Osteoporosis.

Last updated Monday, December 27, 2004

Management and treatment

How is osteoporosis treated?

Many of the steps you can take to prevent osteoporosis--such as increasing calcium, exercising regularly, and taking estrogen--may also be used to treat it.

Some treatments for osteoporosis may either increase bone formation or decrease bone loss. The doctor will treat fractures in other ways. The treatment may include casts, braces, or surgery. Other treatment may include physical therapy, muscle relaxants, pain relievers, and rest.

Hormones

Calcitonin is a hormone which occurs naturally in the body. It reduces the loss of bone mass and also helps relieve pain. This hormone is used to treat osteoporosis in women after menopause. Calcitonin may help reverse the loss of bone mass occurring in someone who has taken cortisone drugs for a long time. It is currently available by injection.

Estrogen is effective for women who have osteoporosis. Estrogen can increase bone mass by more than five percent and reduce fractures by half.

Can diet help treat osteoporosis?

Increasing calcium

As a child, you were probably told to drink milk in order to build strong bones. Milk, other dairy foods, fruits, vegetables, and legumes (beans) contain a mineral called calcium. Calcium is one of the main building blocks of bone. You still need calcium as an adult. If the calcium level in your blood drops too low, your body takes calcium from the bones.

You may need to increase the amount of calcium in your diet. How much calcium you need depends on your sex, age, and risk for osteoporosis. Most adults need 1,000 to 1,500 milligrams of calcium a day from food and/or calcium supplements, but get only about half or 500 milligrams in their diets. Getting enough calcium is especially important if you're a woman under age 35, because your body is still able to absorb and store calcium in your bones easily. Experts recommend 1,500 milligrams per day for teens, pregnant or breast feeding women, and older adults. As you age, you need to take in more calcium, since your intestines don't absorb calcium as well. One study of elderly people showed that their risk of hip fracture was reduced when they took extra calcium.

Foods are the best natural source for calcium. You can increase the amount of calcium in your diet by eating more dairy foods. Dairy products--such as milk, cheese, and yogurt--have the highest amounts of calcium. An eight ounce glass of milk has about 300 milligrams, or one-fourth of your daily need for calcium. To avoid adding fat and calories to your diet, buy skim or low-fat dairy products. Other foods high in calcium include green leafy vegetables, shellfish, sardines, oysters, brazil nuts, tofu, and almonds. Some foods--such as orange juice, breads, and breakfast cereal--may be fortified with calcium.

If you do not like or cannot eat dairy foods, calcium supplements may make up for the calcium you don't get from food. Calcium supplements come in tablet or liquid form.

Supplements vary widely in the amount of calcium they contain for the price. Supplements of calcium carbonate contain the highest amount of useful or elemental calcium. If you take a calcium supplement, be sure to take it with meals and drink six to eight glasses of water each day.

Avoiding (or quitting) smoking

People who smoke cigarettes have a greater risk of fracture than nonsmokers. Smoking reduces bone mass. Smokers may have an increased risk because they often weigh five to ten pounds less than nonsmokers. Smoking lowers women's estrogen levels. Menopause begins at an earlier age for women smokers. Smoking is already linked to a number of other serious diseases, including cancer and heart disease. The link to osteoporosis adds one more reason to stop smoking or never start. People who smoke cigarettes have a greater risk of fracture than nonsmokers.

Avoiding heavy alcohol use

Men and women who drink a lot of alcohol have a higher risk for developing osteoporosis. People who drink heavily have less bone mass and lose bone more rapidly. This loss of bone mass may be the direct result of alcohol's effect on bone. Heavy drinking also increases your chances of falling and breaking a bone.

If you drink alcohol, experts recommend drinking no more than two drinks per day to keep bones healthy. One alcoholic drink is equal to 12 ounces of beer, five ounces of wine, or one and one half ounces of liquor.

Can exercise, therapy, rest, posture, or stretching help treat osteoporosis?

Exercises that place weight on, or increase the force of gravity against your bones, may help you keep bone mass. Changes in pressure and force that occur during daily activities and exercise cause bones to develop mass and strength. When you move your body against the force of gravity and do exercises that strengthen muscles, you are producing forces that push and pull on your bones. Bones respond to this kind of movement and become stronger.

You lose bone mass when you do not put weight on your bones. For instance, anyone who cannot get out of bed or does not walk loses bone mass and has an increased risk of fracture. Astronauts do special exercises while they are in space to keep from losing bone mass. This is important because they are weightless in space and cannot exercise against gravity.

Some exercises or activities that use gravity and your muscles to strengthen your bones are listed below. If you do them regularly and quickly, some are also good for your heart. Exercise helps you move more easily and keep your balance, which helps you avoid falls.

Helpful exercises and activities:

• Aerobics
• Ballroom/square dancing
• Cross-country skiing
• Household chores-standing (sweeping, vacuuming, etc.)
• Mowing the lawn
• Racquetball
• Rowing
• Running/jogging
• Stair climbing
• Tennis
• Walking/hiking

Doing regular exercise that puts weight on your bones helps keep them strong. Experts do not know exactly how long you must exercise to prevent loss of bone mass. Most guidelines for exercise apply to heart health, not bone health. A good guideline is to do some type of weightbearing exercise three to four times a week for a total of 20 to 30 minutes. You can exercise 10 or 15 minutes at a time, if you do not want to do it all at one time.

Many people are able to start exercising without talking to their doctors, if they start slowly and gradually. However, check with your doctor before starting an exercise program if you have not been physically active or you have any of the following:

• Osteoporosis or previous fractures after age 40
• Heart disease, high blood pressure, stroke, high cholesterol, or a family history of heart disease
• Pain or pressure in the chest, neck, shoulder, or arm during or after exercise
• Dizziness or extreme shortness of breath after mild exertion
• Any condition that might need medical attention before an exercise program begins, such as diabetes

Surgery for Osteoporosis at the University of Washington

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