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<s>[INST] How does TB spread? [/INST] Am I likely to spread the infection if I share food or shake hands with someone too? TB spreads when a person with active lung TB talks, sings, coughs, or sneezes releasing TB bacteria in the air, in the vicinity of susceptible individual. However, TB does not spread through handshakes, using public toilets, sharing food and utensils, and casual contact. TB patients can continue living their normal lives after treatment completion. They should cover their mouth and nose while coughing and sneezing as a practice. Source: Government of India. Link: https://tbcindia.gov.in/index4.php?lang=1&level=0&linkid=382&lid=2754. Field: Lung Disease. Disease: Tuberculosis </s>

<s>[INST] What is osteoporosis? [/INST] Osteoporosis is a skeletal disease characterized by low bone mass, and the deterioration of bone architecture leading to bone fragility and increased risk of fracture. Bone normally rejuvenates itself through a process of bone absorption and formation called bone remodeling. Osteoporosis occurs when bone breakdown, or absorption, occurs at a rate greater than bone formation. Osteoporosis means "porous bones". It is a condition in which the bones become fragile and weakened, increasing the risk of fractures, especially in the wrist, hip and spine. Any bone can be affected, but the most serious concerns are fractures of the hip and spine. If hypertension is the silent killer, then osteoporosis is the silent thief, insidiously robbing the skeleton of its banked resources often for decades until the bone is so weak that it cannot withstand normal mechanical stress. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why is osteoporosis such an important problem? [/INST] In developed countries, osteoporotic fractures has been labeled as an “orthopaedic epidemic” as the populations in these countries ages. It affects an estimated 75 million people in the USA, Europe and Japan combined. Osteoporosis causes more than 1.5 million fractures each year, including more than 300,000 hip fractures and 700,000 vertebral fractures. One in two women over the age of 50 and one in eight men over age 50 will have an osteoporosis‐related fracture in their lifetime. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How does osteoporosis develop? [/INST] Bone is living, growing tissue composed of a network of collagen fibers inlaid with calcium and phosphate. The minerals are mixed with water to form a hard cement‐like substance called hydroxyapatite. Calcium is the principal ingredient of hydroxyapatite. Calcium also plays an important role in transmitting signals to nerves and muscles and is therefore important in regulating heart rate, muscle contractions, blood pressure and other bodily functions. In order to keep these functions regulated, the calcium stored in the blood must be maintained at certain levels. When calcium in the blood drops too low, it is replenished with calcium from the bone. Resorption, the process by which calcium is released from the bone into the blood, results in the breakdown of bone. It is coupled with another process called formation in which bone is rebuilt. Together, the two processes constitute bone remodeling. The continuous remodeling cycle serves to supply the body with needed calcium and to maintain the skeleton by replacing old bone with new. When formation exceeds resorption, bone mass increases. When resorption takes place faster than formation, bone mass loss occurs. If excessive bone loss continues over time, osteoporosis develops. During the early years of life, formation is greater than resorption and bone mass increases. Maximum, or peak, bone mass is reached around age 30. After that time, bone is removed faster than it can be replaced and bone mass decreases. While gradual bone loss is a normal part of aging, it is those individuals who fail to achieve optimal peak bone mass and those with accelerated bone loss who are at greatest risk for osteoporosis. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Am I at risk of developing osteoporosis? [/INST] There are many factors that can increase a woman's risk of osteoporosis. A few of the risk factors are: Postmenopausal Ethnicity‐Caucasian and Asian Family history Petite, small frame Eating disorders Caffeine Smoking Excessive use of alcohol Vitamin D deficiency Inactivity Thyroid disease Chronic steroid use Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What are the symptoms of osteoporosis? [/INST] Osteoporosis is often called the "silent" disease, because it can progress without symptoms. Without proper screening and diagnosis, a person may not know they have osteoporosis until they break a bone. Fractured bones were once the only way to tell if a person had osteoporosis. Fortunately, there are new methods today that can detect osteoporosis before a fracture occurs. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do I have osteoporosis? [/INST] In order to demonstrate bone loss, a bone scan would need to be performed. The most common type of bone scan is a DEXA test which would provide a value of Bone mineral Density (BMD). A bone scan is recommended for all women over 65 years old. In addition, women with risk factors other than menopause, postmenopausal women with a history of a fracture and women considering therapy for osteoporosis should speak to their health care providers about early testing. WHO defined (a) Normal BMD as values >1SD (standard deviation) below to the young normal adult mean, (b) “Osteopaenia” as value between ‐2.5SD and ‐1SD, (c) “Osteoporosis” as BMD <‐2.5SD and (d) “Establishedor Severe Osteoporosis” is BMD below ‐2.5SD in the presence of fractures Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How does osteoporosis affect people who have it? [/INST] The biggest concern for people with osteoporosis is the risk of bone fractures. Once a fracture occurs, a person’s independence, quality of life and even survival can be greatly reduced. Fractures of the spinal vertebrae, called compression fractures, lead to a progressive change in the shape of the spine and back. Vertebrae may crush suddenly without warning. A person may lose height or develop a pronounced curvature of the spine, known as a "dowager’s hump". A person may not want to participate in daily activities, such as walking, lifting objects, dressing, housecleaning, shopping and other simple pleasures of life, for fear of fracturing a bone or because the pain is too great. The loss of self‐esteem caused by changes in body image, the loss of independence and the fear of future fractures can lead to depression and increasing isolation. Probably the most serious consequences arise from hip fractures. A hip fracture almost always leads to surgery and hospitalization and can result in lengthy or permanent nursing home stays, numerous visits to rehabilitation centers, pain and physical disability, inability to perform daily living activities and loss of independence. These factors, alone or in combination, lead to deterioration in emotional health and social life. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can anyone get osteoporosis? [/INST] Yes, although certain people are more likely to develop osteoporosis than others. Risk factors that increase the likelihood of developing osteoporosis may be related to your body type, your family history, or your lifestyle behaviors, or some combination of these three factors. However, about 30% of individuals with osteoporosis have no identifiable risk factors. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How can I prevent/treat osteoporosis? [/INST] Treatment and prevention of osteoporosis depends on the severity of the disease. The first line of prevention is calcium supplementation and exercise. Medications can also be added if additional protection from osteoporosis is indicated. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can osteoporosis be prevented? [/INST] Yes, but prevention involves a lifelong effort, starting in early childhood. One of the most important factors in preventing osteoporosis is achieving optimal peak bone mass during childhood, adolescence and early adulthood. Much of the peak bone mass achieved is determined genetically. However, there are several controllable factors that can increase bone mass. These include a balanced diet adequate in Vitamin D and calcium and weight‐bearing exercise. It is also important to maintain the bone mass achieved as a child to help prevent osteoporosis. This requires adequate calcium intake, weight‐bearing exercise, and avoiding tobacco and excessive alcohol intake. At around 40‐45 years of age, it becomes important to stop the age‐related bone loss that occurs. This includes adequate calcium and vitamin D intake, weight‐bearing exercise and hormone replacement. