Bone Health (Osteoporosis) Conditions


Description: Osteoporosis is a condition of decreased bone mass. This leads to fragile bones, which are at an increased risk for fractures.  Osteoporosis is not a normal part of aging.  It can be prevented, as well as diagnosed and treated before fractures occur.

Risk Factors: Lifestyle factors, genetics, certain medications and other medical conditions can increase the risk for osteoporosis. Low calcium intake, vitamin D insufficiency, high caffeine intake, excessive alcohol, smoking, inadequate physical activity, eating disorders and weight less than 120 pounds are examples of lifestyle factors. Medications that contribute to osteoporosis include heparin, hormonal therapies used to treat breast and prostate cancer, prednisone, anti-seizure medications and lithium. Medical conditions associated with osteoporosis include diabetes, hyperparathyroidism, overtreated thyroid disease, celiac sprue, inflammatory bowel disease, intestinal malabsorption, gastric bypass surgery, lupus, ankylosing spondylitis, rheumatoid arthritis and kidney disease. A prior osteoporotic fracture is the single most important risk for future fracture.

Diagnosis: The DXA scan is a safe, accurate, and quick diagnostic test for osteoporosis.  CCAO offers on-site DXAs.

Prevention: Adequate daily calcium and vitamin D is important to reduce fracture risk. Adults need at least 1200mg of dietary calcium daily (including supplements if necessary). NOF recommends 800-1000IU OF vitamin D Per day for adults age 50 and older. Regular weight-bearing and muscle-strengthening exercise is also important to reduce the risk of falls and fractures and also improve bone density. It is also important to avoid smoking and drinking excessive alcohol (3 or more drinks a day). Efforts should be made to reduce the risk of falls (these include nightlights, vision and hearing optimization, home safety evaluation, review of medications that may impair balance and evaluation of neurological problems if present).

Treatment: There are ways to prevent osteoporosis (which is the best treatment), but many developments have been made to treat osteoporosis when prevention is no longer possible. The most common treatments include the bisphosphonate family. There are pills (available to take once a week or possibly just once a month) such as Fosamax (available as generic alendronate), Actonel and Boniva. When the pills are either not tolerated or not effective, intravenous infusions such as IV Boniva (every 3 months) and IV Reclast (once a year) are also available. The FDA has recently approved IV Reclast every 2 years for the treatment of postmenopausal osteopenia (lower than normal bone mineral density but not osteoporosis). In addition to the bisphosphonates, Forteo, a daily injection therapy, is also available to treat those at highest risk of fracture. The FDA is currently considering approval of denosumab (injection every 6 months), which has a mechanism different from the bisphosphonates and Forteo, for treatment of osteoporosis and prevention of bone loss in patients undergoing hormone ablation therapy for prostate and breast cancer.

Resources: The National Osteoporosis Foundation

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