Osteoporosis For Dummies book cover

Osteoporosis For Dummies

Carolyn Riester O'Connor ,
Sharon Perkins
Published: July 1, 2005


Facts and advice to help people understand and prevent osteoporosis

There are an estimated 55 million Americans over the age of 50 who have low bone mass. This easy-to-understand guide helps readers assess their risk and find a practical approach to the diagnosis, treatment, and prevention of osteoporosis. It covers bone density tests and a wide range of treatment options for osteoporosis-from hormone replacement therapy and acupuncture to calcium-rich foods, supplements, and exercise-and offers pointers on preventing broken hips and other common fractures.

Facts and advice to help people understand and prevent osteoporosis

There are an estimated 55 million Americans over the age of 50 who have low bone mass. This easy-to-understand guide helps readers assess their risk and find a practical approach to the diagnosis, treatment, and

prevention of osteoporosis. It covers bone density tests and a wide range of treatment options for osteoporosis-from hormone replacement therapy and acupuncture to calcium-rich foods, supplements, and exercise-and offers pointers on preventing broken hips and other common fractures.

Osteoporosis For Dummies Cheat Sheet

When you have osteoporosis (a skeletal disorder where your bones become porous and weak), you have increased chances of sustaining bone fractures. But which bones are most commonly broken, and how long do they take to mend? You can lessen your chances of breaking bones by knowing how to prevent falls.

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Osteoporosis Articles

Dealing with Osteoporosis Pain without Medication

Although popping a pill may be easy for instant relief of pain associated with osteoporosis, you (and your doctor) need to aim pain treatment at more than temporary relief. The nonmedication methods noted here may relieve pain and keep it from coming back.

Heating it up or cooling it down

Heat packs and/or ice packs can be very helpful for relieving pain, especially if the pain is localized to one spot. If you're very stiff in the morning, standing in the warm shower can be enough to loosen you up, but be sure you're using your handrails! Cold packs can be wonderful for reducing swelling and inflammation, and can reduce pain by temporarily numbing the nerves.

If you want to make your own hot packs, you can warm slightly dampened towels in the microwave. Remember that microwaves don't apply heat evenly, and make sure the towel doesn't get too hot in one spot; you could end up with a painful burn in addition to your other aches and pains.

Frozen vegetables, especially peas, which can be made to conform to oddly shaped areas, make very good cold packs. Crushed ice in a resealable baggie also makes a good ice pack.

Using physical therapy

Physical therapy can help you maintain and improve the muscle strength you have, as well as increase your energy levels and raise your levels of endorphins (natural painkillers released by your body).

Some physical therapists come directly to your home and can help you assess your home for possible sources of injury. A physical therapist can assess your gait, help you improve your posture, reduce muscle strain, and help strengthen weakened or problem areas with specific exercises.

Many insurance plans cover part or all the cost of physical therapy, which can become quite costly if you go two to three times a week. Your plan may only cover if you go to a certain therapist, so make sure you check with the physical therapist's office to see if it's part of your plan.

Exercising to get rid of pain

When you're hurting, the last thing you may want to do is exercise, but exercise keeps you limber, builds your strength, and increases your energy level. The key to exercise is finding the right kind, not overdoing when you first begin, and not giving it up after a short time.

Walking in a pool filled with very warm water is beneficial in relieving pain and in beginning the muscle-strengthening process. Swimming, although not a weight-bearing exercise and therefore not helpful to improve bone mass, is a good exercise for weakened or damaged tissue. Warm water may also be wonderful for relieving muscle spasm.

Some insurance companies also cover part of the cost of pool or gym membership, realizing that exercise helps reduce health problems overall. You may have to pay upfront and be reimbursed; check with your insurance company for what it requires.

Exploring TENS units

A Transcutaneous Electrical Nerve Stimulation (TENS) unit uses electrical impulses to block pain signals. A technician places electrodes on your skin near the site that is hurting, and transmits a mild electrical current through them, blocking the sensation of pain for several hours.

TENS units cost around $100, and the electrodes run around $30 for a pack of four. Electrodes are good for between 15 to 30 uses. TENS units run on batteries, and most are small enough to hook to your belt so you can keep moving while you're wearing one.