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why is Vitamin D important in preventing osteoporosis? [/INST] Vitamin D can be thought of as the "key" that unlocks the door to the body to let calcium in. Without Vitamin D, your body can’t use calcium very well, even if you get enough calcium in your diet. The exact optimal daily dose of Vitamin D has not been determined, but most experts recommend that you get 400‐800 IU of Vitamin D each day. Less than 400 IU per day will keep you from getting full benefit from the calcium in your diet. More than 800 IU per day may be harmful. There are two ways to get Vitamin D: Vitamin D is formed naturally in your body after exposure to sunlight. About 15 minutes in the sun each day will make all the Vitamin D your body needs. You can also get Vitamin D from the foods you eat. Food sources include Vitamin D fortified dairy products, egg yolks, saltwater fish and liver. Most standard multi‐vitamins contain adequate amounts of Vitamin D and many calcium supplements also contain Vitamin D. If you are elderly, do not get outside often or you live in the North during the winter, you may need to consider a supplement if adequate Vitamin D cannot be obtained from the diet. If you are taking a multi‐vitamin or calcium supplement containing Vitamin D, make sure that your vitamin D intake from all sources does not exceed 800 IU. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How much exercise do I need to protect myself from osteoporosis? [/INST] Exercise stimulates the bone remodeling cycle. Weight bearing exercises such as weight training, running, walking, biking and cross country machines will provide both aerobic and weight bearing exercise. Exercise is an important part of keeping your bones healthy and can help maintain bone mass. Any exercise that causes your body to work against gravity or exerts resistance against the body is effective. Weight‐bearing exercise is the most beneficial exercise for maintaining bone mass. Weightbearing exercises are also popular because they are simple and do not require learning new movements or any cash outlay. Examples of weight‐bearing exercises include walking, hiking, dancing, tennis and stair climbing. You should try to perform at least one of these exercises for approximately 45 minutes a day at least 3‐4 days a week. Strength‐training exercise, which uses weights for resistance, helps strengthen muscles. Strength training can be done at home with free weights or at a gym using weight machines. Weight training must be done correctly to get good results and to avoid injury. Other exercises, such as swimming and cycling, do not benefit bone strength but are beneficial for your heart and lungs and help maintain or improve mobility. You don’t need to become an athlete to benefit from exercise. Just make weight‐bearing activity part of your everyday life. Even if you already have osteoporosis, you can benefit from exercise. REMEMBER: Always check with your doctor or health care provider before starting a new exercise program. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What medications are used to treat osteoporosis? [/INST] There are several medical treatments for osteoporosis. Estrogen therapy has been used to treat osteoporosis for many years. Newer non hormonal treatment options are now available, these are the bisphosphonates, alendronate and risedronate, raloxifene, a selective estrogen receptor modulator, parathyroid hormone and calcitonin. Talk to your health care provider to determine the best treatment option for you. Source: Malaysian Osteoporosis Society. Link: https://www.osteoporosis.my/aboutOsteo/faq.asp#:~:text=Poor%20calcium%20intake%20at%20any,the%20presence%20of%20adequate%20calcium.. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] In addition to calcium and vitamin D, I have heard that vitamin K is important for my bones. If I have osteoporosis, should I be taking a vitamin K supplement? [/INST] Like many vitamins and minerals, vitamin K appears to play a role in your bone health. The recommended daily intake is 90 -120 micrograms (μg).There are two types of vitamin K. They are vitamin K1 and vitamin K2. Vitamin K1 sources include kale, brussels sprouts, spinach, mustard greens, turnip greens and vegetable oils. Vitamin K2 sources include egg yolks, organ meats and natto (a type of fermented soybean). At this time, research does not support the practice of taking vitamin K supplements to prevent osteoporosis and broken bones. Taking a supplement doesn’t always have the same effects as eating whole foods that contain that same nutrient. Also, because vitamin K plays a role in blood clotting, getting too much vitamin K could cause problems in individuals who take blood thinning medicines or are at risk of blood clots. More research will help us to determine the amount and type of vitamin K that is necessary for bone health. Until we know more, try to get enough vitamin K from food sources. Talk to your healthcare provider about any nutrition deficiencies you may have and discuss which supplements you should take for your bone health. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Is there any harmful effect if one takes more than 1200 milligrams of calcium? If so, what kind of harmful effect could excess calcium cause? [/INST] Taking more calcium than what you need is not beneficial and may even be harmful. When you take too much calcium from supplements, the excess calcium is excreted through your kidneys into your urine. In some people, this increases the risk of kidney stones. Some studies have also suggested a link between calcium supplements and heart disease, however these finding are not conclusive. To play it safe, BHOF recommends trying to meet your daily calcium needs by eating calcium-rich foods. Only supplement the estimated amount you do not get through your diet. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] If you have osteoporosis, does it mean you’re not getting enough calcium? [/INST] There are many factors that can contribute to osteoporosis, one of which is not getting enough calcium. However, people who get enough calcium from foods and/or supplements can still be at risk of bone loss due to other reasons, such as having a family history of osteoporosis, not exercising, smoking, drinking too much alcohol, not getting enough vitamin D and having certain medical conditions or taking certain medicines that can cause bone loss. While getting the recommended amounts of calcium, vitamin D and exercise each day does not always prevent osteoporosis, these healthy lifestyle behaviors can help everyone have healthier bones. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I am lactose intolerant. Should I drink calcium-fortified soymilk or lactose-free milk? [/INST] While there is no agreed upon answer to this question, some would suggest trying the lactose-free milk which is naturally rich in calcium. Calcium-fortified soymilk tends to have about the same amount of calcium as regular milk, however this is because calcium has been added the beverage. If you are lactose-intolerant, you may think you should avoid all dairy products that aren’t labeled lactose-free. However, you may be surprised to learn that many people who consider themselves lactose-intolerant are able to consume certain dairy products without side effects. Most aged cheese, including cheddar, Colby and parmesean are naturally lactose-free. Many people who are sensitive to lactose can also tolerate yogurt with live cultures. These tips may help you to add more foods that are naturally rich in calcium back into your diet. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I am a 55 year old woman with osteoporosis. I have read that jogging is one of the best exercises for building strong bones. Is running considered safe for me? [/INST] For most people with osteoporosis, jogging would be considered unsafe. While jogging is a high-impact weight-bearing exercise that can help keep bones strong, it may also increase the risk of breaking a bone. Individuals with low bone density (osteopenia) can also benefit from following the precautions for people with osteoporosis. This is because these people may be at an increased risk of breaking a bone. Power walking and walking briskly are much safer and almost as effective for achieving the many health benefits of exercise. Your healthcare provider, who knows your individual medical history and bone mineral density, should be able to provide guidance as to whether jogging is safe for you. A physical therapist can also be an excellent resource for information about exercise and bone health. If you’re interested in working with a physical therapist, your healthcare provider should be able to provide a referral for physical therapy. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I have osteoporosis. Can I do yoga exercises where I bend at the waist and touch the floor? Is it safe to twist from side-to-side? [/INST] If you have osteoporosis, you should avoid any movements that require you to bend forward from the waist, such as doing a toe touch. When you bend forward from the waist, your shoulders and back become rounded. This is also known as spine flexion and can increase the risk of a spine fracture. Many movements that involve spine flexion can be modified by bending the knees and hinging at the hips. Gentle twisting motions should be safe for most people. If you have osteoporosis or are otherwise at risk of breaking bones in your spine, you should avoid twisting to a point of strain. Examples include a full golf swing or swinging a tennis racket. Ask your healthcare provider, who knows you best, what types of exercises and movements are safe for you. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Will a weighted vest help me build bone? [/INST] The evidence for using a weighted vest exercise program to improve bone mineral density or prevent skeletal fractures in women and men is uncertain. Larger studies of older adults with low bone density or osteoporosis over a longer follow up time are needed to determine whether weighted vest exercise will lead to beneficial. A weighted vest may not be safe for those who have had spine fracture, spine surgery or have high risk of breaking a bone. To prevent injury, before using a weighted vest consult with a healthcare professional or exercise specialist with expertise in osteoporosis to better understand if this may be a good option for you. