Know Your Osteoporosis Basics

Down to Basics

Osteoporosis is a health condition that causes bones to become thinner, gradually making them weaker and more brittle. Our bodies go through a continuous bone-building cycle, in which old bone is broken down and new bone is formed. Osteoporosis is caused by a change in this cycle, in which too much bone is broken down and not completely rebuilt.

Osteopenia is a less severe form of bone loss than osteoporosis.

With osteoporosis or osteopenia, you cannot feel your bones becoming weak.

With the help of your health care professional, you can develop a program of proper nutrition, exercise, and medicine that can help keep bones healthy and may help reverse bone loss.

Risk Factors for Osteoporosis

Many factors determine who will develop osteoporosis. The first step is to determine whether you are at risk.

Risk factors for women

Osteoporosis occurs mostly in women after menopause. In fact, one-third of a woman's lifetime bone loss can occur in the first 5 years after menopause. This rapid bone loss can cause bones to become thin, weak, and more likely to fracture. Risk factors may include:

• Past menopause: Even if none of the other risk factors listed here apply to you, you may still have or may develop osteoporosis if you’re past menopause.
• Caucasian or Asian descent: Although osteoporosis can affect women of all ethnic backgrounds, Caucasian and Asian women are at greater risk of developing osteoporosis.
• Low bone mass: Measured by a bone mineral density (BMD) test (see "Testing for Osteoporosis").
• Family history of osteoporosis or broken bones that occur relatively easily: If a parent or grandparent was diagnosed with osteoporosis, you might be at increased risk. A personal history of fractures that occur relatively easily as an adult also may be a sign that you are at risk of osteoporosis.
• Thin or petite build: Small-boned women and thin women (under 127 lb) are at greater risk of developing osteoporosis than other women.
• Regular use of certain medicines: A significant risk factor in the development of osteoporosis is the use of certain medicines, such as steroids, to treat chronic health conditions including asthma and arthritis.
• Smoking: Smoking may interfere with estrogen levels and thus also can weaken your bones.
• Drinking several caffeinated or alcoholic beverages per day: Alcohol can reduce bone formation and is associated with increased risk of fracture. Caffeine also can reduce bone formation.
• Getting too little calcium or vitamin D: Even if you are taking medicine for osteoporosis, it is important that you get enough calcium and vitamin D from foods (see "Get enough calcium and vitamin D"). If you are not, you should talk with your health care professional about the need for supplements.
• Inactivity: Inactivity makes your bones lose strength and become thinner. Over time, thin bones may break.

Risk factors for men

Osteoporosis is not strictly a women's health condition, although it is less common in men. Men naturally have larger, stronger bones than women, and their bone loss generally starts later in life. Approximately 2 million men in the United States have osteoporosis, and another 12 million are at risk of this health condition. Risk factors may include:

• Decreased testosterone levels: Low levels of the male sex hormone testosterone can contribute to bone loss.
• Low bone mass: Measured by a BMD test (see "Testing for Osteoporosis").
• Family history of osteoporosis or broken bones that occur relatively easily: If a parent or grandparent was diagnosed with osteoporosis, you might be at increased risk. A personal history of fractures that occur relatively easily as an adult also may be a sign that you are at risk of osteoporosis.
• Low body weight: Men with low body weight are at higher risk of osteoporosis than other men.
• Regular use of certain medicines: A significant risk factor in the development of osteoporosis is the use of certain medicines, such as steroids, to treat chronic health conditions including asthma and arthritis.
• Smoking: Smoking is a risk factor for bone loss and thus can weaken your bones.
• Drinking several caffeinated or alcoholic beverages per day: Alcohol can reduce bone formation and is associated with increased risk of fracture. Caffeine also can reduce bone formation.
• Getting too little calcium or vitamin D: Even if you are taking medicine for osteoporosis, it is important that you get enough calcium and vitamin D from foods (see "Get enough calcium and vitamin D"). If you are not, you should talk with your health care professional about the need for supplements.
• Inactivity: Inactivity makes your bones lose strength and become thinner. Over time, thin bones may break.

