Written By: Deborah Bieter-Schultz, D.O.

It is estimated that currently 18 million Americans are affected with significant bone loss, 8 million with osteoporosis and 34 million with osteopenia, a precursor to osteoporosis. Osteoporosis is much more prevalent in women than men, with a 5 to 1 ratio, and much more prevalent in women after menopause than before.

Osteoporosis is the thinning of bones to the point where they can break with very little injury or even spontaneously. Something as simple as a sneeze can cause a rib fracture, and multiple small fractures of the spine cause a curvature of the spine: Dowager’s hump. These fractures are not only very painful but if severe enough can significantly decrease breathing ability. More commonly, hip fractures are the result. A significant percentage of women who fracture their hip will die within 6 months due to complications.

Throughout you entire life, your bones are living and changing with you. You are always destroying old bone cells and replacing them with new ones. You replace your entire skeleton every ten years! In your youth, you are building more bone than you break down, so your bones grow bigger and stronger, reaching their peak strength by age 30. As you mature, you break down more bone than you replace. If you break down enough bone without replacing it, osteoporosis develops.

There are several risks factors for osteoporosis, some of which you can control and some of which you cannot. Things that cannot be changed include: age (over 50), gender (female), ethnicity (caucasian or asian), genetics (your family history), and bone structure (petite). But you can try to decrease your risk in several ways. Inactivity, calcium or vitamin D deficiency, alcohol use, caffeine intake and smoking all contribute to developing osteoporosis. Weight bearing exercise such as walking, jogging and aerobics decrease your risk, as does taking calcium and vitamin D daily, and avoiding alcohol, tobacco and caffeine. Certain medications such as steroids and thyroid hormone replacement can also increase your risk, however, in most cases these medications are essential and their benefits outweigh their risks.

Unfortunately the first symptom of osteoporosis is often a fracture, therefore routine screening is the best plan. A woman after menopause, or who has other risk factors, should be screened with a bone density test every two years. The most common is the DEXA, where a slight amount of radiation is sent though the bones of the hip and spine, depending how long it takes to pass through, the density of the bone is determined. Anything reported as -1.0 to -2.5 is considered osteopenia, and anything over -2.5 is osteoporosis.

Women with osteoporosis, or osteopenia with other risk factors should consider treatment. First and foremost is weight-bearing exercise and calcium with vitamin D supplementation. Women should be getting 1000-1500 mg daily along with 400 to 800 IU of vitamin D.

Estrogen replacement therapy is good for prevention and helpful in the treatment of osteoporosis. However, with the risks associated with it such as heart attack, stroke and breast cancer, unless you are having other menopausal related symptoms, there are other less risky and more effective therapies available.

Evista, a selective estrogen, does increase bone mass as well as provide some protection against breast cancer. It can still cause heart attacks and strokes, and may cause hot flashes, but is an effective and less risky alternative to traditional estrogen.

The primary drugs being used today for osteoporosis are the bisphosphonates. They work by preventing the breakdown of bone cells, so bone eventually becomes more dense again. This class of drugs includes Fosamax, Actonel, Boniva and Reclast. The most common side effect with these medications is stomach distress. Women with GI problems like ulcers, gastritis, or reflux should consider non-oral forms if possible. Boniva and Reclast can both be given intravenously: Boniva every three months and Reclast yearly. Their most common side effect is mild achiness for the first few days. Osteonecrosis of the jaw, is an extremely rare, but highly publicized complication of these medications. Its incidence is about 1 in 100,000 users, and usually only with other risk factors.

Calcitonin, a naturally occurring hormone, is another nonoral choice. It is a nasal spray and highly effective, however can cause nasal irritation.

Forteo, a synthetic parathyroid hormone, is extremely effective. It is a daily injection with an extremely small needle, is very effective, and actually causes growth of new bone, rather than preventing loss of older bone as the others do. Its side effects include nausea and dizziness.

Osteoporosis is a silent killer, but we have many ways to prevent and treat this disease. If you have not already, you should discuss your situation with your health care provider.

Take the first step and call Woman to Woman Obstetrics & Gynecology .