Monday, November 5, 2007

I think I might be at risk. Can I be tested for osteoporosis?

You cannot see or feel your bones getting thinner. Many people are unaware of any problems until they break a bone or start to lose height.

If you think you are at risk then discuss it further with your GP. You may need a special scan which measures bone density, called a dual energy x-ray absorptiometry (DXA) scan. It is a simple, painless procedure and is recommended for those people considered at high risk of breaking a bone because of osteoporosis.

Osteoporosis diagnosed on a bone density scan does not always mean you have a high risk of breaking a bone at the time of the scan so a drug treatment is not always necessary or appropriate. Other factors, such as your age, will need to be taken into account.

If you have broken a bone because of osteoporosis there are a range of drug treatments. These will help to reduce your risk of breaking another bone. The way you live your life can also help.

Environmental Factors Influencing Normal Bone Formation

There are also some important lifestyle issues which have an effect on the normal formation of bone. Physical activity and good nutrition appear to be the most important of these "environmental" factors. It appears that poor activity levels and nutrition during the years of bone formation may prevent the normal growth of bones which may cause them to be less dense. Smoking during these years may also decrease the amount of bone which is formed. A significant illness during the teenage years which causes prolonged bed rest and lack of exercise will also prevent the complete acquisition of bone density. Persons who are affected by any of these factor are likely to enter adult life with a bone mineral density (BMD) which is less than their healthier peers.

Remember, it is the difference between how much healthy bone is formed during the first 28 or so years of life and the rate at which it is remodeled and removed later in life which determines how much osteoporosis or osteopenia a person has.

Factors Involved in Normal Bone Formation

There is a rapid formation of bone mass in the fetus and infant. This slows somewhat during childhood until age 11 in females and a year or so later in boys. During the growth spurt which which accompanies adolescence, tremendous bone formation occurs. The vast majority of adult levels of bone mass are achieved by age 18 or so, with only a small amount added until about 28 years old.

There are a number hormones which are important to this rapid formation of bone during the first two decades of life. These factors include, estrogens in females, testosterone in males, and growth hormone, and some other "minor" hormones in all persons.

Three new bone density machines in Nova Scotia

Nova Scotians' access to bone density testing took a great leap forward last week, with the provincial government’s announcement that three new machines will be added to the province’s health care system.

The province now boasts eight bone mineral density (BMD) machines, a sharp increase from the two that existed back in 2001 - the year Osteoporosis Canada's Nova Scotia Chapter officially came into existence. Since then, the Chapter has advocated tirelessly to enhance the province's capacity for screening.

"While we are very pleased with the announcement of three new densitometry machines for the province, we recognize that areas of Nova Scotia are still under serviced for diagnosing osteoporosis," says Elaine Brooks, Chair, Nova Scotia Chapter. She added that the Chapter's Advocacy Committee has consistently requested seven additional machines so that community members from each of the Health Districts would have convenient access.
"The three announced machines will assist with wait times, particularly in the Capital Health district, where the wait time has been over 400 days," comments Elaine. "We look forward to working with the government in continuing to fulfil the requirement for four additional BMD machines."

The long-awaited machines, which will be located at the IWK Health Centre, Dartmouth General Hospital and Valley Regional Hospital, were purchased using donated funds. However, the government has pledged to undertake the yearly yearly operating costs.

"Osteoporosis affects nearly 60,000 Nova Scotians who are at much greater risk of fractures as a result of the disease," said Health Minister Chris d'Entremont. "That's why we continue to provide the necessary tools to help health professionals prevent and treat the disease. The addition of this equipment will increase the testing capacity in the province by 22,000 tests per year."

It is estimated that osteoporosis affects more than 43,000 women and 15,000 men over the age of 50 in Nova Scotia. About 20 per cent of people who have a hip fracture die from complications within the first year. Many others require care in nursing homes.

Though Osteoporosis Canada’s Nova Scotia Chapter remains optimistic about the future of osteoporosis screening in the province, they are not about to give up. "The announcement is an excellent start in addressing the osteoporosis diagnosis needs of the people of Nova Scotia. However, we will not decrease our advocacy efforts until our goal of twelve machines in the province is realized," says Elaine.

How osteoporosis is treated

To maintain bone health:

Make sure there is enough calcium in your diet (1000 mg per day of calcium for women before menopause and 1500 mg per day for women who are postmenopausal).

Get adequate vitamin D intake, which is important for calcium absorption and to maintain muscle strength (400IU per day until age 60, 600-800 IU per day after age 60). Doses can be adjusted according to blood levels of vitamin D.