Testing for Osteoporosis

Early on, osteoporosis is a silent health condition, so you may not see any signs. However, it can eventually lead to broken bones. The good news is if osteoporosis is detected early enough, you may be able to help prevent future fractures.

A BMD test is a quick and painless way to help your health care professional measure the health of your bones. It also may be used to monitor your rate of bone loss and your response to treatment.

Who should be tested?

The National Osteoporosis Foundation (NOF) recommends BMD testing for all women older than 65 years; postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis, other than being Caucasian, postmenopausal, and female; and postmenopausal women who have had a recent fracture. The NOF recommends BMD testing for all men older than 70 years, and for men aged 50 to 70 years with 1 or more risk factors. If you fit into any of these categories, ask your health care professional about a BMD test. There also may be other reasons why he or she may recommend a BMD test, including the long-term use of certain medicines, such as steroids.

What are the types of BMD tests?

There are several ways to measure bone mineral density. The DXA (dual-energy X-ray absorptiometry) test is used most often to measure the bone density of your hip or spine. It is currently the most accurate test available. Other BMD tests include ultrasound (which uses sound waves) and computed tomography (CT) scanning.

Will I be exposed to radiation during BMD testing?

If you are tested with a machine that uses sound waves, you will not be exposed to any radiation. Other machines expose you to very little radiation.

Will my health insurance cover my BMD test?

Some insurance companies cover BMD testing. Check with your individual health plan to find out whether BMD testing is covered. If you are a woman older than 65 years and you qualify, the cost of your BMD test may be covered by Medicare.

Where can I get tested?

Some pharmacies conduct BMD testing periodically at their stores. Talk to your health care professional or local pharmacist about BMD testing.

What Do the BMD Test Results Mean?

Bone density test results, known as T-scores (which measure bone strength), compare your bone density with that of healthy young adults of your sex. Normal bones are healthy and strong. Bones weakened by osteoporosis have become thin, making them more likely to break.

Understanding your T-score can help you and your health care professional take appropriate action. Think of a T-score as a way to describe the percentage of bone loss. A T-score above –1.0 indicates normal bone mass. If you have a T-score of –2.5 or less (that is –2.6, –2.7, and so on), you have osteoporosis.

Talk with your health care professional about your T-score and what you can do to help build bone and help prevent fractures caused by osteoporosis. The lower the T-score, the greater the risk. But having a low T-score today does not mean you cannot improve your score the next time.

Living With Osteoporosis

If you have been diagnosed with osteoporosis or thinning bones, keep these tips in mind:

Stay active

Exercising is important for building and maintaining bone mass. Always check with your health care professional before beginning any activity plan or increasing activity. It’s also important to ask him or her what your target heart rate is to help determine what exercise intensity is appropriate for you. There are a lot of activities you can try that can help keep your bones strong, including:

• Resistance exercises, such as strength training, which help maintain bones by strengthening the muscles around them.
• Weight-bearing activities, such as walking, stair climbing, and dancing, which help your bones and muscles work against gravity.
• Non–weight-bearing exercises, such as swimming or water exercises, which may help build muscles.

To learn more about the types of activities mentioned above, go to the Getting Fit section of MerckEngage.com.

The amount and type of activity you do play a part in keeping your bones healthy and strong. Vary your activities so you exercise different parts of your body.

Use weights only as instructed. If any exercise causes pain, stop doing it and see your health care professional.

Get enough calcium and vitamin D

Throughout your life, calcium and vitamin D play a key role in maintaining your bone health. They are particularly important while your bones are still growing, generally until about age 35.

Even if you are taking medicine for osteoporosis, it is important that you take supplemental calcium and vitamin D if dietary intake is not enough.

Boosting calcium: Calcium helps keep your bones strong. Major food sources of calcium include milk (whole or skim), yogurt, cheese (mozzarella, Muenster, and cheddar), ice cream, fish and shellfish (oysters, sardines, and salmon), and vegetables (broccoli, turnip greens, and tofu).

