• Health Reference Library
• Publications Library
• Osteoporosis: Beyond Calcium and Vitamin D

Osteoporosis has frequently been called a "silent disease" since it is asymptomatic until a fracture occurs. However, referring to the disease as silent is also a way to call attention to the lack of awareness and knowledge about osteoporosis in otherwise healthy individuals. This association between osteoporosis and fractures is a significant health concern. These fractures lead to chronic pain and disability, increased nursing home placement and increased mortality, particularly with hip and spine fractures.

What is Osteoporosis?

Osteoporosis is a skeletal disease characterized by low bone mass (bone density) and architectural deterioration of bone tissue (bone quality), leading to bone fragility and increased risk of fractures. One in two women and one in every four men will experience an osteoporotic fracture during their lifetime. Each year in the United States, there are more than 1.5 million osteoporotic fractures, including 700,000 spine; 300,000 hip; 250,000 wrist; and 300,000 other types of fractures. The most common fractures are of the spine. However, spine fractures cause severe back pain only 25 percent of the time, while 75 percent of these fractures occur without significant pain. The presence of a vertebral fracture increases further fracture risk four to eight-fold, independent of bone density. Despite these numbers, it is widely recognized that osteoporosis is preventable and treatable.

Decreasing the Risk of Osteoporosis

Numerous studies have found clear associations between several health behaviors and decreased risk of osteoporosis. These include participation in physical activity, cessation of smoking and adequate intake of calcium and Vitamin D in the diet. Particularly, calcium and Vitamin D supplementation have been shown to decrease the risk of hip and non-spine fractures, especially in elderly women and men. However, that supplementation cannot be considered the sole, sufficient treatment in most individuals with established osteoporosis since other therapeutic regimens are required.

How Can I Tell If I Have Osteoporosis?

Through measurement of bone mineral density (BMD) physicians are able to evaluate and determine individuals at risk for osteoporosis and monitor the presence or absence of bone loss. Regarding fracture risk, there is no better predictor of future fracture in patients who have not yet fractured than a low BMD.

When is Bmd Testing Indicated?

BMD testing is indicated for:

• Women aged 65 and older, and men aged 70 and older.
• Men and women with a fracture after age 45.
• Men and women with a disease or condition associated with low bone density or bone loss (such as hyperthyroidism, hyperparathyroidism, malabsorption and inflammatory bowel disease).
• Men and women taking medications associated with low bone density or bone loss (hormone treatments in men with prostate cancer and women with breast cancer).
• Postmenopausal women under age 65 with risk factors, particularly a family history of fracture, low body weight ( < 127 pounds) or frequent falls.
• Postmenopausal women discontinuing estrogen therapy, with known risk factors.
• Anyone being considered for treatment with steroid therapy (cortisone, prednisone or other steroids).
• Anyone being considered for treatment for osteoporosis or being monitored for treatment effect.

What are Current Options to Treat Osteoporosis?

Available treatment to reduce fracture risk includes several bone-active agents that act by inhibiting bone loss. Estrogens, selective estrogen receptor modulators (SERMs) such as Evista, bisphosphonates such as Fosamax, Actonel and Boniva, calcitonin (Miacalcin nasal spray) and calcium with Vitamin D all have bone-sparing properties by different mechanisms and to some extent by varying degrees. The benefit of these therapies occurs rapidly and is evident within 6-12 months of initiating therapy. The effectiveness of these therapies is sustained over time and they are generally well tolerated. Finally, a number of new agents that increase bone formation (anabolic therapies) are available for the treatment of osteoporosis and prevention of fractures. One agent, Forteo, has been approved for the treatment of women and men with osteoporosis at high risk for fracture. Other strategies to improve bone health such as exercise and fall-prevention techniques or hip protectors should be incorporated into a fracture-prevention program.

The primary goal of treatment is to prevent fractures. Careful consideration of the risks and benefits of each of these treatments will serve as a guide in choosing the best therapy for the individual patient. Early detection and treatment can make a difference.