Women and Bone Disease Osteoporosis, Part 2

In addition, adults also need somewhere between 400 and 800 international units, or IU, of vitamin D each day. Vitamin D is the key that unlocks the door that allows calcium to leave the intestine and enter the bloodstream.

“I tell my patients if they eat a healthy diet, drink two eight-ounce glasses of milk and take a 1,600-milligram calcium supplement with 200 IU of vitamin D each day, they’ll meet their daily calcium and vitamin D needs,” Cosman says.

Exercise goes hand in hand with diet in the battle against osteoporosis. Calcium builds bones but exercise makes bone stronger and denser. Two specific types of exercise are key in building bone and maintaining bone mass and density: weight-bearing and resistance.

Weight-bearing exercises — such as dancing, jogging, walking, stair climbing and soccer — place weight on your feet and legs. Resistance exercises — such as working out with free weights or weight machines — build up your body’s infrastructure by improving muscle mass and strengthening bone.

Testing and Treatment
Since osteoporosis is a silent disease, the best way to diagnose it prior to a fracture is with a special test called a bone mass measurement, or bone mineral density test.

There are several methods and machines that measure bone mineral density. They’re all safe, painless, noninvasive and becoming more readily available. The tests measure the bone density in your spine, hip and/or wrist. Recently, the Food and Drug Administration approved tests to measure bone density in the middle finger, heel or shinbone.

Your bone density is measured against two standards: “age matched,” or what’s typical in someone your age, sex and size; and “young normal,” or the optimal peak bone density of a healthy young adult of the same sex. Your test results tell you where you stand within the ranges of normal and determine your risk for fracture. Generally, the lower your bone density, the higher your risk for fracture.

Currently, there are four medications approved by the FDA for the treatment of postmenopausal women to either prevent and/or treat osteoporosis.”It’s good news because we can choose a treatment to meet the needs of our patients,” Chestnut says. “In the future, there will be even more and probably better treatments to choose from and we’ll be able to combine therapies to further tailor treatments to women’s needs.”

Estrogen was the treatment of choice for years. It helps eliminate the hot flashes associated with menopause and helps prevent heart disease.

“But there’s a real layer of uncertainty concerning estrogen and breast cancer,” Chestnut says. “So for some women it’s not a good treatment”

Raloxifene is estrogen-like, “but without the breast cancer-risk baggage of estrogen,” Chestnut says. “It works positively on both the heart and on bone. But 1 in 5 still have hot flashes.”

Alendronate, a bisphosphonate, only affects skeletal mass and doesn’t do anything for hot flashes. It can cause gastrointestinal problems in some women. Currently, it’s taken on an empty stomach first thing every morning. Patients cannot lie down after taking it and they can’t eat for about an hour. “Some women don’t like it because they have to wait so long to eat,” Chestnut says. Once-a-week doses.

Calcitonin is a nasal spray. It works specifically on the skeleton and preserves bone, but also helps reduce pain. “That’s something the other treatments don’t do,” Chestnut says. The drawback is that some patients experience nasal congestion, drippy noses or nosebleeds.

“We’ve made great strides in the field of osteoporosis in the past decade because women recognized the serious nature of this condition and started demanding some attention,” Chestnut says. “So, we’ve come a long way. But we’ve only scratched the surface.”

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