Question: The other day I went to my doctor and she recommended me to get the test to find out if I have osteoporosis because I was losing my height. I have heard of osteoporosis. The other day I went to the nursing home where my neighbor was recuperating from a fracture. She said that she had osteoporosis. Is osteoporosis an overblown problem? — Margie, of Van Wert
Osteoporosis is a disease that makes your bones weak. People with the disease can break their bones too easily. For instance, people with osteoporosis sometimes break a bone after falling at home.
Breaking a bone can be serious, especially if the bone is in the hip. People who break a hip sometimes lose the ability to walk on their own. Many of them end up in a nursing home and lose their independence. That is why it is so important to avoid breaking a bone in the first place.
Osteoporosis is a silent disease and does not cause symptoms until you break a bone. But your doctor can have you tested for it for you break a bone. The best test is a bone density test called the “DXA test.” It is a special kind of X-ray. You lie on the table and the machine checks your bones to find out how much calcium you have in some of your bones.
Experts recommend bone density testing for women who have gone through menopause and stop their menstrual cycles. That is because menopausal women have the highest risk of osteoporosis. Still, other people should sometimes be tested, too. Your doctor may decide if you need to be tested.
Some people learn that they have osteoporosis because they break a bone during a fall or a mild impact. People with healthy bones should not break a bone that easily. People who have fractures may be at high risk of having other bones break.
Can you prevent osteoporosis?
You can. Eat foods with a lot of calcium, such as milk, yogurt and green leafy vegetables. Eat foods with a lot of vitamin D, such as milk that has vitamin D added, and fish from the ocean.
You may need to take calcium and vitamin D pills if you do not get enough from the food that you eat. You may need 1,000 to 1,200 mg of calcium and 1,000 to 2,000 units of vitamin D daily. Vitamin D deficiency is quite common in areas that are covered with clouds for most of the year. You also get deficiency of vitamin D if you avoid the sunlight. Vitamin D is needed to absorb the calcium. If you are low in vitamin D you may not be able to absorb enough calcium.
Being active for at least 30 minutes most days of the week helps get your bones stronger.
Avoid smoking. Smoking has many bad effects, and one of them is weakening of the bones.
Limit the amount of alcohol you drink to 1 to 2 drinks a day at most. Many people who drink a lot get osteoporosis. Over consumption of alcohol is one of the important causes of osteoporosis in men.
Do your best to keep from falling, too. It sounds simple, but you can prevent a lot of fractures by reducing the chances of a fall.
Make sure all your rugs have a no-slip backing to keep them in place. Sometimes electrical cords need to be tucked away to reduce your chances of tripping and falling. Keep the steps free. Use nighlights, and light all walkways well.
Watch out for slippery floors, especially after they have been mopped.
Wear sturdy, comfortable shoes with rubber soles to have a better grip of the floor.
Poor eyesight from cataracts or other reasons increases your chances of falling. Have your eyes checked.
Many people take many medicines. Some of them have side effects and may cause you to be dizzy. Your medicine list must be checked for side effects of dizziness. Dizziness increases the chance of falling.
Can osteoporosis be treated? Yes, there are a few medicines to treat osteoporosis. These medicines can reduce the chances that you will break a bone.
What do osteoporosis medicines do? If you have osteoporosis or a high risk of breaking a bone, the medicines your doctor prescribes can:
• Reduce bone loss
• Increase bone density or keep it about the same
• Reduce the chances that you will break a bone
For the medicines to work, you must also take calcium and vitamin D supplements. Your doctor will tell you how much medicine to take and how often to take it. Deficiency of vitamin D or calcium prevents the osteoporosis medicines from working. That has to be corrected first.
Which medicines might I need? There are many different osteoporosis medicines. Your doctor will work with you to choose the best one for you.
Bisphosphonates is what most people being treated for osteoporosis take first. If they do not work well enough or cause side effects that are too hard to handle, there are other options.
Bisphosphonates come in a pill or a shot. Most people take one pill every week or once a month. There are different kinds of injections for osteoporosis. Some injections have to be taken daily, others have to be taken every six months. There are some injections which are taken once a year. If your doctor prescribes a bisphosphonate pill, you must take the medicine exactly as directed. If you do not, the medicine can irritate your food pipe or stomach. For most bisphosphonate pills, you must:
• Take the pill first thing in the morning, may be an hour before breakfast.
• Drink an 8-ounce glass of water with the pill, but not eat or drink anything else for 30 to 60 minutes.
• Avoid lying down for 30 minutes after taking the pill. You must sit or stand during that time. This may prevent the medicine from irritating your food pipe.
There is one bisphosphonate pill — delayed release risedronate — that is taken in a different way from the others. It is taken after breakfast with four ounces of water.
“Estrogen-like” medicines: Medicines called selective estrogen receptor modifiers (or “SERMs”) act like the hormone estrogen. Estrogen helps prevent bone loss. SERMs can act like estrogen to stop bone loss. Some of them also reduce the risk of breast cancer in women at high risk. SERMs are only for women who have gone through menopause.
Hormone medicines: Estrogen hormones are not used often to treat osteoporosis in women who have gone through menopause. This is because other medicines usually work much better. But they can help women who have bothersome symptoms related to menopause (such as hot flashes) and who have osteoporosis but cannot take other osteoporosis medicines.
Some men get osteoporosis because their bodies do not make enough of a hormone called testosterone. If this happens, doctors can give testosterone to treat the osteoporosis. Men start having osteoporosis at much later age than women.
PTH or PTHrP analog: Both of these are artificial forms of hormones the body makes naturally. PTH stands for parathyroid hormone, and PTHrP stands for parathyroid hormone-related protein. Both tell the body to make new bone. They are usually only for people with severe osteoporosis.
Romosozumab: Romosozumab is a medicine that blocks a protein in the body. This protein usually stops new bone from being formed. Blocking the protein allows the body to make new bone. Romosozumab is usually only for people with severe osteoporosis.
Denosumab: Denosumab blocks a different protein in the body. This protein usually causes bone to break down. By blocking the protein, denosumab reduces bone loss and the chance of breaking a bone. If other osteoporosis medicines cause bad side effects or do not help, your doctor might give you denosumab. It might also be a good choice for people with kidney problems. When you stop taking denosumab, your bone density goes down again very quickly. Some people might be at higher risk for breaking a bone when this happens. If you stop denosumab, your doctor will prescribe a different osteoporosis medicine to prevent rapid bone loss.
Calcitonin: Calcitonin is a hormone the body makes naturally from some cells located in the neck. It is not used as often as other medicines because it does not work as well. But it can help relieve pain from broken bones in the spine.
If you are at high risk for breaking a bone, you can safely take osteoporosis medicines for many years. If you are not at high risk for breaking a bone, you might be able to stop your medicine for a year or more. Your doctor will check your bone density to make sure you are not losing too much bone. If you do stop the medicine, you will probably need to start it again later. If you take osteoporosis medicines, your doctor will do regular exams and tests to see how well the medicines are working. If they are not working well, you might need a different medicine.
How will I know the treatment is working? Doctors often order bone density tests to check if osteoporosis medicines are working. These are the same tests they use to find osteoporosis in the first place. Sometimes a blood or urine test is also needed.
Lets us hope your osteoporosis test can help you.
Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville