Osteoporosis Questions and Answers

Q: Why is osteoporosis called a "silent disease"?

A: Osteoporosis is sometimes called a "silent disease" because it can occur gradually over many years without your knowledge. Often the very first symptom of osteoporosis is a broken bone, also called a fracture that usually happens at the hip, spine or wrist. Osteoporosis thins and weakens your bones, making them fragile and more likely to break. But the good news is that osteoporosis can be prevented and treated. Early detection is important; therefore, you should discuss your concerns with your health care professional soon.

Q: Can't I just take a multi-vitamin to prevent osteoporosis?

A: No! Most multi-vitamins contain only minimal quantities of calcium. Calcium carbonate and calcium citrate are available over-the-counter as supplements if your diet is low in this essential mineral. Girls age nine to 18 need 1,300 mg/calcium/daily (the equivalent of three, eight-ounce glasses of milk plus trace sources found elsewhere in the diet will be enough). The average woman age 19 to 50 needs 1,000 mg/calcium/daily for the average woman. And women 50 and older should be getting 1,200 mg/calcium/daily. In addition, be sure your diet (or supplement) also provides between 400 IU (international units) and 600 IU of vitamin D, which helps your body absorb calcium. Taking the recommended daily amount of calcium and vitamin D can cut your risk of fracture by as much as half, particularly in older women. Calcium is found in other dairy products besides milk. Yogurt and cheese also contain calcium. Fortified orange and other juices and many types of grains are other sources.


Q: If I've already reached the age of menopause, isn't it too late to do anything about osteoporosis?

A: It's never too late to make lifestyle changes and receive the appropriate treatments for osteoporosis. Although you can't restore all the bone that has already been lost, you can build some new bone and prevent bone loss with a diet rich in calcium and vitamin D, a program of weight-bearing exercise, and, in some cases, medications.

Q: Isn't it true that we get shorter as we age?

A: Substantial loss of height and a stooped posture are not normal results of growing older and can be signs of multiple fractures in the spine or back. Height loss of one to one and one-half inches can be due to degenerative risk disease and not necessarily osteoporosis related. Frequently, individuals don't know they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or vertebra to collapse. It is these collapsed vertebra that lead to loss of height, stooped posture and other spinal deformities.

Q: If I have one or more of the risk factors for osteoporosis, does that mean that I probably have the disease but don't know it?

A: Not necessarily. Your health care professional will take into account a number of factors in determining your likelihood of developing osteoporosis. These include your personal health history, your individual osteoporosis risks, your lifestyle - including whether you exercise and are getting adequate calcium - and possibly the results of a bone mineral density (BMD) test. This quick test measures bone strength, predicts if your bones are at risk for fracture, may be helpful in monitoring the effects of treatment if the test is conducted at intervals of a year or more, and can help predict your future risk for osteoporosis. If you are concerned about your risks, be sure to discuss osteoporosis with your health care professional. Bone density tests are the single best way to predict your risk of fracture.


Prevention and Treatment of Osteoporosis

Q: Is the test for osteoporosis painful?

A: No! A BMD test is safe, quick and painless. Simple measurements are usually taken of the bones in your hip, wrist and spine. You typically remain clothed during the procedure. No dyes are injected. There are several types of BMD tests; some may use a very small amount of radiation, while others do not. Talk with your health care professional to learn more about the procedure and to further alleviate any fears you may have about this simple exam and, be sure to ask your health care professional what your test results mean, when you get them.

Q: My health care professional recommended that I start working out with weights, but I'm afraid of lifting such heavy weights. What should I do?

A: Good news: You don't have to lift heavy weights to benefit from strength training. You should lift a light amount of weight and gradually increase your threshold as your strength increases. The goal is to build bone and muscle strength - not muscle mass, which requires numerous lifts with heavy weights. So enjoy this important activity and work at your own pace. Just remember, if you do not routinely exercise, ask your health care professional to recommend a simple, safe program and start soon.


Q: What medications are available to prevent and treat osteoporosis?

A: There are several medications approved by the U.S. Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis. These medications may postpone bone loss indefinitely, but only when they are taken regularly. Medications currently available include postmenopausal hormone therapy- which are most often prescribed to relieve the symptoms associated with menopause - and the drugs alendronate (Fosamax), calcitonin (Miacalcin), raloxifene (Evista) and risedronate (Actonel). Teriparatide (Forteo), a new drug approved by the FDA in 2002, is the first medication that actually stimulates bone formation instead of slowing the breakdown of bone, as do some other osteoporosis drugs. As with any medication therapy, there are risks and side effects associated with each of these medications. Ask your health care professional for more information.

New studies published in July 2002 suggest that the health risks associated with use postmenopausal hormone therapy outweigh the benefits of using it for most women.

As a result of the studies, the FDA now requires a new, highlighted and boxed warning on all estrogen products for use by postmenopausal women. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen - risks identified by at least one of the major studies.

The "black-box" warning also advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time.

New, lower-dose versions of the hormone therapies used to treat symptoms of menopause are currently being developed. The FDA recently approved a low-dose version of the combination estrogen-progestin treatment sold as Prempro.

Ask your health care professional about the risks and benefits of any recommended treatment and how they apply to your individual health needs and personal health history.

Copyright 2003 National Women's Health Resource Center Inc. (NWHRC)