Osteoporosis Symptoms and Solutions

Skeletal loss is not inevitable. A healthy diet can keep it away, new scans can detect it and drugs that build bone can even reverse it.

LOOK INTO THE FUTURE. DO YOU see brittle bones and a dowager's hump? The need to take careful little steps lest you fall and break a hip? Does each extra birthday candle loom as a sign that osteoporosis is that much closer?

Then you are looking through a glass too darkly. This ominous view of aging, which sees the deteriorated bones of osteoporosis as inevitable, is fast being replaced by the realization that women can prevent and even reverse bone loss. Thanks to better diagnostic tools, you don't have to wait for a fracture to learn your osteo-status. And with drugs that don't merely hold the line on bone loss but actually let bones rebuild themselves, you don't have to join the 8 million American women, including 25 percent of those over 65, who are afflicted with the disease. What you do have to do is take some simple steps to prevent osteoporosis.

Begin with adequate calcium intake. The bones store about 99 percent of the calcium in the body, but calcium is also used by most other organs. If there isn't enough calcium in the diet to satisfy those organs, the blood will rob the bones to get it. To avoid this, experts recommend a minimum daily intake of 1,200 mg of calcium for everyone, from the teenage years on. That's approximately four cups of yogurt or milk, or six ounces of cheese, or a whole lot more ofthe best nondairy sources: 3i cans of sardines, three cups of dry-roasted soybeans or seven cups of collard greens. Since most Americans eat only half that much calcium, supplements that also include 400 to 800 mg of vitamin D are a good bet. (Vitamin D helps the intestines absorb calcium and encourages bones to grow.)

After eating all this good food, you might want to move a little, too. Regular weight-bearing exercise--jogging, jumping rope, walking briskly or lifting weights--can boost bone density 3 to 5 percent a yearin those who previously didn't exercise. Women who do exercise are already benefiting from stronger bones; to maintain your strong skeleton, all you need to do is take 30-minute walks or jogs three to five times a week. Just don't exercise so much that you stop menstruating, which happens to some athletes. (This also occurs frequently in anorexics.) Losing your period means your body has virtually stopped producing estrogen, which leads to bone loss similar to that brought on by menopause.

Osteoporosis is often called the silent disease, because a woman feels no pain as her bones gradually thin to the point where even a slight bump or a fit of coughing can cause a fracture. Diagnostic techniques have been so poor that the pain from these breaks was often the first sign of a problem. No more. The best tool for diagnosing brittle bones is called a bone-mineral-density test; the new generation of machines includes the DXA, the most accurate. All the tests use sophisticated X-rays or sonograms to read bone density. A bone-density score of 1 or less is considered safe. Scoring between 1 and 2.5 could indicate a risk for the disease but doesn't guarantee it; 2.5 or above indicates bone loss of 25 percent or more, the definition of osteoporosis.

Should you ask your doctor for a bone-density test? The key word here is ``ask,'' because many physicians seem to be somewhat in the dark about diagnosing and treating osteoporosis. According to the National Osteoporosis Risk Assessment, 80 percent of low bone mass and osteoporosis goes undiagnosed. ``Women need to be proactive about this disease, and question their doctors and even provide information if need be,'' says Dr. Aurelia Nattiv, director of the UCLA Osteoporosis Center. She suggests following the National Osteoporosis Foundation guidelines on who should get the test (box), which is now routinely covered under Medicare. In general, while bone loss is a universal fact of life, sex, race and size all influence how much bone a woman will end up with, how great her risk of osteoporosis is and therefore how much she needs the bone test. African-American women have denser bones than Caucasian, Hispanic or Asian women, for instance: a recent study of 48,000 women found that only 38 percent of postmenopausal African-Americans had bone loss that could lead to osteoporosis, compared with 50 percent and more among Caucasians, Hispanics and Asians.

Don't panic if the test results make your bones look about as sturdy as butterfly wings. Several drugs, some old and some new, can halt and even reverse bone loss in women with osteoporosis. None of these drugs directly ``builds'' bones. Rather, they all reduce the body's tendency to slough off old bone cells, so new cells gradually fill in the holes. While this might result in only a 2 or 3 percent yearly increase in bone mass, that small amount can reduce the likelihood of painful fractures--the real key to measuring the effectiveness of an osteoporosis drug. The pharmaceutical options:

    * Hormone-replacement therapy. HRT has long been considered the best therapy for preventing and treating osteoporosis. Itreduces the risk of both hip and forearm fractures by half and the risk of spinal fractures by up to 75 percent. Drawback: long-term use seems to increase the risk of breast cancer and blood clotting.
    * Raloxifene. This first example of a new class of drugs called selective estrogen receptor modulators (SERMs) was introduced in 1997. It has been approved for prevention of osteoporosis, but not treatment, although new data showing that itreduces the risk of spinal fracture by about half might soon change that. There are no data yet on how well it reduces hip fractures. Raloxifene works like estrogen, but doesn't increase--and may reduce--breast-cancer risk. Drawback: it can cause blood clots and may cause hot flashes. A new generation of SERMs, which should be available as early as next year, might work even better.
    * Alendronate. This powerful treatment, available since 1995, can reduce spine, hip and wrist fractures by up to 50 percent. Drawback: the drug must be taken on an empty stomach, with a large glass of water, first thing in the morning, at least 30 minutes before eating, and you must remain upright to avoid heartburn. The next class of similar drugs, known as biphospho-nates, is expected within about a year, perhaps with fewer side effects.
    * Calcitonin nasal spray. Inhaling this synthetic version of a salmon hormone once a day can reduce the risk of spinal fractures by about 40 percent, though for unknown reasons it doesn't work as well on other bones. Introduced in 1995, this is the only drug that actually reduces the persistent long-term pain of existing spinal fractures. Drawbacks: nasal irritation and bleeding..

Even with these new drugs, plain old-fashioned prevention works best. So drink your milk, eat your dark leafy greens and heft some weight now so your bones won't be unbearable in the future.

WHO SHOULD GET A BONE SCAN?
Osteoporosis experts recommend bone-mineral-density tests for these women:

Postmenopausal women under 65 with one or more risk factors, including use of glucocorticosteroids, thyroid problems, eating disorders, amenhorrea (cessation of menstruation) that lasted three months or more, smoking, family history of osteoporosis, being very thin, alcoholism, lifelong low calcium intake

Premenopausal women with any of these risk factors should ask a doctor's advice about getting a scan

Postmenopausal women who have suffered bone fractures

All women over 65

Last updated Jan 4/07