Use a TENS unit only under the supervision of your doctor or physical therapist; your insurance may reimburse the cost as long as you have a prescription for the unit. You can also rent a TENS unit before buying one to make sure it's going to help you with your pain. Many medical companies let you rent one for a month and apply the rental fee to the purchase price if you decide to buy the unit.

If you have a pacemaker, you may not be able to use a TENS unit without interfering with your pacemaker. Talk to your doctor before considering a TENS unit.

Massaging away the pain

You can also use massage therapy to decrease pain, relax muscles, and relieve tension. Some malls have massage therapists set up so you can shop and then drop onto the table for some relaxation, but make sure the person doing your massage is a trained therapist.

Massage therapists should be graduates of an institution accredited by the Commission for Massage Training Accreditation (COMTA) and should also be members of the American Massage Therapy Association (AMTA).

If you have osteoporosis, don't allow a therapist to deep massage near your spine. The pressure can cause fractures.

Bracing yourself, internally and externally

Spinal fractures are less likely to cause pain and deformity if they're braced; that is, if the broken bones are held in place to keep your spine in the best possible alignment. Bones can be held in place externally, by the wearing of a back brace, or internally, by a newer technique called percutaneous vertebroplasty.

External braces are often worn only during the acute phase after injury, because long-term use may weaken your back muscles. Meanwhile, percutaneous vertebroplasty involves stabilizing the fracture by injecting an acrylic cement into the broken areas of the vertebrae. An even newer technique called kyphoplasty inserts acrylic cement after inserting a balloon device into the vertebrae to try and restore the vertebrae to their normal position. This procedure reduces the deformity known as a dowager's hump that develops when the vertebrae collapse.

Coping with pain psychologically

Your mind is a powerful thing. In fact, "mind over matter" actually can reduce pain. Several different techniques use your mind to overcome pain:

  • Biofeedback: With this technique, you discover how to use your body's response to decrease pain and stress through positive reinforcement. Often the technique is first taught with the use of a machine that records your heart rate and other vital signs as they change in response to stimuli.
    Eventually you figure out how to respond positively to pain by relaxing muscles, breathing deeply, or by using visual imagery to distract you from the pain.
  • Guided imagery: This technique induces relaxation and decreases tension and anxiety by using visual images.
  • Hypnosis: This technique puts you into a "trance state" characterized by extreme suggestibility and relaxation. A therapist may demonstrate a type of self-hypnosis similar to relaxation training so you can use it at home yourself.
  • Relaxation training: This technique shows you how to relax tense muscles and reduce anxiety that can intensify pain.
  • Music therapy: You can use this technique in conjunction with relaxation therapy to decrease anxiety and relax tense muscles.

You can also incorporate several of these methods together, such as relaxation training, music therapy, and biofeedback, to help cope with pain.

Seeing a pain management guru

You also have the option of seeing a pain management specialist. Typically a pain management specialist is an anesthesiologist with special interest in pain who is trained to give nerve blocks and other special procedures.

Pain management specialists often use a medication referred to as gabapentin (Neurontin) for pain. Originally the FDA approved this drug for treatment of seizures, but physicians discovered that it was useful for the pain that occurs after shingles and for the pain that occurs from damaged peripheral nerves, as seen in diabetes. Now doctors use gabapentin as a medication for treatment of all kinds of pain, as well as a number of other diseases.

Some pain management physicians are anesthesiologists with special training in performing nerve blocks as well as other sophisticated procedures designed to inhibit the impulses from the nerves causing pain. You may have these procedures tried if you have severe back pain from crushed vertebrae. Ask your primary care doctor to refer you, if nothing else has worked.

Osteoporosis Articles

Looking at Bisphosphonates for Building Up Bone

Bones are like a bank; your bone "balance" stays healthy as long as you're not taking out more than you put in. That analogy may be a little simplistic but in essence, bone strength depends upon the balance between the bone cells that build bone versus those cells that break down bone.

Researchers have used the "bone strength equals bone buildup minus bone loss" formula to develop drugs that prevent and treat bone loss. Drugs that slow down bone breakdown are referred to as antiresorptive drugs. The wonderful part of antiresorptive drugs is that not only do they build bone density, but they also actually reduce the frequency of bone fracture.

