What Can Be Done About Osteoporosis?
Prevention and treatment

Osteoporosis is a skeletal disease characterized by severe bone loss, and is a common cause of fractures (broken bones), especially in women who are beyond menopause. However, by strengthening your bones, slowing bone loss, and avoiding falls, you can help prevent or treat the condition and avoid fractures.

Diet
Prevention and treatment of osteoporosis begins with proper diet. Ensuring that you get enough calcium and vitamin D each day is a great start. Calcium helps your body build bone, and vitamin D helps your body absorb calcium. Calcium can be found in dairy products (e.g., milk, cheese, yogurt, and ice cream); in salmon and sardines with bones; in dark green leafy vegetables (e.g., kale and broccoli); and in food with added calcium, such as orange juice. The National Osteoporosis Foundation recommends the following calcium intake each day:

• 800 mg for children ages 1-11
• 1200 mg for ages 11-24
• 1000 mg for adults
• 1200 mg for pregnant and lactating women
• 1500 mg for postmenopausal women not on estrogen.

You need at least 400 international units (IU) of vitamin D each day. You can get your daily requirement by taking a multivitamin; getting 30 to 60 minutes of sun exposure, or consuming foods that contain vitamin D, such as fortified milk (a 1-cup serving contains 100 IU) or salmon (a 3-ounce serving contains 425 IU). Although vitamin D in adequate amounts helps your body absorb calcium, it is harmful if taken in excessive amounts. Most people should avoid taking more than 800 IU a day. Exercise

You can help reduce the risk of developing osteoporosis by exercising regularly. Furthermore, exercise, as part of the treatment for osteoporosis, stabilizes bone density and helps reduce the risk of bone fracture. Your regular exercise program should include weight-bearing and resistance exercises that strengthen bones and muscles. Weight-bearing exercises include activities such as walking, jogging, dancing, hiking, and housework. Resistance exercises include weight training and pushups. You should participate in an exercise program three to five times each week. Remember to talk with your doctor before starting any exercise program. Your health care professional can help you create a program that fits your needs and abilities.

Medication
Your doctor may prescribe various medications that help slow the loss of bone mass so your body can build new bone as old bone is lost. Currently, the US Food and Drug Administration has approved estrogen, alendronate, raloxifene, risedronate, and calcitonin to help in the treatment of osteoporosis.

Hormone replacement therapy for the replacement of estrogen is one of the most valuable options for women who are candidates for such medication. In addition to the treatment of bone loss, the benefits of this therapy includes a reduction in the risk of heart disease and in the symptoms of menopause. Unfortunately, some women cannot or will not take estrogen because of side effects (e.g., breast tenderness, slight bloating, and vaginal bleeding), certain risk factors (e.g., endometrial [lining of the uterus], breast, or uterine cancer), or other associated problems (e.g., uncontrolled hypertension, impaired liver function, or porphyria). Some women may not be able to take estrogen if they have problematic diabetes, gallbladder disease, migraine headaches, pancreatitis, high triglyceride levels, or endometriosis. However, these women may be able to take other medications, such as alendronate (Fosamax), calcitonin, or calcium plus vitamin D. Talk with your doctor to find out which is best for you.

Home safety
Falls often lead to fractures in people with osteoporosis. To prevent falls, create a safe home. Remove or anchor rugs and furniture that can cause you to trip. Install night-lights and grip-bars in your bathroom, and use a rubber mat in the bottom of your bathtub. Keep regularly used items at a height you can reach easily without a stool. Make sure that the rooms in your home are well lit.

Screenings and lifestyle changes
By age 30, you and your doctor should discuss your risk of developing osteoporosis. Regular osteoporosis screenings that may include a bone density test should begin for women by age 65 and for men by age 75. Younger men and women should have these regular screenings if they have any of the following risk factors: alcoholism, heavy tobacco use, or have an associated disease (e.g., hyperparathyroidism [excessive parathyroid hormone], disease treated with steroids, glandular disease, or advanced kidney or liver disease.)

In addition to checkups, you can help prevent osteoporosis by making some lifestyle changes. Stop smoking and decrease your alcohol intake. Increase your physical activity level and improve your diet.

Prevention of osteoporosis is obviously preferred to treatment, but adequate treatment can reduce the risk of fracture, increase bone mass, improve mobility, and reduce pain. Both men and women should be concerned about osteoporosis and should not wait until signs and symptoms appear before taking action. Education, wise lifestyle choices, and regular screenings can reduce the likelihood that the disease will affect your quality of life.

Clark H. Cobb, MD
Columbus, Georgia