Osteoporosis in Women
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Osteoporosis in Women What is osteoporosis? Osteoporosis is the loss of bone that can occur as you get older. As the bones get thinner, they become weaker. There is a much greater risk they will break if you fall or have an otherwise minor injury. Medical complications of these injuries can result in longer stays at the hospital, disability, and even death. Osteoporosis is most common in white and Asian women, especially slender women. How does it occur? Osteoporosis occurs as women get older. Sex hormones help keep bones strong. The hormone estrogen helps women's bones stay strong. For example, it helps deposit calcium in the bones. While men continue to produce testosterone, their sex hormone, as they get older, women produce much less estrogen after menopause. Surgical removal of the ovaries and intense exercise (such as marathon running) can also reduce estrogen levels. The lower levels of estrogen cause a weakening of the bones. Osteoporosis can also occur as a result of hormone disorders or prolonged bed rest during serious illness. It may appear with osteomalacia, a condition in which the bones soften and weaken from lack of vitamin D. Other possible causes include an imbalance in the body's natural acidity or a loss of phosphate. Too much aluminum hydroxide, a chemical used to treat ulcers, in the body can also be a cause. Women who smoke or are physically inactive are at a greater risk of developing osteoporosis. Too little calcium in the diet or a family history of osteoporosis are other risk factors. What are the symptoms? You may have no clear symptoms until a bone breaks. Broken bones are the most common problem for people with osteoporosis. The hip, arm, and wrist are common places for breaks. The bones of the spine are also a common area of thinning. Often, over time, the bones of the spine (vertebrae) collapse on themselves, one at a time, causing loss of height, back pain, and changes in posture. How is it diagnosed? Your health care provider may discover you have osteoporosis from an x-ray taken for some other problem. Otherwise, the diagnosis might be made from a review of your medical history and symptoms, a physical exam, and x-rays and blood tests. If you are in a high-risk category, your provider may order tests that measure the density of the bones in your forearm and spine. How is it treated? Treatment cannot eliminate osteoporosis, but it can slow down the loss of bone. The single most effective treatment for osteoporosis is estrogen (hormone replacement therapy). Women begin to produce less estrogen before menopause. Without this hormone to help bones stay strong, women are more likely to have osteoporosis. Taking estrogen pills around the time of menopause is the best way to slow calcium loss from the bones and keep your bones strong. Many physicians are now prescribing estrogen replacement for women in the near- menopause period because the greatest loss of bone density occurs in the first years of menopause. There are pros and cons for taking estrogen. Estrogen helps slow the loss of bone and may decrease your risk of heart and blood vessel disease. However, estrogen taken alone, without the hormone progesterone, can cause uterine cancer. Also, you should not take estrogen if you have a history of breast cancer, blood clots, or stroke. You and your health care provider need to discuss your specific situation. Treatment also includes increasing the calcium your body gets, usually through diet and supplements. Calcium is helpful in the treatment of osteoporosis, especially if you are not taking estrogen, but it is not nearly as helpful as estrogen. Generally, doctors recommend 1,000 milligrams of calcium for women taking estrogen and 1,500 milligrams for women who are not. New treatments for osteoporosis are being studied. Two examples of new medicines are calcitonin and alendronate. Calcitonin helps prevent bone weakening but is not as effective as estrogen. The most convenient form of calcitonin is a nasal spray, which requires just a single spray per day. The newest drug is alendronate (Fosamax). It also helps prevent bone thinning or weakening. It is taken in the form of pills once a day. Alendronate can cause mild digestive-system side effects. Weight-bearing exercise, such as walking or stair climbing, also helps keep your bones strong. Doing this kind of physical activity every day may help stop further weakening of your bones. Swimming, although very healthy, is not a weight-bearing exercise. It can be part of your overall fitness program, but for women at risk for osteoporosis, exercise should include walking. How long will the effects last? The risk of a broken bone resulting from osteoporosis increases with age. Once menopause begins, most women, especially Caucasian and Asian women, need to take precautions for the rest of their lives to prevent osteoporosis. How can I take care of myself? Follow the treatment prescribed by your health care provider. In addition, you can: - Eat healthy foods, especially low-fat milk and dairy products, green leafy vegetables, citrus fruits, sardines, and shellfish. - Take a daily calcium supplement if your provider recommends it. - Do weight-bearing physical activity, such as walking, regularly. Be sure to exercise your upper body also. What can I do to help prevent osteoporosis? You can help prevent osteoporosis with: - hormone replacement therapy at menopause - adequate calcium in your diet, both before and after age 35 (the age when a woman's bone density is at its peak) - regular exercise. What can I do to reduce my risk of injury? You can reduce the risk of injury and broken bones if you: - Avoid lifting heavy objects. - Avoid unusually vigorous physical activity; build your activity level gradually. - Wear proper footwear: low-heeled shoes with nonslippery soles for walking and suitable shoes for sports and recreation. Make sure the soles of your shoes don't catch on carpeted surfaces. - Use support for walking, such as a cane, if you need it. - Maintain a safe, well-lit, and uncluttered home to help prevent falls. - Avoid throw rugs on your floors at home. - Avoid icy, wet, or slippery surfaces, especially in the bathroom. Use nonskid mats in the shower and bathtub. Developed by Phyllis G. Cooper, R.N., M.N., and Clinical Reference Systems. ©1998 Wake Forest University Baptist Medical Center All rights reserved.