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**Osteoporosis:      The Bone Thief**
*Helen      grew up on a farm in the Midwest. She drank lots of milk as a child. She      also walked a lot, but not after high school. That was when she became a      secretary in a local law office. Then she never found time to exercise.      Helen went through menopause at age 47. At age 61, she was looking forward      to retirement � traveling and working in her garden. But then she      slipped on a small rug in her kitchen and broke her hip. After Helen      recovered, getting around was a lot more difficult � she needed a cane      to walk.*
Helen      had osteoporosis, but she didn�t know it. Osteoporosis is a disease that      thins and weakens bones to the point where they break easily �      especially bones in the hip, backbone (spine), and wrist. Osteoporosis is      called the �silent disease� � you may not notice any changes until a      bone breaks. But your bones have been losing strength over many years. 
Bone is living tissue. To keep bones strong, the body is      always breaking down old bone and replacing it with new tissue. As people      enter their forties and fifties, more bone is broken down than is      replaced. A close look at the inside of bone would show something that      looks like a honeycomb. When you have osteoporosis, the spaces in this      honeycomb grow larger. The outer shell of your bones also gets thinner.      All this makes your bones weaker. 
**Who      Gets Osteoporosis?**
Ten      million Americans have osteoporosis, and 8 million of them are women.      About 34 million more have *osteopenia.*This means they don�t have      osteoporosis yet, but have lost enough bone to make them more likely to      get it. One in two women and one in eight men over age 50 will have an      osteoporosis-related fracture during their lives. White and Asian women      are most likely to get osteoporosis. Other women at great risk include      those who:-  have a family history      of the disease, have not gotten enough      calcium throughout their lives, had an early      menopause, had surgery to remove      their ovaries, had extended bed rest,used certain medicines      for a long time, or have small body      frames.
The risk of      osteoporosis grows as you get older. Bone loss may begin slowly in some      people when they are in their late thirties. At the time of menopause      women may lose bone quickly for several years. Then the loss may continue      but more slowly. As men age, they do not have the same kinds of striking      hormone changes as women do in mid-life because they do not have a      menopause. In men the loss of bone mass occurs more slowly. But, by age 65      or 70 men and women are losing bone at the same rate.
**How      Do I Know If I Am Losing Bone?**
Losing      height or having a bone break easily is often the first sign of      osteoporosis. But it doesn�t need to be. *Bone density*is a term      that describes how solid your bones are. Ordinary x-rays do not show bone      loss until a large amount of bone mass is gone. The best way to measure      bone density is by a **DEXA-scan (dual-energy x-ray absorptiometry)**.      Ask your doctor about this test if you think you are at risk for      osteoporosis or if you are a woman around the age of menopause or older.
The DEXA-scan tells what your risk for a fracture is. It could      show that you have normal bone density. Or, it could show that you have      osteopenia or even osteoporosis.
**Can      I Prevent Bone Loss?**
Osteoporosis      is preventable. A diet that is rich in calcium and vitamin D and a      lifestyle that includes regular weight-bearing exercise are the best ways      to prevent weakened bones in later life.
***Calcium****.*Getting enough calcium all through your life helps to build      and keep strong bones. Since 1997 the National Academy of Sciences (NAS)      has suggested that people over age 50 should get 1200 mg of calcium daily.      To do this, make foods that are high in calcium part of your diet. These      include low fat dairy foods, canned fish with soft bones such as salmon,      dark green leafy vegetables, and calcium-fortified foods like orange      juice, breads, and cereals. 
If you think you need to take a supplement to get enough      calcium, check with your doctor first. Calcium carbonate and calcium      citrate are two common forms of calcium supplement. Be careful not to get      more than 2500 mg of calcium a day very often. More than that amount can      increase your chance of developing kidney problems.******Vitamin D.***      Your body uses vitamin D to absorb calcium. Being out in the sun for a      total of 20 minutes every day helps most people�s bodies make enough      vitamin D. You can also get vitamin D from eggs, fatty fish, and cereal      and milk fortified with vitamin D. If you think you need to take a      supplement, check with your doctor. The NAS says people age 51 to 70      should have 400 IU (international unit) each day. People over 70 should      have 600 IU. More than 2000 IU of vitamin D each day may cause harm to      your liver and even lower bone mass. ******Exercise.***      Exercise makes bones and muscles stronger and helps prevent bone loss. It      is also a way to stay active and mobile. Weight-bearing exercises, done      three to four times      a week, are best for preventing osteoporosis. Walking, jogging, playing      tennis, and dancing are examples of weight-bearing exercises.      Strengthening and balance exercises may help you avoid falls and lessen      your chance of breaking a bone. ******Your Health.***      Some commonly used medicines can cause loss of bone mass. These include      glucocorticoids (a type of steroids) which are used to control diseases      such as arthritis and asthma, some antiseizure drugs, certain sleeping      pills, some hormones that treat endometriosis, and some cancer drugs. An      overactive thyroid gland or using too much thyroid hormone for an      underactive thyroid can also be a problem. If you are taking these      medicines, talk to your doctor about what can be done to protect your      bones. ******Other Lifestyle Changes.*** Avoid smoking. Also limit how much alcohol you drink. Too      much alcohol can put you at risk for falling and breaking a bone.
**How      Is Osteoporosis Treated?**
Prevention      and treatment of osteoporosis aims to stop bone loss and rebuild bone to      prevent fractures. Along with making life-style changes, there are several      medication choices. Some will slow your rate of bone loss, and others can      help rebuild bone. Talk with your doctor to see if one of these is good      for you:-  ***Alendronate and      risedronate.*** These      1medicines are bisphosphonates, drugs that slow the breakdown of bone and      increase bone density. They can lessen your chance of breaks in the spine,      hip, and other bones. Side effects may include nausea, heartburn, and      stomach pain. A few people have muscle, bone, or joint pain while using      these medicines. These drugs must be taken in a certain way � when you      first get up, before you have eaten, **and** with a full glass of      water. You **should not** lie down or eat for at least one-half hour      after taking the drug. They can cause serious digestive problems. These      are available in both once-daily and once-a-week versions. 
 