Bisphosphonates are a type of antiresorptive drug that inhibits bone removal by the osteoclasts. Taking bisphosphonates can increase bone density in both the hip (by 3 percent) and lumbar spine (by 5 percent). Changes in bone density can be seen in the first year of treatment. Fracture rates are reduced by 50 percent.

Using alendronate, ibandronate, and risedronate

The most commonly used antiresorptive drugs belong to a class of compounds referred to as bisphosphonates, also called diphosphonates. Three oral bisphosphonates are approved in the United States for both prevention and treatment of osteoporosis:

  • Alendronate (Fosamax)
  • Ibandronate (Boniva) (the newest drug, it may be difficult to find)
  • Risedronate (Actonel)

All bisphosphonates bind to osteoclasts (cells that break down bone) and slow their ability to resorb bone. The drugs differ somewhat in their chemical makeup, but all are antiresorptive drugs, with alendronate being the first developed.

You may find that you tolerate one drug better than the other. For example, alendronate may cause you more difficulty with stomach irritation, and risedronate may not. Ibandronate may be your choice because it only needs to be taken once a month. All the bisphosphonates vary in their side effects and their dosing regimens. People also respond to different drugs differently, so if you start with one and have side effects, don't hesitate to tell your doctor!

You may hear alendronate, ibandronate, and risedronate called "diphosphonates" instead of "bisphosphonates." A diphosphonate is the same thing as a bisphosphonate; just chalk it up to the idiosyncrasies of the scientific world to have two words (long ones, at that) for the same thing. The prefix bis- and di- both refer to the word "two." These drugs contain two phosphonate groups attached to one carbon atom. This particular structure is responsible for the strong binding of the drug to osteoclasts.

Deciding when to treat with bisphosphonates

When is it time to start bisphosphonates? When everyone else in your bridge group is on them? When your children keep hounding you about taking something for your bones? No.

Your doctor makes the final determination of when to start medications for osteoporosis, but she usually follows these guidelines for starting treatment:

  • T-score is less than 2.5. (A T-score is the number of standard deviations the bone mineral density measurement is above or below the young normal mean bone mineral density. In other words, your T-score is your score compared to that of young adults.
  • T-score is less than 2.0 with multiple risk factors, such as corticosteroid use and low body mass index (BMI).
  • T-score is less than 1.5 and you're taking drugs that cause rapid bone loss, such as corticosteroids and phenobarbitol.
  • Menopausal status is a factor because rapid bone loss can occur in menopause due to a decrease in estrogen.

Who shouldn't take bisphosphonates?

Not everyone is a good candidate for taking bisphosphonates. Your doctor may decide not to give you bisphosphonates if you have any of the following conditions:

  • Esophageal strictures
  • Kidney disease
  • Severe gastroesophageal reflux
  • Vitamin D deficiency

Some people develop side effects that are intolerable, such as stomach irritation, or muscle and joint pain. Sometimes switching from one bisphosphonate to another may help. Among the newer bisphosphonatelike drugs, there is no clear advantage of one medication versus another in preventing fractures.

Taking bisphosphonates with adequate amounts of calcium and vitamin D is critical. You need 1,500 mg of calcium daily and 400 to 800 International Units (IU) of vitamin D daily. Check with your doctor to find out the right amount for you.

Remember that over-the-counter medications, including herbs and homeopathic remedies, are still drugs. Inform your doctor of all medications you take so she can monitor them.

Taking bisphosphonates correctly

Some bisphosphonates can be given in either daily or weekly doses as a preventive. For risedronate (Actonel), the dose is 5 mg daily or 35 mg once a week. Doctors often prescribe alendronate (Fosamax) in a higher dose (10 mg daily or 70 mg once a week). The Food and Drug Administration (FDA) approved ibandronate (Boniva) in 2005 to be taken once a month.

All bisphosphonates need to be taken first thing in the morning with eight ounces of water. Don't eat or drink anything else for 30 minutes after taking your medication. You need to remain upright for about 30 minutes — no sneaking back to bed for a quick nap — to help decrease stomach irritation after taking your medication.

These drugs are absorbed slowly from the gastrointestinal tract. They can cause an irritation of the esophagus (a chemical esophagitis). You must use them with caution if you have any problems with your esophagus. Taking them with water is important because water doesn't compete with the drugs' absorption in the stomach; juice or other foods interfere with absorption.

