There's no disputing the numbers - osteoporosis exacts a great toll on women. Of the estimated 28 million Americans affected by this crippling disease, 80% are female. Half of all women over age 50 will suffer an osteoporosis-related fracture. This Patient Handout is designed to help you better understand your risk of developing this disease, as well as the options for diagnosing and treating it.

When everything is working right, our bones are continually rebuilding themselve: Old bone is removed and new bone replaces it. Osteoporosis occurs when not enough new bone is formed or when too much bone is removed - or both. Specifically, you are diagnosed with osteoporosis if you have a bone density that is 25% to 30% below the average for a healthy young adult. Often called a "silent" disease because it has no early symptoms, osteoporosis is characterized by a loss of strength in bones and an increased risk of fracture. Bone fractures resulting from osteoporosis can cause stooped posture, chronic pain, disability, and loss of independence.

Who is at risk?

Women have a greater risk of developing osteoporosis than men do because we have less bone tissue to begin with and because we lose bone more rapidly after menopause, when our estrogen levels decline. Some of us have additional risk factors:

• Non-modifiable risk factors: Caucasian race; early menopause or postmenopausal age; small, thin stature; history of bone fracture as an adult; parent or sibling with a history of fracture
• Modifiable risk factors: diet low in calcium; excessive drinking; sedentary lifestyle; eating disorders; cigarette smoking

Bone mineral density (BMD) tests are recommended if you are 65 years or older; are postmenopausal with at least one risk factor; or are postmenopausal and have suffered a previous fracture. These painless tests use small amounts of radiation. Your doctor can use the information they provide to predict your risk of fracture. These tests are available:

• Dual-energy x-ray absorptiometry (DXA): measures BMD in the spine, hip, and wrist in a few minutes, with one-tenth the radiation of a standard chest x-ray
• Single-energy x-ray absorptiometry (SXA): measures BMD in the wrist and heel
• Ultrasound densitometry: assesses bone in the heel, lower leg, and knee
• Radiographic absorptiometry: measures bones in the hand
• Quantitative computed tomography: measures BMD in the spine

Four medications have been approved (see disclaimer) to prevent and/or treat osteoporosis:

• Estrogens (Estrace®, Estraderm®, Estratab®, Ogen®, Ortho-Est®, Premarin®). Studies show up to a 60% decrease in spinal fractures and a 25% decrease in other fractures with 5 years of estrogen replacement therapy. This therapy may not be suitable for women who have a history or an increased risk of breast or uterine cancer. To lessen the risk of uterine cancer, doctors prescribe a formulation that contains both estrogen and progesterone (Premphase®, PremPro®). Estrogen-containing preparations are used for both prevention and treatment. 
• Alendronate sodium (Fosamax®). In postmenopausal women with osteoporosis, this drug slows bone loss and increases BMD in both the spine and the hip. It reduces the risk of fractures of the spine, hip and wrist by about 50%. It is prescribed for both prevention and treatment. 
• Calcitonin (injectable: Calcimar®, Miacalcin®; intranasal: Miacalcin Nasal Spray®). A naturally occuring hormone, salmon calcitonin slows bone loss, increases spinal bone density, and may relieve pain associated with fractures. The nasal spray has been shown to reduce the risk of spinal fracture by 36% to 45%. Calcitonin is recommended for treatment of women who are at least 5 years into menopause.
• Raloxifene (Evista®). This drug has estrogen-like effects in some parts of the body but not in others. Unlike estrogen, however, it does not stimulate uterine or breast tissue, and it has no beneficial effects on hot flashes. In patients with osteoporosis, raloxifene reduces spinal fractures by about 50%. It is currently used for prevention. 

After getting your test results, your doctor may want to build a lifestyle plan for you that combines medication with diet and exercise.

Your doctor may also test your urine to determine how quickly you are losing bone. When you are re-examined in 3 months, he/she will ask you about any side effects you may be experiencing, and may follow up with a second urine test 3 months later to see whether the medication is working. One to 3 years after your diagnosis, your doctor will perform another BMD test to re-evaluate your condition.

Can it be prevented?

Yes! Experts agree that fractures from osteoporosis are preventable in most women. How? Here are a few tips (but remember that some women who are genetically disposed to osteoporosis may need medication to prevent fractures and that only you and your doctor can determine what is right for you):

• Consume 1200 to 1500 milligrams of calcium each day. A large amount of calcium is found in low-fat dairy products, dark-green leafy vegetables, tofu, almonds, salmon, and sardines with bones. To ensure that you're getting enough, your doctor will probably suggest that you take both calcium and vitamin D supplements; the latter help absorb the calcium into your bones.
• Exercise for at least 20 minutes, 3 times weekly. Weight-bearing exercises such as walking, jogging, stair climbing, and dancing can all help keep your bones strong.
• Don't smoke. If you drink, do so in moderation.
• Don't forget to follow up with your doctor. BMD testing is an essential part of any osteoporosis prevention plan.

Disclaimer: The articles and information, while with the best effort to be accurate and up-to-date, may not be. Also, every physician and medical professional holds their own views on certain diagnosis and advice. There truly are no textbook cases. It is always best to consult with your personal physician regarding medical/health related problems. The information is to be used as a general resource and not as a substitute for trained medical advice and/or treatment.