beginners feel intimidated by starting a group sport or training program and find rebounding to be far less daunting. Typically, trampoline-based routines are approached with high impact movements, but less intensive movements can be done on a smaller rebounder, resulting in less joint strain. Routines needn`t be overly complicated, since the body is forced to use muscles automatically to balance itself. Because of the additional cushioning provided by the rebounder, it is possible for fit individuals to receive the benefits of low-impact and high-impact workouts simultaneously.

Simple bounces help to increase cardiac health and fitness but varied movements can target specific muscles. By raising a leg while jumping, both thighs are targeted more precisely. Doing twisting movements while jumping involves the core muscles around the torso. Raising the knees at the same time helps to ensure that all abdominal muscles are exercised at once.

The perfect exercise routine includes flexibility training, which helps to prevent injuries and stretches out tension. This form of training needn`t be a lonely endeavor, since many offer group classes. It`s often easier to stay motivated when working with a class and the guidance of a trainer ensures that the results of workouts are maximised and focused. By adding the cushioning of pads from the Trampoline Pad Shop rebounding has extra elasticity, adding to the gentleness of routines while protecting the rebounder from wear and tear.