Osteoporosis Articles

Bad for the Bones — Being Too Thin

You may remember the teenage angst of feeling "too fat," even when your weight barely touched the 100-pound mark. Teens today are as acutely aware of their weight, and many, if not most, teenage girls want to be thin. Unfortunately, the desire to be thin can lead to behaviors that can have disastrous consequences for bones down the road.

Because the teen years are so important in building the bone mass that you draw from for the rest of your life, behaviors aimed at staying thin, such as smoking and excessive dieting, will result in bone loss that can never be regained, even if you change behaviors as an adult.

For example, some teenage girls see smoking cigarettes as a way to curb their weight. One Japanese study showed teens that were concerned about their weight were four times more likely to start smoking. In fact, nearly 30 percent of American teenage girls are regular smokers.

Dieting and bone loss

Avoiding the "it's in to be thin" emphasis today is difficult, especially if you're young and impressionable. Being severely underweight can have devastating consequences to bone, especially if there is an associated eating disorder, such as anorexia and bulimia.

The American Psychiatric Society defines anorexia nervosa and bulimia nervosa in the following way:

Anorexia nervosa is

  • A refusal to maintain weight that's over the lowest weight considered normal for age and height
  • An intense fear of gaining weight or becoming fat, even though underweight
  • A distorted body image
  • In women, three consecutive missed menstrual periods without pregnancy

Doctors and counselors direct treatment of anorexia at achieving weight gain. When an anorexic reaches 90 percent of her normal body weight, her period usually resumes. Estrogen therapy may also help. Studies have shown that bone lost during this time period isn't easily regained, and the increased risk of fracture may be permanent, even with treatment.

Meanwhile, bulimia nervosa is

  • Recurrent episodes of binge eating, which means eating more than needed to satisfy hunger; (minimum average of two binge-eating episodes a week for at least three months)
  • A feeling of lack of control over eating during the binges
  • A regular use of one or more of the following to prevent weight gain:

• Self-induced vomiting

• Strict dieting or fasting

• Use of laxatives or diuretics

• Vigorous exercise

  • A persistent over-concern with body shape and weight

Bulimics aren't always underweight; many maintain their weight within normal limits and don't experience the stopping of menstrual periods and bone loss that anorexics do.

The female athlete triad

The female athlete triad may sound like some sort of Olympic event, but it actually describes a serious result of eating disorders combined with too much exercise. Young athletes involved in sports, such as ballet, gymnastics, and figure skating, where keeping their weight low is important, often suffer from this condition.

What causes this condition? The combination of stringent dieting and excessive exercise results in a loss of menstrual periods, which lowers estrogen levels. The outcome? The athlete lacks the nutrients to grow strong bones and hormones to maintain bone, which causes osteoporosis at a young age, leading to stress fractures and weakened bones that can last a lifetime.

A young athlete may seem to be taking in a normal number of calories, but the amount eaten may be far below what she needs because of her greatly increased physical activity.

The female athlete triad isn't an uncommon problem. In fact, among female athletes, the syndrome may be present in as many as 50 percent or more of athletes. If you're a parent, grandparent, or close friend of a young athlete, watch for these signs to see if the child is taking training to a dangerous level:

  • Loss of menstrual periods for three months in a row
  • Preoccupation with eating and/or using diet pills, laxatives, or diuretics
  • Frequent visits to the bathroom immediately after eating
  • Menstruation not begun by age 16
  • Always wearing baggy sweatshirts and pants so weight loss isn't evident

Girls with the female athlete triad may be put on hormone replacement therapy to supply necessary hormones. They also need to be under a physician's care.

If you're the relative, coach, or friend of a young athlete, how can you help them avoid the trap of the female athlete triad? Follow these three simple steps:

1. Don't emphasize winning as the most important thing.

The benefits of sports are many, and although winning is great, don't seek it at the price of permanent health problems.

2. Be aware.

Watch for the signs that your athlete is taking diet and exercise to an extreme, and don't wait until you notice everything is out of hand before doing something about it.

3. Take action.

Don't bury your head in the sand when you see signs. Don't assume that just talking to your athlete will fix the problem. Enlist the help of your doctor and the coach.