Get regular exercise, especially weight bearing exercise.

A number of medications are also used for the prevention and treatment of osteoporosis:

Bisphosphonates: Alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva) have been FDA-approved for the prevention and treatment of osteoporosis in postmenopausal women. (Alendronate is the only one currently approved for management of osteoporosis in men.) Both alendronate and risedronate are approved for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women. These medications help slow down bone loss and have been shown to decrease the risk of fractures. All are pills that must be taken on an empty stomach with water. Because they have the potential for irritating the esophagus, remaining upright for at least an hour after taking these medications is recommended. Alendronate and risedronate can be taken once a week, while ibandronate can be taken once a month. An IV form of ibandronate, given through the vein every 3 months, also has been FDA-approved for osteoporosis management. Two other IV forms of bisphosphonates available, pamidronate (Aredia) and zoledronic acid or zoledronate (Zometa), are not currently FDA-approved for osteoporosis management.

There have been reports of jaw osteonecrosis (permanent bone damage of the bones of the jaw) resulting from high dose IV bisphosphonates used primarily in the management of people with underlying cancers. The risk for this problem in those taking these medications at doses recommended for osteoporosis management is not clearly established, but appears to be low.

Use of bisphosphonates in women who are pregnant or breastfeeding is not well studied. Animal studies show that bisphosphonates cross the placenta and enter fetal bone. The risk of fetal harm in humans is theoretical. Thus, the anticipated benefits of bisphosphonates in women who are pregnant or want to become pregnant should be weighed against the potential risks. Calcitonin is safe in pregnancy. Blood calcium levels in women who take bisphosphonates during pregnancy should be monitored.

Calcitonin (Calcimar, Miacalcin): This medication, a hormone made from the thyroid gland, is given usually as a nasal spray or as an injection under the skin. It has been FDA-approved for the management of postmenopausal osteoporosis and helps prevent vertebral (spine) fractures. It also is helpful in controlling pain after an osteoporotic vertebral fracture.

Estrogen or Hormone Replacement Therapy: Estrogen therapy alone or in combination with another hormone, progestin, has been shown to decrease the risk of osteoporosis and osteoporotic fractures in women. However, the combination of estrogen with a progestin has been shown to increase the risk for breast cancer, strokes, heart attacks and blood clots. Estrogens alone may increase the risk of strokes. Given the complexity of this decision, consult with your doctor about whether hormone replacement therapy is appropriate for you.

Selective Estrogen Receptor Modulators (SERMs): These medications mimic estrogen’s good effects on bones without some of the serious side effects such as breast cancer. Raloxifene (Evista) decreases spine fractures in women, and is approved for use only in women at this time.

Teriparatide (Forteo): Teriparatide is a form of parathyroid hormone that helps stimulate bone formation. It is approved for use in postmenopausal women and men at high risk for osteoporotic fracture. It is given as a daily injection under the skin and can be used for up to 2 years. If you have ever had radiation treatment or your parathyroid hormone levels are already too high, you may not be able to take this medication.

Strontium ranelate (Protelos): A powder dissolved in water and taken daily, this medication has been shown to reduce the risk for fractures in postmenopausal women. It is currently available in Europe, but not the USA. Because of an increased risk of blood clots, it should be used with caution in women who have a history or risk for deep venous thrombosis or pulmonary embolism.

Who gets osteoporosis

Osteoporosis is more common in older individuals and non-Hispanic white women, but can occur at any age, in men as well as in women, and in all ethnic groups.

In the U.S., about 8 million women and 2 million men have osteoporosis. Those over the age of 50 are at greatest risk of developing osteoporosis and suffering related fractures. In this age group, one in two women and one in six men will suffer an osteoporosis-related fracture at some point in their life. Non-Hispanic white and Asian people are most likely to experience osteoporosis and osteoporosis-related fractures. Hispanic and non-Hispanic black people also can develop osteoporosis and related fractures, but have a lower risk when compared to non-Hispanic whites and Asians.


Osteoporosis makes your bones weak and more likely to break. Anyone can develop osteoporosis, but it is common in older women. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis.

Risk factors include
  • Getting older
  • Being small and thin
  • Having a family history of osteoporosis
  • Taking certain medicines
  • Being a white or Asian woman
  • Having osteopenia, which is low bone mass

Osteoporosis is a silent disease. You might not know you have it until you break a bone. A bone mineral density test is the best way to check your bone health. To keep bones strong, eat a diet rich in calcium and vitamin D, exercise and do not smoke. If needed, medicines can also help.