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I have no family history of osteoporosis. I eat a healthy diet and exercise. How did I get osteoporosis? [/INST] In addition to your family history, there are many factors that can increase your likelihood of developing osteoporosis. That’s why estimates suggest that about one in two women and up to one in four men will break a bone in their lifetime due to osteoporosis. You are at increased risk of developing osteoporosis if you are a postmenopausal woman with a small and thin build. As you age, your risk of osteoporosis and broken bones increases. Also, certain medical conditions or taking certain medicines may increase your chance of developing osteoporosis Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can taking thyroid hormones cause me to have a greater chance of getting osteoporosis? [/INST] Having an underactive thyroid, a condition called hypothyroidism, does not increase your risk for bone loss and osteoporosis. Taking the amount of thyroid hormone medicine needed to replace what your body’s thyroid is not making does not hurt your bones. However, taking more thyroid hormone medicine than you need can cause bone loss. An excess of thyroid hormone is harmful to your bones. This can be caused by an overactive thyroid, a condition called hyperthyroidism. It can also be caused by taking too much thyroid hormone medicine as a replacement for an underactive thyroid. When you take a thyroid hormone medicine, your doctor or other healthcare provider will check your thyroid function with a blood test called a thyroid-stimulating hormone (TSH). If the results of the blood test show that you are taking too much or too little thyroid hormone, your doctor will adjust your dosage. Most doctors do a TSH lab test at least once a year for patients taking thyroid hormones. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I have given birth to five children. Am I at greater risk for osteoporosis than a woman who has had only one or two children? [/INST] During pregnancy, it is important that a woman get enough calcium for both herself and growing baby. Because of this important need for calcium, studies have been done to learn if pregnancy causes a woman to have a greater chance of having low bone density or osteoporosis. Most studies show that while some bone loss may occur during pregnancy, a woman usually regains it after giving birth. According to research studies, women who have been pregnant more than one time have no lasting harm to their bones. These studies include women in the U.S. and other countries. One reason is that women absorb more calcium during pregnancy, especially in the second and third trimesters. This additional absorption of calcium helps to meet much of the developing baby’s calcium needs. Another change during pregnancy that may protect bones is an estrogen surge during the third trimester. Also, a woman carries an increased weight load due to the weight gain of pregnancy. In fact, studies show that having children, even as many as 10, does not increase a woman’s chance of getting osteoporosis later in life. Research even suggests that each additional pregnancy provides some protection from osteoporosis and broken bones. Women who have never been pregnant might actually be at higher risk for bone loss and osteoporosis compared to women who have given birth according to some findings. For women who had pregnancies in their teens, the effects on bone health later in life are still not certain. Teens have not yet reached peak bone mass. This is the point at which they have the greatest amount of bone they will ever have. Additional studies are needed to find out if teen pregnancies can affect future bone health. Breastfeeding for the recommended 6-12 months has great health benefits for both mother and baby. Breastfeeding even longer does not appear to cause lasting influence on bone health. All women who are pregnant or nursing need to get enough calcium, vitamin D and appropriate exercise to keep their bones healthy. Pregnant or breastfeeding women age 19 years and older need 1,000 mg of calcium and 400-800 IU of vitamin D every day. Pregnant or breastfeeding teens age 18 years and younger need 1,300 mg of calcium and 400-800 IU of vitamin D every day. Source: Bone Health and Osteoporosis Foundation. Link: https://www.bonehealthandosteoporosis.org/patients/patient-support/faq/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is osteoporosis? [/INST] Osteoporosis is a bone disease that weakens our bones, making them thinner and easier to break. These fractures can lead to pain, stooped and poor posture, or significant trouble moving around. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is osteopenia? [/INST] Osteopenia is often referred to as the beginning stage of osteoporosis. It is weakening of the bones and reduced bone mass, but not quite to the severity of osteoporosis. If your bones continue to lose mass over time, osteopenia can turn into osteoporosis, but the good news is that it doesn’t have to! There are many healthy habits and lifestyle choices that can strengthen your bones, slow osteopenia and prevent osteoporosis. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How many people have osteoporosis? [/INST] According to the National Osteoporosis Foundation, about 54 million Americans have osteoporosis or osteopenia. Studies suggest that approximately one and in two women and one and four men age 50 and older will break a bone due to osteoporosis. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What are osteoporosis risk factors that cannot be changed? [/INST] These factors include: – Gender – approximately 80% of cases affect women – Age – As we age, our bones naturally lose some density and become weaker – Family history of osteoporosis – Studies show that if either of your parents had it, you are more likely to get it. – History of broken bones – even one broken bone increases your risk of developing osteoporosis, simply because it shows your bones may already be slightly compromised. – Size of body frame – people with smaller frames are more prone to osteoporosis. Their bones are lighter and thinner. Conversely, a large frame is NOT a defense against the disease. – Ethnicity – Osteoporosis affects all races and ethnicities, but those of Asian, Latino and Caucasian descent have a higher risk. – Post-menopausal – There is a steep drop in estrogen after menopause. Estrogen protects the bones. When estrogen decreases, bones may lose density and be prone to fractures. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What can I do to try to avoid osteoporosis? There are many risk factors that you are able to control by making good lifestyle choices. [/INST] These are: – Get enough vitamin D and calcium – Exercise regularly – Quit smoking – Do not abuse alcohol – Work with your physician to bring hormonal imbalances under control – Educate yourself on the long-term use and side effects of medications you are taking Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why are women at greater risk for osteoporosis than men? [/INST] The first reason is that women tend to have smaller, thinner bones than men. The second is related to hormones: When women reach menopause, there is a major drop in estrogen levels. This loss slows the bone remodeling process and may help the body lose bone mass at a faster rate. This continues for several years after menopause. The rate of bone loss eventually returns to where it was before menopause, but in the meantime, it gives postmenopausal women a greater chance of having a fracture. The good news is that osteoporosis is NOT an inevitable part of aging. There are many lifestyle habits that help you protect your bones and decrease your chances of getting osteoporosis. If your healthcare provider has not yet talked to you about your bone health, you should bring it up! Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can taking certain medications increase my chances of developing osteoporosis? [/INST] Some medications may be harmful to your bones, even if you need to take them for other conditions. Always talk to your healthcare provider about risks and side effects of medicines you take and how they may affect your bones Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How can I be sure I get enough calcium and vitamin D in my diet? [/INST] It is recommended that most people take a vitamin D3 supplement. If you are on medications to treat irregular heartbeat, blood pressure, talk with your doctor. If you have lymphoma, kidney disease, liver disease, or hormonal disease, talk to your doctor. Most foods are not high enough in Vitamin D to provide all that we need for optimal wellness. The following foods and drinks are listed because they are either high in calcium and other minerals and are alkaline, therefore allies in the fight against osteoporosis, OR they are low in the necessary minerals and/or acidic and increase your chance of osteoporosis. Eat often: • Fresh fruits (oranges, dates, olives) • Vegetables (turnip greens, kale, collards, spinach, broccoli) • Beans and Legumes • Nuts (Brazil nuts, almonds) • Fish (herring, salmon, sardines) • Eggs • Fortified dairy products • Fortified juices, cereals, and oatmeal • Non-GMO, minimally processed soy is an excellent source of plant based protein Eat Rarely or Not at All: • Sodas • Refined, processed packaged foods • Excessive amounts of animal proteins • Excessive sodium and table salt • Coffee (limit to one or two per day, as caffeine leaches calcium from the bones) • GMO, processed soy products, as the oxalates (chemical components in soy products) can bind up calcium and make it unavailable to the body. