NIH - Medical Encyclopedia Osteoporosis

"Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient, or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer. As people age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. Both situations can result in brittle, fragile bones that are subject to fractures, even without trauma. Usually, the loss occurs gradually over years. Many times, a person will sustain a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and the damage is severe. The leading causes are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men. Other causes include excess corticosteroid from Cushing's syndrome, hyperthyroidism (too much thyroid hormone), hyperparathyroidism, being confined to a bed, and bone cancers.

Symptoms occurring late in the disease include:

• Fractures of the vertebrae, wrists, or hips (usually the first indication) • Low back pain • Neck pain • Bone pain or tenderness • Loss of height over time • Stooped posture

EXERCISE

Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and perhaps even gain density. Researchers found that women who walk a mile a day have 4-7 more years of bone in reserve than women who don’t. Some of the recommended exercises include: • Weight-bearing exercises -- walking, jogging, playing tennis, dancing • Resistance exercises -- free weights, weight machines, stretch bands • Balancing exercises -- tai chi, yoga • Riding stationary bicycles • Using rowing machines • Walking • Jogging

DIET

A diet that includes an adequate amount of calcium, vitamin D, and protein should be maintained. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses for bone formation and maintenance is available. Supplemental calcium should be taken as needed to achieve recommended daily calcium dietary intake. Current recommendations are for nonpregnant, menstruating women to consume 1000 mg/day, pregnant women need 1200 mg/day, and postmenopausal or nursing mothers should consume 1500 mg/day. High-calcium foods include low-fat milk, yogurt, ice cream and cheese, tofu, salmon and sardines (with the bones), and leafy green vegetables, such as spinach and collard greens. Vitamin D aids in calcium absorption and 400-800 IU per day should be taken by all individuals with increased risk of calcium deficiency and osteoporosis. "

Highlighted Article

Osteoporosis: strategies for prevention and management. (Best Pract Res Clin Rheumatol. 2007)

"The goal of treatment is to reduce the risk of future fracture. Patients at high risk for fracture should be assessed and screened to exclude secondary causes for osteoporosis. Bisphosphonates (alendronate, etidronate, ibandronate, risedronate) are the first-line therapy for the majority of patients and these treatments can be given either orally or intravenously. Alternative treatment options include strontium ranelate and raloxifene. Anabolic therapy with parathyroid hormone can be considered for patients with severe disease. These patients will often require referral for specialist assessment and monitoring. All patients at risk of developing osteoporosis should be given lifestyle advice regarding dietary intake of calcium and vitamin D and regular weight-bearing exercise."