-  ***Calcitonin.*** This is a naturally occurring hormone that increases bone      mass in the spine and may lessen the pain of fractures already there. It      comes in two forms � injection or nasal spray. The injection may cause      an allergic reaction and has some unpleasant side effects. The only side      effect of the nasal spray is a runny nose in some people. Although it is      not prescribed often, calcitonin is most useful for women who are 5 years      past menopause.
 
-              ***Raloxifene.*** This drug is approved to prevent osteoporosis. It is a SERM      (selective estrogen recep-tor modulator). It prevents bone loss and spine      fractures, but may cause hot flashes or increase the risk of blood clots      in some women. 
 
-  ***Estrogen.*** Doctors sometimes prescribe estrogen at the time of menopause      to slow the rate of bone loss and to increase bone mass in the spine and      hip. Estrogen alone, called estrogen replacement therapy (ERT), is used in      postmenopausal women who have had the uterus removed (hysterectomy).      Postmenopausal women who still have a uterus and choose to take estrogen      also receive a progestin to protect the lining of the uterus. This is      called hormone replacement therapy (HRT). There are risks with long-term      use of these hormones. HRT increases the risk of breast cancer, heart      disease, stroke, and blood clots, but lowers the risk of hip and other      fractures and colorectal cancer. Estrogen increases the risk of uterine      cancer in a woman with a uterus who does not take a progestin and also the      risk of blood clots. Each woman thinking about ERT or HRT should discuss      benefits, risks, side effects, and other possible treatments with her      doctor.       

 
-  ***In the future.*** Other SERMs and bisphosphonates are being studied as improved      prevention or treatments for osteoporosis. Also promising as a possible      therapy is parathyroid hormone (PTH). 
**What      About Falls?**
When      bones are weakened by osteoporosis, a simple fall can cause a fracture or      break. This**can result in a trip to the hospital, surgery, and      possibly a long-lasting disabling condition in the case of a hip fracture.      Osteoporosis is the cause of 1.5 million fractures each year. 
It is important to prevent falls. Some things you can do      include:-  Make sure you can see      and hear well. Use your glasses or a hearing aid if needed.Ask your doctor if any      of the drugs you are taking can make you dizzy or unsteady      on your feet. Use a cane or walker      if your walking is unsteady. Wear rubber-soled and      low-heeled shoes.Make sure all the rugs      and carpeting in your house are firmly attached to the floor, or remove      them.Keep your rooms well      lit and the floor free of clutter.Use nightlights.
**What      About Osteoporosis in Men?**
Osteoporosis      is not just a woman�s disease. Men have it also, although not as often      as women do. This may be because most men start with more bone mass than      women and lose it more slowly as they age. 
The disease has not been as well studied in men as in women.      Most prevention and treatment recommendations are based on studies in      women. However, many of the risk factors for men are the same as those for      women � smoking, not enough calcium or vitamin D, too much alcohol,      family history, too little exercise, and taking certain drugs. 
Low levels of testosterone in older men may increase their      loss of bone and chance of hip fracture. 
Older men who fracture a bone easily or have risk factors for      osteoporosis should get a DEXA-scan. If the scan shows osteoporosis, a man      should talk with his doctor about which treatment is best for him. Choices      are much like those suggested for older women except for estrogen and      raloxifene. These drugs have not been well studied in men and are not      presently prescribed for osteoporosis prevention or treatment in men.      Testosterone supplements may help some men with low levels of      testosterone. 
**Resources
 

**National      Osteoporosis Foundation**1232 22nd      Street, NW      Washington, DC 20037      202-223-2226      Website: *www.nof.org
 

**NIH      Osteoporosis and Related Bone Diseases      National Resource Center**1232 22nd      Street, NW      Washington, DC 20037      1-800-624-BONEWebsite: *www.osteo.org/*
The **National      Institute on Aging      (NIA)** has a book and video about exercise for older people. For more      information and a free publications list, write or call:
**NIA      Information CenterPO Box 8057      Gaithersburg, MD 20898-8057      1-800-222-2225      1-800-222-4225 (TTY)Website: *www.nia.nih.gov*
*National Institute on Aging      U. S. Department of Health and Human Services      National Institutes of Health      August 2002*
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