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can I get all the vitamin D I need from sunshine? [/INST] Large amounts of Vitamin D3 are made in your skin when you expose your entire body to summer sun, so it is technically possible that sun exposure will produce all you need. However, the average person does not spend enough time outdoors every single day so a quality D3 supplement is important. As far as sun exposure goes, there is no magical formula to tell you how long one should be outside each day because there are many factors that play into just how much exposure is necessary. It could be just 15 minutes of exposure for a fair skinned person, but a couple of hours for a more dark skinned person. The amount of vitamin D you get from exposing your bare skin to the sun depends on: – The time of day – Your skin produces more vitamin D if you expose it during the middle of the day – Your geographic location – the closer you are to the equator, the more intense the exposure is to the sun, so it would be quicker to produce vitamin D. – The color of your skin – pale skin makes vitamin D quicker than dark skin – The amount of skin you expose – the more skin that is exposed, the more vitamin D your body will produce. – Age – as we age, our skin has a harder time producing vitamin D Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why is exercise good for bone health? [/INST] Weight bearing physical activity is one of the best defenses against osteoporosis. Bone is living tissue and responds to loads placed on it. Regular exercise is beneficial for minimizing progressive bone loss during aging. During exercise, as you put more tension on your muscles, it puts more pressure on your bone, which causes new tissue to form and enables the body to continuously create fresh, new bone. Exercise can increase your muscle strength, improve your balance, decrease the risk of bone fracture, maintain or improve your posture, and relieve or decrease pain. It is important to exercise safely and with caution. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Does osteoporosis have any warning signs? [/INST] Osteoporosis often starts silently, and may not be found until someone suffers a fracture. Other early signs may include: – Progressive loss of height or stooped posture – Sudden back pain without any obvious cause – it could be a vertebral compression fracture – A fracture after a seemingly minor incident Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How is osteoporosis diagnosed? [/INST] The gold standard for osteoporosis diagnosis is a combination of assessing risk factors and performing a full body Bone Mineral Density (BMD) assessment of the spine, lower back, and hips, which is done as a Dual-Energy X-ray absorptiometry, or DEXA scan. The DEXA is brief and painless. It requires the patient to lay flat for a few minutes on the DEXA scanner. You will be exposed to a very small amount of radiation. The results are given as a number called a T-Score. This score will tell you whether your BMD is above or below that of a young, healthy adult. Source: OSC - ORTHO. Link: https://www.osc-ortho.com/frequently-asked-questions-about-osteoporosis/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why is osteoporosis related to age? [/INST] It is known that ageing leads to a progressive loss of bone mass. This loss usually begins at around 45–50 years and in the case of women it is more notable during the menopause, a period in which there is a marked decrease in oestrogen levels. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do men also suffer from osteoporosis? [/INST] Men are also afflicted by osteoporosis, although less frequently than women. In fact, 1 in every 5 men over 50 will suffer an osteoporotic fracture during their lifetimes. Furthermore, it is important to highlight that the main causes of osteoporosis in men are corticosteroid treatments, excessive alcohol consumption and hormonal disorders; having said this, no cause of the osteoporosis can be found in almost half of all cases, particularly among young individuals. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can young people also have osteoporosis? [/INST] Yes; young adults (men and women below the age of 50) can also develop osteoporosis but much less frequently. In this event, it is advisable to analyse the presence of other illnesses, treatments or associated hormonal disorders. Occasionally, the diagnosis of osteoporosis in young people is not associated with any illness and, in some individuals, it may be related to a genetic component and the failure to achieve a sufficiently high peak bone mass. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] If I have already suffered a bone fracture, should I undergo a study for osteoporosis? [/INST] It is very important to consider how the fracture occurred, whether due to a high-velocity (e.g., a traffic accident) or low-velocity impact (e.g., falling over). The location of the fracture must also be taken into consideration. Fractures associated with osteoporosis normally occur in the wrist, spine, hip (femur), arm (humerus) and pelvis. If you have suffered a fracture in any of these locations and/or one caused by a low-velocity impact, then you should discuss the potential need for an osteoporosis study with your doctor. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How is diagnosed? [/INST] A bone density scan should be performed to confirm the diagnosis of osteoporosis. This should be accompanied by a blood analysis to evaluate bone metabolism parameters. Furthermore, any prior fractures must be assessed and so you will often undergo X-rays of the spine to rule out the presence of any undetected vertebral fractures. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can I undergo a bone density scan if I have an implant? [/INST] The hip or lumbar spine (surgical fixation in the lumbar spine region) implant material can affect the determination of bone mass in this area, as can vertebral deformities such as scoliosis. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Are all osteoporosis treatments the same? [/INST] No; each drug has its own features. Nor are all bone resorption reducing agents or antiresorptives (bisphosphonates, denosumab, SERMs and oestrogens) equal; and neither are the bisphosphonates. Although they all initially act on bone-degrading cells (osteoclasts) they do so by different mechanisms. Bone-forming treatment with teriparatide acts on bone-forming cells, known as osteoblasts, whereas the mode of action of antiresorptive treatments involves the cells responsible for degrading, reabsorbing and remodelling bone, these are called osteoclasts. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What are the action mechanisms of the main drugs for treating osteoporosis? [/INST] Antiresorptive treatments act on bone-degrading cells (osteoclasts) and decrease their activity through different mechanisms. While the bone-forming treatment has a direct effect on the cells that create bone (osteoblasts) and increases their activity. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Are all calcium supplements the same? [/INST] No; they vary in composition and the amount of calcium they contain. Different calcium formulations are available – calcium carbonate, calcium lactate gluconate, calcium pidolate and calcium citrate, amongst others. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can I take calcium supplements if I have kidney stones? [/INST] Patients with kidney stones should optimise their calcium intake through their diet; you should not take calcium food supplements. If you have kidney stones, then we recommend that you discuss it with your doctor. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How should I take the calcium supplement? [/INST] This depends on its composition. For example, calcium carbonate, the most commonly used calcium supplement, should be taken with meals. Whatever the case may be, if in doubt you should discuss it with your pharmacist. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do sunscreens interfere with the skin’s ability to synthesise vitamin D? [/INST] Yes; the use of sunscreens reduces the amount of vitamin D synthesised by the skin. However, sunscreens must be worn to prevent skin cancer. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Does exposure to sunlight through a glass window reduce the skin’s ability to synthesise vitamin D? [/INST] Yes; exposure to sunlight through a glass window does not activate any vitamin D synthesis. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can I suspend the treatment at any given moment? [/INST] This depends. There are treatments, e.g., the bisphosphonates, that have a residual effect on the skeletal system as they remain bound to the bone for years. Therefore treatments with alendronic acid and zoledronic acid, which are the bisphosphonates with the highest bone binding affinity, have a residual effect that will last for several years after discontinuation. Risedronic acid also has a residual effect but it does not last for as long. However, it is important to point out that there are treatments that will lose or diminish any benefits gained within 1 or 2 years of discontinuing the therapy. And so upon suspending treatment with teriparatide (bone-forming agent) or denosumab (antiresorptive agent) osteoporosis patients need to take another treatment to “fix” or maintain the positive effect (this could be an oral or intravenous bisphosphonate). Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do all yoghurts contain the same amount of calcium? [/INST] It depends; most yoghurts contain 130–150 mg of calcium per unit regardless of whether they are natural, sweetened and/or flavoured. Nor are there any significant differences in calcium content between skimmed and whole-milk yoghurts. Calcium-enriched yoghurts contain approximately 500 mg of calcium per unit. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Does skimmed and semi-skimmed milk contain the same amount of calcium as whole milk? [/INST] Yes; skimmed, semi-skimmed and whole milk all contain the same amount of calcium (they contain an average of 250–275 mg per 250 mL). Nevertheless, calcium-enriched milk contains approximately 400 mg of calcium per 250 mL. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] what about lactose-free milk and almond milk? [/INST] Lactose-free milk contains approximately 250–275 mg per 250 mL. Almond milk can contain up to 300 mg of calcium per 250 mL. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do all cheeses contain the same amount of calcium? [/INST] No; the calcium content depends on whether it is a soft or hard cheese. Table 3 summarises the approximate calcium content found in different types of cheese. Source: Clinic Barcelona. Link: https://www.clinicbarcelona.org/en/assistance/diseases/osteoporosis/frequently-asked-questions. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is osteoporosis? [/INST] Osteoporosis literally means “porous bones.” This occurs for several reasons. About 62% of your bone density is a result of genetics — you may never have had dense bones. Look to your parents for hints. If you did not build bone sufficiently during your bone building years, you are at a lower threshold when you age. With the falling levels of estrogen (in women) and testosterone (in men) and its associated bone loss, you may have bone density below a normal level. Inadequate intake of calcium and vitamin D as a child or as an adult or both will lead to osteoporosis. Some medications, although necessary, will cause bone loss. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is osteopenia? [/INST] Osteopenia or low bone mass is a status classification used to describe bones that are thinner than normal, but have not yet reached the osteoporosis stage. We are now beginning to refer to osteopenia as low bone mass since osteopenia suggests that you have lost bone density. It is possible that you never built bone that was any stronger. If you are older with a bone density in this range, your doctor may consider a bone medication to prevent fractures. Osteopenia and osteoporosis are on the same spectrum of bone thinning. The bones become more porous and can be at increased risk for fracture. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why do they compare my bones to a 30 year old? [/INST] The classification of low bone density and osteoporosis was standardized against peak bone mass. Adults typically reach peak bone mass around age 30. The scientists used large databases of test results to determine the average for normal peak bone mass, and then the range for low bone mass (osteopenia) and very low bone mass (osteoporosis). In 1994, the World Health Organization (WHO) reviewed the worldwide data on bone density testing and fracture risk. Prior to this publication, many bone density testing centers reported results by comparing a patient to other patients of the same age. The WHO concluded that, based on studies of older women, reporting the relation of the bone mineral density (BMD) to the average peak bone mineral density of a 30-year old would be more appropriate. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I had a bone density test and my doctor said my bones were “just fine.” What does that mean? [/INST] It’s a good idea to always ask what the doctor means. Sometimes they may be looking at your bone density test results and comparing them to others your own age and gender. This is called a Z-score. It’s an adequate comparison, but it’s much better to know how you compare to a 30-year-old normal bone — the T-score. Always ask to have a copy of your report sent to you so you can see how strong your bones are for yourself. Following good bone health practice is always appropriate and is a life-long task Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What causes osteoporosis or osteopenia? [/INST] There are two main classifications of causes for bone loss: Primary osteoporosis refers to bone loss as a result of aging (we lose bone density as we age), gender (women lose more bone density because of the reduction of estrogen after menopause), and genetics (about 62% of you bone structure is related to race and family history.) Secondary osteoporosis refers to bone loss that is cause because you have a chronic medical condition or take a medication that can affect bone loss or increase fracture risk. These factors also may increase your risk of fractures. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I’m taking a medicine that contributes to bone loss. Should I stop taking those medicines to protect my bones? [/INST] That is something to discuss with your doctor. Tell him/her of your concerns. But keep in mind that your doctor prescribed the medications for a reason. That reason probably outweighs the concerns about bone loss. Your doctor, however, may (or may not) be able to prescribe something different. Also look at the handouts on risk and focus on the strategies you can use to prevent bone loss, falls and fractures. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I feel fine, quite healthy and exercise every day so do I have to worry about osteoporosis? [/INST] Since you build all the bone you are ever going to have by the time you are 30 years old, much of your bone health depends on your genetics and how well you built your bone density during those teenage years. A bone density test (DXA) will tell you if you should be concerned about osteoporosis and fractures. Even though you feel fine now, did you have any condition that could have affected your ability to maximize your bone density by age 30? Were you underweight or an athlete with a strong drive for training that could have caused Athletic Energy Deficit (AED)? Did you experience disordered eating (anorexia or bulimia), an early pregnancy (before age 20), cancer, cancer treatments or other childhood diseases? If you have, do not be surprised to have low bone mass. Just recognize that you may never have been in the “normal” range as measured by DXA when you were 30 years old. Most people are surprised to learn that 70% of the people who have low impact fracture have not been diagnosed with osteoporosis and have never had a DXA. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] If I have family members with osteoporosis will I also develop osteoporosis? [/INST] Having a strong family history of osteoporosis is associated with an increased risk of developing osteoporosis. You have important information that you can act on now. Make sure you are getting plenty of calcium-rich foods, weight-bearing activity and reducing habits like smoking, vaping or excess alcohol. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can men get osteoporosis? [/INST] One out of every two women and one out of every four men has an osteoporotic fracture if they live past 50. We also know that men die more often than women following a hip fracture. So yes, men do have to be concerned. Although men generally build more bone and have higher peak bone mass, their bone mass begins to decline around age 70. Medicare guidelines cover DXAs for men only under certain circumstances. The American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men If a man has a moderate or high fracture risk, based on the American Bone Health Fracture Risk Calculator™, he should be able to get a DXA at an earlier age through his insurance. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is my osteoporosis risk if I’m trans? [/INST] Gender-affirming hormone therapy has been shown to maintain or promote acquisition of bone density as measured by bone density testing. No differences in fracture rates have been seen in trans women or men in short, prospective trials. Trans children and adolescents on gonadotropin-releasing hormone may be at risk for decreasing bone density while not on sex steroid hormone replacement. Screening for osteoporosis should be based on clinical factors. Treatment for osteoporosis follows the same guidelines as cisgender populations or the same as your gender identification at birth. