Osteoporosis

Some experts say frequent failure to diagnose and treat osteoporosis after a fracture is scandalous. The washington DC-based National Osteoporosis Foundation (NOF) recommends that adults who suffer a low-trauma fracture (such as breaking a bone after falling from ground level or a low height) have a bone density test followed by medications if necessary.

Are You At Risk?

Use this checklist to determine your osteoporosis risk:

• I'm a woman over age 65

Or:

• I'm a postmenopausal woman with one or more of the following warning signs:
  1. I've broken a bone as an adult
  2. I have a family history of osteoporosis or hip fracture
  3. I'm small boned and thin (less than 127 lb
  4. I take corticosteroid medication (such as Prednisone) for a chronic medical condition
  5. I am a smoker
  6. I have persistent back pain.

"Many women think that taking calcium is sufficient to prevent osteoporosis, or they think supplements such as glucosamine will help, neither of which is true," says rheumatologist Timothy Harrington, MD, director of the University of Wisconsin Medical Foundation's Bone Density Center in Madison. While healthy lifestyle behaviors such as sufficient calcium intake, exercise, and not smoking are essential to optimum bone health, he says they are not a substitute for medications in postmenopausal women at greater risk.

Doctors also may have mistaken beliefs about osteoporosis treatment, he says. "Some physicians still believe that hormone replacement therapy is an effective treatment for osteoporosis. But its main role in bone health is to prevent bone loss in early postmenopausal women at risk."

For women with osteoporosis, he adds, bisphosphonates have been shown to reduce vertebral, hip, and long-bone fractures in women by 50 to 90%. And other promising treatments are expected to be widely available soon, including parathyroid hormone.

But the most important message, Harrington says, is that "women need to understand that they have to be advocates for their own best health care. When it comes to getting diagnosis and treatment, you can't take no for an answer."

"when an adult fractures a bone, it should be a call to action to prevent the next one," says endocrinologist John Bilezikian, MD, a Prevention advisor and director of the Metabolic Bone Diseases Program at Columbia-Presbyterian Medical Center in New York City, who notes that the vast majority of fractures in adults over age 40 are associated with osteoporosis and are highly predictive of future fractures. "Having a fracture at least doubles your risk of sustaining another fracture within a year."

WHAT YOU CAN DO

In addition to making sure that your doctor gives you a bone-density test to check for osteoporosis, here are 4 steps you can take to ensure the health of your bones:

1. Get a prescription. - If a bone-density test and a complete medical workup indicate osteoporosis or ostepenia (somewhere between strong bones and osteoporosis), diet and exercise alone won't halt further bone loss. Several drugs can slow ot stop the bone-thinning process. Your doctor can help ou decide if one of them is right for you.
   • Alendronate (Fosamax) can be taken once a week.
   • Calcitonin (Miacalcin) is available as a nasal spray.
   • Raloxifene (Evisa) appears to lower the risk of breast cancer.
   • Risedronate (Actonel) is taken daily.
   • teriparatide (Forteo) is the newest osteoporosis medication and the first drug to actually stimulate new bone growth.
2. Take calcium and vitamin D. - Whether you have osteoporosis or not, getting enough of these nutrients is essential for bones. These are the Recommended Dietary Allowances:
   • Calcium: women under 50, 1,000 mg a day; women 50 and older, 1,200 mg a day.
   • Vitamin D: women under 70, 400 IU a day; women 70 and older, 600 IU a day.
3. Get appropriate exercise. - regular exercise is crucial for every woman. without it, your bones thin automatically. Here is what you need:
   • If you have osteoporosis: Certain movements can be harmful, consult with your doctor. Consider an exercise video designed for women with osteoporosis, such as Be Bone Wise - Exercise from the NOF.
   • If you have osteopenia: Get regular weight bearing exercise, such as jogging, walking and dancing, plus resistance exercise, such as weight lifting with either free weights or weight machines.
4. Stay informed. The NOF offers a super web site with information that will answer many of your questions. It also provides access to osteoporosis support groups.