The NOF recommends that adults under age 50 need 1,000 mg of calcium daily; adults aged 50 and over need 1,200 mg of calcium a day.

Increasing vitamin D: Your body needs vitamin D to help absorb calcium. Major food sources of vitamin D include vitamin D-fortified orange juice, dairy products, and cereals; oily fish (salmon and mackerel); and cod liver oil.

The NOF recommends that adults under age 50 get 400 to 800 international units (IU) of vitamin D daily, and that adults aged 50 and over get 800 to 1,000 IU of vitamin D daily. Some people may need more.

Know the effects of your other medicines

Some medicines can contribute to bone loss; these include hydrocortisone and prednisone (used for such conditions as arthritis, asthma, and certain skin disorders). If you take these medicines, ask your health care professional about possible bone-related side effects.

Monitor your progress

Your health care professional will determine if BMD tests can help keep track of your bone health. To help you track your nutrition and activity goals, consider using the Meal Planning and Activity Planning tools at MerckEngage.com.

Tips for Preventing Falls

If you have osteoporosis or are at risk, learn how to prevent falls that may lead to broken bones. Take these steps to help avoid accidents:

• Remove or firmly anchor rugs that may slide or bunch up and cause a fall.
• Have good lighting in every room.
• Keep electrical and telephone cords out of walking paths.
• Keep a flashlight by the bed for use at night. Check the batteries often.
• Make stairways safe with railings and nonslip surfaces.
• Equip your bathroom with grab bars and other aids, such as night lights.
• Apply adhesive strips to your tub or shower floor.
• Choose chairs and couches that are easy to get into and out of.
• Be careful when walking on wet or icy surfaces outside at night, in poorly lighted areas, or near curbs.

Some Questions to Ask Your Health Care Professional

You may want to talk with your health care professional about helping to prevent or treat osteoporosis. Questions to ask may include:

• What are my risk factors for osteoporosis?
• What can I do to prevent osteoporosis?
• Do I have osteoporosis?
• Am I getting enough calcium and vitamin D?
• I’m already taking calcium and vitamin D. What else can I do?
• What is a bone mineral density (BMD) test?
• How is a BMD test done? How long does it take? How much does it cost?
• Should I get a BMD test? Where can I go to get tested?
• What is a T-score? What does it tell us about my bone mass and risk of fracture?

Understanding the Words Your Health Care Professional May Use

You may hear some of these words:

Bone mineral density (BMD): A measure of bone density, which shows the strength of bones.

Bone mineral density (BMD) test: A painless way to help your health care professional measure the health of your bones. A BMD test also may be used to monitor your rate of bone loss and your response to treatment.

Calcium: A mineral that helps keep your bones strong.

Menopause: The time in a woman's life when her menstrual cycle ends. Menopause is a key factor contributing to the development of osteoporosis.

Non–weight-bearing exercises: Activities, such as swimming or water exercises, which may help build muscles.

Osteopenia: Lower than normal bone mass. This is a less severe form of bone loss than osteoporosis.

Osteoporosis: A health condition that causes bones to become thinner, gradually making them weaker and more brittle.

Resistance exercises: Activities, such as strength training, which help maintain bones by strengthening the muscles around them.

T-score: The result of your BMD test and a measure of your bone health. It will tell you if your bone density is below normal.

Testosterone: A male sex hormone. Low levels of this hormone can contribute to bone loss.

Vitamin D: Your body needs vitamin D to help absorb calcium.

Weight-bearing activities: Activities, such as walking, stair climbing, and dancing, which help your bones and muscles work against gravity.

Some Sources for More Information

For general information and publications:

National Osteoporosis Foundation
1150 17th Street NW
Suite 850
Washington, DC 20036
202-223-2226
800-231-4222
nof.org

Also, check out health information online:

Osteoporosis
nlm.nih.gov/medlineplus/osteoporosis.html