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is a bone density test (DXA)? [/INST] A DXA scan or a bone mineral density (BMD) test is the current standard to diagnose osteoporosis. The test measures the quantity of bone at specific locations in the body—the lower back bones (lumbar region) and the upper end of the thighbone where it connects to the pelvis (total hip and its subdivisions—the femoral neck and trochanter). These locations are used for two primary reasons: 1) they have a large quantity of trabecular bone—the spongy, lattice-like bone on the inside—where we first begin to see bone loss as we age; and 2) measurements taken at these locations can be more easily replicated to be able to monitor changes in the quantity or density of bone over time. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Is a bone density test (DXA) a blood test? I have heard you can have one to determine bone status. [/INST] A DXA—the “gold standard” for diagnosing osteoporosis— is not a blood test. It is a low dose X-ray that is fast and painless. You lie on a table and the arm of a machine passes over your hip and spine. Sometimes doctors order blood tests for bone turnover markers to determine how rapidly you are losing bone. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do I have to fast prior to the bone density test? [/INST] No, but many testing centers ask that you not take calcium supplements during the 24 hours before your test. This is because as the tablet goes through your digestive tract, it may obscure the view of one of your spine bones. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How do I understand my bone density test (DXA) results? [/INST] Sometimes you will receive a short summary from your doctor which provides the results in somewhat subjective language. Always ask for the full report, including the images. The images are helpful if you move and have a follow-up test at another location. The technician has a better chance of more closely matching the original placement of your body for imaging. The full report will give you a T-score which shows how much your bone density differs from the mean or average. For DXAs, the mean is based on a composite of average healthy 30-year-olds. The T-score is a statistical comparison to peak bone mass at age 30. Think of T-scores as a bell shaped curve divided into standard deviations from the mean. Peak bone mass is zero. The normal range is from -1.0 to +3.0 and higher. Osteoporosis is 2.5 standard deviations below the mean or zero (-2.5). What’s in between those two ranges is called low bone density. Normal = T-score greater than -1 Osteopenia/Low bone density = T-score from -1.1 to -2.4 Osteoporosis = T-score of -2.5 and lower Severe or established osteoporosis = T-score of osteoporosis + low impact fracture Note: Even if your T-score places you in the low bone mass range, if you have an osteoporotic fracture you are considered to have osteoporosis. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I had an osteoporosis test at a health fair. How accurate is that? [/INST] Many health fairs or pharmacies offer screening using machines that measure the heel bone, fingers, or wrist. Some machines are ultrasound and some are X-ray. Since osteoporosis is a systemic disease, these screenings can be a good indicator of the bones in the rest of your body, but remember it is only a screening. You should have a bone density test of your hip and spine on a table DXA to confirm the screening results. Since the bone in the heel, wrist and fingers change more slowly, they are not suitable for monitoring changes in the skeleton or following treatment. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] My doctor suggested a bone density test, but since there is x-ray involved, I am concerned. Should I be? [/INST] There is a small amount of X-ray in a bone density test—;ess than the amount of radiation that you would get flying from California to New York as a result of being closer to the sun. We naturally absorb about 10 uSv (microsievert) of radiation per day if we are living at sea level or 2–3 times that much if we live at higher elevations like Denver (elevation 5,000). A bone density test would give you about 0.4 uSv of radiation. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] My doctor told me that I didn’t need a bone density test because I am so sturdy. Is that true? [/INST] Your doctor really cannot assess your bone density just by looking at you. The only way to determine how healthy your bones are is to have a bone density test. Seventy percent of the people who have a low impact fracture have not been diagnosed with osteoporosis and have never had a bone density test. The United States Preventive Services Task Force published guidelines for testing. Medicare Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one of more of these conditions: You’re a woman whose doctor determines you’re estrogen deficient and at risk for osteoporosis, based on your medical history and other findings. Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures. You’re taking prednisone or steroid-type drugs or are planning to begin this treatment. You’ve been diagnosed with primary hyperparathyroidism. You’re being monitored to see if your osteoporosis drug therapy is working. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How often could/should I repeat my bone density test (DXA)? [/INST] That depends on a number of issues including your age, menopausal status, previous bone density results, medicines that you may be on that cause bone loss or increase fracture risk, and what type of osteoporosis treatment you may have started. Generally, doctors follow-up with DXAs every two years since changes in bone density are usually slow. Usually, health plans will pay for bone density testing every two years, but if your bones are in good shape, your doctor may extend the time between tests. Some of the newer medicines act faster on bone metabolism, so your doctor may repeat your DXA after one year. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I’m young (under 30), but I have Rheumatoid Arthritis. Should I get a DXA? [/INST] Your doctor may want to monitor your bone density, especially since you are probably on a steroid medicine. Your rheumatologist may recommend a DXA for you between age 30 and 35 to determine peak bone mass. Because you are young, the doctor would be unlikely to put you on an osteoporosis medicine unless you are having fractures. You should definitely work on prevention strategies for preventing bone loss, like making sure you get enough calcium, vitamin D and weight bearing exercise (if you can manage it). Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] How likely am I to have a fracture? [/INST] Your risk of breaking a bone is more than just your bone density score. Your risk is based on a variety of factors, including family history, medical conditions you’ve had and medicines you’ve taken. Use American Bone Health’s Fracture Risk Calculator™ to get a clearer picture of your risk. Once you know your actual risk you can create your plan to avoid fractures and stay independent. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Why do I need to do a fracture risk assessment? I have a healthy diet, and I exercise regularly. I’m doing everything right. [/INST] Having a healthy diet and regular exercise is a great way to take care of your bones. Doing a fracture risk assessment can give you additional information about factors that you might not have thought about that could affect your bone health. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] My bone density (T-score) hasn’t changed. Why have I moved from low risk to moderate risk? [/INST] Even if all your other risk factors remain the same, fracture risk increases with age. The mix of fractures also changes with age: at 45–49 years, hip fractures account for only 7% but increase to 50% at 75 years. In contrast, the proportion of wrist fractures decreases with age, from 60% among the younger group to 26% among the older. Fractures are often related to falls, and the risk of serious injury from a fall increases with age. There are many reasons older adults are susceptible to falls. These include side effects of some medications, loss of muscle mass and strength, declining balance, loss of agility, and vision impairments. Keep in mind that your fracture risk score is not predictive for you. It is merely the average 10-year risk of someone with similar characteristics. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I don’t know my T-score. Can I still use the Fracture Risk Calculator™ to calculate my fracture risk? [/INST] You can still use the calculator without your bone density number, but the results won’t be as accurate. Your results will be based on your body mass index and the fracture risk of a group of similar age, race, gender, and body mass. The actual risk may be higher, especially for someone with a T-score in the osteoporosis or low bone density (osteopenia) range. Ask your doctor for the complete report from your last DXA. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] My mother broke her hip, and my sister was just diagnosed with osteoporosis. Should I be worried? [/INST] There is certainly a strong genetic factor in determining whether you may get osteoporosis. In fact, family history is one of the main risk factors. The only way you can find out if you have osteoporosis is by having a bone density test. Family history of hip fractures increases the risk of hip fractures for their children. