Osteoporosis

WHAT IS OSTEOPOROSIS?

Osteoporosis or “brittle bone disease” is a condition where the bones become porous and fragile due to the loss of minerals. If not prevented or treated, osteoporosis progresses painlessly until a fracture occurs—typically in the wrist, hips or spine. While any bone can be affected by osteoporosis, of particular concern are fractures of the hip and spine. A hip fracture almost always necessitates hospitalization and major surgery. It can impact a person’s ability to walk unassisted, causing prolonged and often permanent disability and even death. (More women die from osteoporotic fractures each year than from breast and ovarian cancers combined.) Spinal fractures also have serious consequences, including loss of height, severe back pain, and deformity. So thin and porous are the bones of an affected person that even sneezing can cause fracture of one or more bones in the spine.

HOW COMMON IS OSTEOPOROSIS?

As the Baby Boom generation ages and as people in general become less active, so the incidence of osteoporosis is on the increase. One in four women and one in eight men over the age of 50 have the condition. Many women may suffer from a condition called Osteopenia (bone thinning) that is not as severe as Osteoporosis; however, it may progress to Osteoporosis over time.

WHAT ARE THE WARNING SIGNS?

Since osteoporosis progresses silently over time, the warning signs for the condition also include the risk factors:

Risk Factors:

• Female of post-menopausal age (the hormone, estrogen, which wanes after menopause, is partly responsible for keeping calcium in the bones).
• Surgical menopause (complete hysterectomy with removal of ovaries).
• History of bone fracture not attributable to an accident/injury.
• Thin, small build
• Chronic use of anti-inflammatory steroids
• Excessive doses of thyroid medications or anticonvulsants
• Family history of osteoporosis or fractures.
• Sedentary lifestyle
• Poor diet that does not include foods rich in calcium, magnesium, vitamin D and phosphorus.
• Excessive intake of alcohol, caffeine or carbonated beverages.
• Long-term smoker.
• Hereditary factors. (Tendency towards developing osteoporosis can be passed down from parent to child.)
• Having an overactive thyroid gland, diabetes or rheumatoid arthritis can increase your risk for osteoporosis.

Warning Signs:

• A sharp pain in the mid to low back that seems to have no cause.
• Unexplained fractures of the femur (thigh bone) hipbone or lower arm bone above the wrist or fractures of these bones following a relatively minor knock or fall.
• A gradual loss of height.

HOW DOES OSTEOPOROSIS PROGRESS?

People build the bulk of their bone mass during their teens and early twenties. This mass will sustain them through their adult years to old age. Throughout life, the bones act as calcium “banks.” When calcium is required for other body functions, and is not supplied in the diet, calcium is literally leached from the bones. When dietary calcium levels are high, the bones absorb calcium. Several factors affect the absorption of calcium, in particular, activity level. When stress is placed on the muscles, the bones receive the message to build up in order to support the muscles. Significant amounts of calcium will not be absorbed by the bones if a person remains sedentary.
In a person at risk for osteoporosis, more calcium is leached from the bones than is deposited. Day after day, year after year, as more calcium leaves the bones they become more porous and likely to fracture under physical stress or injury.

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UNDERSTANDING OSTEOPOROSIS MEDICATIONS

Bone building consists of two distinct stages: bone resorption and bone formation. During resorption, special cells called osteoclasts on the bone's surface dissolve bone tissue and create small cavities. During formation, cells called osteoblasts fill the cavities with new bone tissue. Usually, bone resorption and bone formation occur in close sequence and remain balanced.
Osteoporosis medications have one goal: to restore this delicate balance through inhibiting the activity of the osteoclasts.

• HORMONE REPLACEMENT THERAPY
  Hormone Replacement Therapy (HRT) can reduce the rate of bone loss in post-menopausal women. Estrogen can be taken alone or along with progesterone. HRT reduces the rate of bone destruction. Examples of estrogen drugs are Estrace®, Climara®, Estraderm®, Premarin®, Estratan®, Menest® and Ogen®. Combination estrogen and progesterone medications include Prempro® and Premphase®.
  Undesirable side-effects of HRT include return of menstrual flow, breast tenderness, mood swings, bloating, migraine headaches, gallstones and an increased of breast and/or endometrial cancer in those who have a family history of these diseases. Deep vein thrombosis (DVT) is a potential side effect particularly in those with a history of abnormal blood clotting. Estrogen requires a prescription.
   
• BISPHOSPHONATES
  These drugs inhibit the activity of osteoclast cells and so prevent bone breakdown. They are often given to people who cannot or do not want to take hormone replacement therapy. Bisphosphonates can also be useful in treating osteoporosis that has resulted from steroids, such as found in other types of medication. The most commonly prescribed bisphosphonates are risedronate (Actonel®), alendronate (Fosamax®) and etidronate (Didrocal®).
  Side effects are uncommon, but may include abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus. Bisphosphonates require a prescription.
   
• CALCITONIN
  Calcitonin is a hormone that occurs naturally within the body. It helps increase bone density by affecting the levels of calcium in the blood. Calcitonin inhibits osteoclast activity and so slows down the breakdown of bone. It may also relieve the pain that results from spinal fractures. Prescription calcitonin is usually given in doses much higher than normally occurs within the body. Calcimar® and Miacalcin® are two commonly prescribed calcitonin drugs.
  Injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea, vomiting and skin rash. The side effects reported with the nasal spray (Miacalcin®), are runny nose, nosebleed, bone pain and headaches. Calcitonin requires a prescription.
   
• SERMs
  SERMs or special estrogen receptor modulators, help increase bone mass by slowing down the rate at which osteoclasts break down bone. While studies show that SERMs reduce the risk of spine fractures, it is not yet known if this class of drugs can reduce the risk of hip and other fractures.
  As with all SERMs, the commonly prescribed raloxifene (Evista®) can only be taken after menopause. Side effects may include spotting, hot flashes, sinusitis, weight gain, muscle pain, leg cramps, ankle swelling and an increased risk of pulmonary embolism and deep vein thrombosis. SERMs require a prescription.
   
• Nutricol
  This formulation, available as Recovery® in many pharmacies, is believed to prevent breakdown of the body’s cells and tissues by stabilizing their structures. Nutricol® also appears to naturally increase the cells’ receptivity to hormones such as insulin which are required to speed tissue repair.
  
  Nutricol® (Recovery®) may be safely combined with other medications or taken on its own to help speed tissue repair. It does not produce unpleasant side effects.
  
  View feedback from health professionals and users of Recovery® with Nutricol®.