What is osteoporosis?

Osteoporosis is a disorder that causes bones to become thinner, weaker and more likely to break. Osteoporosis increases the risk of fracturs, most commonly in the wrist, hip, and spine.

Factors that may increase the likelihood of osteoporosis include:

• Female
• Advanced age
• Menopause
• Low calcium
• Have a medical condition that results in poor absorption of calcium and vitamins
• Some medications may cause osteoporosis; examples include prednisone, heparin, and lithium.
• Smoking
• Alcohol (3 or more drinks per day)
• Family history of osteoporosis
• History of fractures

How is osteoporosis diagnosed?

Osteoporosis is diagnosed through a special type of X-ray called DEXA or DXA (Dual energy X-ray absorptiometry) that scans the hipbone and spine bone to measure bone density.

During your physical exam, your doctor may suspect osteoporosis if there’s a reduction in height. Your doctor may request additional tests to confirm diagnosis.

Ultrasound of the heel is a cheaper and quicker test than DEXA to measure bone density. Because it is not accurate enough, if osteoporosis is diagnosed by heel ultrasound, your doctor may perform DEXA of your spine and hip.

Is osteoporosis curable?

Treatment of osteoporosis significantly improves bone mass and reduces the risk of fractures. However, bone mass does not return to normal.

Are there preventive measures for osteoporosis?

A number of preventive measure for osteoporosis include:

• Vitamin D and calcium supplementation
• Regular weight bearing exercises
• Avoid smoking
• Avoid excessive alcohol consumption
• Diet as low fat dairy products, sardines, salmon, and green leafy vegetables

What is the relation between menopause and osteoporosis?

Estrogen suppresses the breakdown of bones. Low levels of estrogen during menopause result in bone loss. Estrogen replacement may be used for treating menopause-associated osteoporosis but its use has fallen out of favor due to increased risk of heart disease and stroke when taken more than 10 years after menopause.

Raloxifene (Evista) and Duave are example of preventive medications used for menopause-related osteoporosis.

What are the most common medications used for treatment of osteoporosis?

1. Bisphosphonates:

• These are first line medications that work by inhibiting breakdown of bone.
• Examples include:
• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Zolendronic acid (Reclast, Zometa)

2. Selective Estrogen Receptor Modulator:

• These agents act like estrogen by inhibiting bone breakdown and increasing bone density. Example: Raloxifene (Evista)

3. Calcitonin (Miacalcin):

• Calcitonin works by inhibiting bone breakdown.

4. Teriparatide (Forteo):

• Forteo stimulates new bone formation.

5. Denosumab (Prolia):

• This medication prevents bone loss and helps increase bone mass.

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