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Osteoporosis

I’m a 48-year-old woman and my mother was recently diagnosed with osteoporosis. Is there anything I can do to decrease my risk?

Osteoporosis is a significant loss of bone density which increases the risk of spine or hip fracture. About 15 percent of post-menopausal Caucasian women are affected. Most are without symptoms until a fracture occurs, which can be catastrophic. One in five women with hip fracture dies within a year of fracture; more than half won’t regain their mobility and independence.

Women accumulate bone mass until age 30 with a slow decline thereafter until menopause. After menopause, the rate of decline accelerates. Osteoporosis, therefore, depends not only on how fast you’re losing bone but also how much bone mass you started with. This is why calcium intake and exercise in younger women are so important in preventing osteoporosis later in life.

So what are risk factors for osteoporosis?

Caucasian or Asian race, being post-menopausal or having a first-degree relative with a hip or spine fracture are fixed risks. Modifiable risk factors include cigarette smoking, alcoholism, corticosteroid use, minimal exercise, inadequate calcium intake, and early menopause. What does this mean for women throughout their lifetimes? Women of all ages should avoid cigarettes, moderate their alcohol use, and regularly engage in weight-bearing exercise. Women ages 19-50 should get 1000 mg of calcium/day; after menopause, 1500 mg calcium plus 400-800 units of vitamin D per day. Calcium can be dietary (1 oz cheese, 8 ozs milk or yogurt or calcium-fortified orange juice, 1 cup broccoli all contain 300 mg of calcium) or supplemental. The cheapest calcium supplement is Tums (calcium carbonate). Each one contains 300 mg, should be taken with food, and no more than two should be taken with any meal–your body can only absorb a limited amount at any one time.

Who should be screened for osteoporosis?

The National Osteoporosis Foundation recommends screening in all women over the age of 65 and women under 65 who have risk factors or a fracture history. Testing includes ultrasound and DEXA scan–a non-invasive bone imaging study. Finally, who should be treated with medications? Women with osteoporosis identified on DEXA scan, or low bone density with other risk factors. Treatment medications include bisphosphonates (Fosamax, Actonel), selective estrogen receptor modulators (SERMs–Evista); and calcitonin. Estrogen is approved for prevention but not for treatment of osteoporosis.

Hip and spine fractures can be devastating in later life. Though screening and treatment are important, adequate calcium intake and exercise play a large role in prevention, even in young women. As always, you should discuss your particular situation with your healthcare provider.

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