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Does having a high fracture risk mean that I’m going to have a fracture? [/INST] If you have a high fracture risk, that means you have at least a 20% chance of having a fracture (depending on your results). If you have a 20% chance of having a fracture, you also have an 80% chance of NOT having a fracture. In counseling patients about the risks and benefits of treatments for osteoporosis, we find that most individuals start to worry about their risk when it reaches “double digits,” and 20% (1 in 5) is usually of great concern. Cost-effectiveness models and treatment guidelines that have been published based on U.S. costs and fracture rates cite high risk as 3% or more for 10-year risk of hip fracture and 20% or more for 10-year risk of any one of four fractures. These same percentage cut points are used to treat cardiovascular disease (National Cholesterol Education Program). Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I’ve had a fracture, now what? [/INST] Here are the steps to speed your recovery and to reduce your risk of breaking another bone. Focus on Healing—Control inflammation and pain; make your home safe and easy to get around; take enough calcium and vitamin D. I’ve Had a Fracture, Now What? Schedule Follow-up Appointments—Start planning your follow-up visits with your orthopedist, physical therapist, bone density testing office and primary care provider. The team will help you get back in action faster. Assess Your Function and Bone Health—Ask for a written rehabilitation plan that you can understand along with specific instructions; get a copy of your bone density test results. Create Your Bone Health Plan—Meet with your primary care provider; talk to your pharmacist about your medications; include nutrition, physical activity and fall prevention in your plan. Build Strength and Get Moving Again—Improve mobility, strength and balance; eat a bone-healthy diet; join a community exercise program. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What exercises are safe for me? [/INST] Weight-bearing exercises are best for bones. Impact on bones helps them adapt and become stronger. Weight-bearing activities can involve either body weight (from running) or gym weights. Activities can be either low impact or high impact. Low-impact activities are less stressful on joints and already-fragile bones, but they still place more stress on the bones than non-weight-bearing activities. A good rule of thumb for low- impact activities is any activity that requires one foot on the ground at any given time. Low-impact activities include walking, step-aerobics, elliptical machines, step-climbing, elastic-band resistance training, and weight-lifting. Low-impact activities can help reduce bone loss. High-impact activities are most beneficial for people who want to build bone density and are not at risk of fracture. Participate in these activities sparingly to avoid overuse injuries of ligaments, tendons, and bones. It is important to incorporate active rest days in between high-impact activities. Active rest days should still involve other low-impact activities to let your body recover and to reap the benefits of a consistent exercise program. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is a healthy diet for my bones? [/INST] Many nutrients play a role in bone health. Calcium, vitamin D and magnesium are the key bone health nutrients that require special attention to ensure you meet your daily requirement. Although many foods contain calcium, dairy products provide the most calcium per serving size. Daily requirements for calcium change with age. People who do not eat dairy foods will need to work hard to meet the recommended daily allowance or may need a calcium supplement. The easiest way to get vitamin D is through exposure to sunlight — but we don’t recommend trying to go that route because of the risk of skin cancer. Talk to your doctor about adding a supplement. Other nutrients for good bone health include: magnesium, phosphorus, potassium, and vitamin A. The USDA recommends 0.36 grams of protein per pound of body weight, but current recommendations suggest that protein needs depend on age, body weight and activity level. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do I need to take calcium and vitamin D supplements? [/INST] It’s best to get your calcium through your diet, but for many people this is not possible because they do not consume dairy products. To meet the current Recommended Dietary Allowance (RDA) of calcium, women ages 18 to 50, and men ages 18 to 70 need 1, 000 milligrams (mg) of calcium. This equals two servings of a calcium-rich food, like dairy or foods and beverages fortified with calcium. Adults who eat cheese, yogurt, milk, and fortified beverages daily are likely getting sufficient calcium from their food and do not need a supplement. As we age and hormone levels drop, we need more calcium to reduce bone loss that can lead to the risk of fractures. For women age 50+ and men age 70+, the RDA increases to 1,200 mg daily. Meeting this calcium requirement can be more challenging in older adults. Only about 30% of women in the US get enough calcium from their diet alone. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What is the best calcium supplement to take? [/INST] Take the kind of calcium you will take regularly! You will benefit from any kind of calcium, if you take it correctly, every day. Keep chewables in your car or on your desk. Put your tablets where you will remember to take them with meals. Calcium is a lifelong requirement, so choose a calcium supplement that is compatible with your lifestyle and one that you can afford. There are a lot of pricey calcium supplements on the market that claim that they’re better than basic or generic products, but the evidence is thin to support the difference in cost. Some calcium supplements may cause gas, bloating, and constipation in some people. If any of these symptoms occur, try spreading out the calcium dose throughout the day, taking the supplement with meals, or changing the supplement brand or calcium form you take. If taken properly it doesn’t matter when you take calcium as long as you don’t exceed a dose of 600 mg. at a time and do take the supplement with something in your stomach. Food helps your stomach produce the acid needed to break calcium down for absorption. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I read that if you are taking certain medications, you cannot absorb calcium supplements. Is this the case? [/INST] Proton pump inhibitors (PPIs) are a type of medicine that reduces stomach acids. They are usually prescribed because a patient’s stomach acid levels are too high, and the medication reduces the acids to a more normal level. You might consider calcium citrate rather than calcium carbonate if you are on these drugs because calcium citrate does not require stomach acid to break it down. Calcium carbonate may cause acid rebound where the stomach overcompensates for the high dose of calcium carbonate, which is alkaline, by churning out more acid. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I heard that people with celiac disease and ulcerative colitis don’t absorb calcium. What should we do? [/INST] Doctors are discovering more and more individuals with these types of gastrointestinal issues that affect calcium absorption. If you have absorption issues, you must maximize your calcium citrate and vitamin D intake. Talk to your doctor about the most absorbable form of calcium for you. Calcium citrate is considered to be a more absorbable form of calcium, and it can be taken with or without food. It is also generally more expensive. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can you take too much calcium? [/INST] Getting too much calcium from foods is rare. Excess intakes are more likely to be caused by the use of calcium supplements. High calcium intake can cause constipation. It might also interfere with the absorption of iron and zinc. High intake of calcium from supplements, but not foods, has been associated with increased risk of kidney stones. Some studies also link high calcium intake, particularly from supplements, with increased risk of cardiovascular disease. It’s best to get your calcium through your diet, rather than supplements. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Can taking too much calcium cause kidney stones? [/INST] Most kidney stones are formed when oxalate, which is naturally found in many foods, binds to calcium while urine is produced by the kidneys. Calcium, however, is not the main culprit in calcium-oxalate kidney stones. A diet that is low in calcium actually increases the risk of such kidney stones. If you are worried about kidney stones, instead of reducing calcium, cut back on salt and pair oxalate-rich foods (examples: peanuts, rhubarb, spinach, beets, chocolate and sweet potatoes) with calcium-rich foods. One of the best ways to avoid kidney stones is to drink plenty of water. Calcium supplements generally are not the cause of kidney stones; however, if you have had kidney stones, it would be wise to check with your doctor about what kind of calcium to take and what foods to limit in your diet.” Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Should I take magnesium along with my calcium? [/INST] Magnesium is needed for good bone health; however, many of our foods are rich in magnesium, so supplementing it in modest quantities is not essential but will do no harm. It is important to recognize that loop diuretics such as furosemide (Lasix) can deplete the body of magnesium if magnesium is not supplemented. Sometimes people will get constipated from calcium because of its mild binding effect. .Adding a bit of magnesium can help. Some people buy a calcium supplement with magnesium for that reason. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I am taking a medicine for osteoporosis; do I still need to take calcium? [/INST] All osteoporosis treatment plans must include calcium and vitamin D. Some medications are now formulated to include calcium. Check with your doctor to make sure you are getting the right amount of calcium and vitamin D. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I don’t like milk and don’t want to supplement, but I am concerned about my bones, so I am eating a lot of greens, especially spinach and broccoli. Is this enough? [/INST] Green vegetables like spinach and broccoli are very good for you, but are not the best source of calcium. Those vegetables contain phytic and oxalic acids that bind with the calcium and make it less bioavailable. This means that the body is not able to absorb the calcium. Additionally, these high fiber vegetables move through the body quickly and reduce the ability of the body to extract the calcium. Calcium bioavailability varies from food to food. Foods that are high in oxalates like spinach, rhubarb, sweet potatoes, and dried beans are poorly absorbed. But there are still a number of good calcium sources outside of milk. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] My calcium supplement has vitamin D in it, and I take a multi-vitamin. Is that enough? [/INST] Current science suggests that the RDA of vitamin D 5 – 10 mcg (200 – 400 IUs) is too low and these levels are under review by the Institutes of Medicine. American Bone Health recommends 25 – 50 mcg (1,000 – 2,000 IUs) daily. Most calcium supplements do not have enough vitamin D and multivitamins contain very little. The combination of vitamin D from all sources should be 25 – 50 mcg (1,000 – 2,000 IUs) daily. Many doctors are using 1,250 mcg (50,000 IUs) once a month in their patients who are deficient. There are reported cases of vitamin D intoxication causing hypercalcemia and renal failure at extremely high daily doses exceeding 1,250 mcg (50,000 IUs) taken for protracted periods of time. You can take Vitamin D at any time of day with or without food. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I spend time in the sun. Do I have to worry about vitamin D? [/INST] There are a number of good reasons to supplement vitamin D. If you are using sunscreen, it screens out the UV rays that convert precursors of vitamin D to vitamin D in your skin. People with darker skin do not process vitamin D as well as those with lighter skin. People, especially older adults, are not generally out in the sun on a regular basis. In northern latitudes for much of the year, vitamin D is screened out by the atmosphere due to the low angle of the sun. And as we get older, our skin does not process vitamin D as well as it does when we are younger. The skin also becomes less efficient at producing the vitamin from sunlight as we age. Vitamin D is being shown to have a beneficial effect on many body functions and is safe at the recommended 25 –50 mcg (1,000–2,000 IUs) per day and not expensive to supplement. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I hear horror stories in the news about the side effects of the osteoporosis medications. [/INST] All medicines have side effects. It’s important to distinguish between minor side effects and very serious but rare adverse effects. Mild side effects may disappear as your body becomes accustomed to the new medicine. Others can be managed by your doctor adjusting the dosage, timing, or even the drug prescribed. Rare harms can occur with long-term use of some osteoporosis medicines. The risk of harm appears to increase the longer a patient stays on the medicine, particularly after 4 to 5 years. Atypical femur fracture (AFF) More information>> Atypical Femur Fracture Osteonecrosis of the jaw (ONJ) More information>> Osteonecrosis of the Jaw All of the osteoporosis medicines are FDA approved for the treatment of osteoporosis. The medicines have gone through rigorous studies, have good safety data and they all reduce the risk of fractures by at least 35%. Using the ABH Fracture Risk Calculator™ can help you weigh the risks of a fracture against the risks of the medicines. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] I don’t want to take osteoporosis drugs (Fosamax, etc.) because of their side effects/adverse effects. [/INST] Taking a medicine for any health issue is a choice. It is important to weigh the risks and the benefits. If you are at high risk of having a fracture, you will benefit from a medicine. All medications can have side effects. By comparison, osteoporosis medicines are relatively safe and only target the bones—no other organ systems. The rare side effects from bisphosphonates and denosumab are rare. The risk of an adverse event is very low (in the range of 1:20,000 to 1:100,000). By comparison, the risk of an osteoporosis fracture for a woman over age 50 is 1:2. From our friends at the Kaiser Healthy Bones program, here is another way to think about it. Out of 1,000 people on a bisphosphonates or denosumab for 5 years: Less than 1 may have a jaw problem (1/100,000) Less than 1 may have a rare treatment related fracture (16/100,000) There is so much information in the media and on the internet that can be marketed as the cure for any number of things. Always ask for the scientific evidence behind the claims. This science should be published in a peer-reviewed journal, meaning that it has been vetted by experts for the scientific method and analysis of the data. Remember, there are also side effects to not taking the osteoporosis medications—fracture, disability, and possibly death. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Will herbal or natural supplements keep my bones strong? [/INST] Herbal or natural supplements, also call nutraceuticals, are not regulated by the FDA. Manufacturers of nutraceuticals have not been required to show that they are safe and effective. Additionally, it is difficult to know how much of any ingredient you may be getting in many herbal or natural remedies. Studies are required to determine if there is sufficient evidence to recommend these supplements. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Are vibration platforms good for bones? [/INST] There is insufficient data and no evidence-based guidelines on vibration platforms, so American Bone Health does not endorse the use of vibration platforms for improving bone health at this time. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do I need a “drug holiday”? [/INST] Women who have been on the osteoporosis medicines called bisphosphonates for 3 to 5 years should get a repeat bone density test and fracture risk assessment. Women who have a low-to-moderate risk of fracture could be prescribed a “bisphosphonate holiday.” During a “drug holiday” the patient’s fracture risk is regularly assessed and treatment resumed accordingly. A “drug holiday” should be considered a short-term vacation, not long-term retirement. The advice about a “drug holiday” applies only to bisphosphonates. Other osteoporosis medicines such as denosumab (Prolia®), teriparatide (Forteo®), abaloparatide (Tymlos®) and romosozumab (Evenity®) must be followed by another medicine. In the case of teriparatide and abaloparatide, using a bisphosphonate or denosumab will help maintain the gains in bone density made by the two bone building medicines. When medicines like denosumab and romosozumab are stopped, the metabolic process that they were inhibiting resumes and there can be rapid bone loss. Do not stop any medicine for osteoporosis before you talk with your health care provider. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] What medicines or treatments do you recommend for osteoporosis? [/INST] There are a number of good options. All of the osteoporosis treatments are FDA-approved and have been shown to significantly reduce the risk of fractures. Finding the treatment that is right for you will be based on how high your fracture risk is and what form of treatment is most convenient for you. There are pills, injections and infusions. All of the medicines have good safety data and only act on the bones. Some have minor side effects, but in general, the risk of starting a treatment may be much less than the risk of having another fracture. All of these treatments require a prescription from a doctor. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>

<s>[INST] Do I need to take medicine for osteoporosis? [/INST] Maybe. Osteoporosis is a diagnosis you get from a bone density test. This test result is one piece of information to consider. To weigh the pros and cons of taking a medicine to prevent fractures and bone loss depends on your risk of breaking a bone. Your next step is to know your fracture risk. However: If you are at high 10-year risk of having a fracture—greater than 20%—you will benefit from taking a medicine to reduce your risk. If you are at moderate 10-year risk of having a fracture—between 10% and 20%—you will need to weigh the risks and benefits carefully with your healthcare provider before making a decision. If you are at low 10-year risk of having a fracture—less than 10%—you will not really benefit from taking a medicine — even if you have osteoporosis as measured by a bone density test. Source: American Bone Health. Link: https://americanbonehealth.org/frequently-asked-questions/. Field: Rheumatology. Disease: Ostoeporosis </s>