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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Osteoporosis in Women
What is osteoporosis?
Osteoporosis is a disease that thins and weakens bones to
the point where they break easily. This disease often
affects bones in the hip, spine, and wrist.
How does it occur?
In young healthy adults, bones continue to grow, reaching
their greatest strength around ages 20 to 35. After that,
bones slowly become weaker as you get older.
The risk of osteoporosis increases with age. Osteoporosis
usually develops in women after menopause, between the ages
of 45 and 55. Women have less bone mass than men and lose
bone mass sooner and faster than men. After menopause women
produce much less of the hormone estrogen. Estrogen helps
women's bones stay strong. For example, it helps deposit
calcium in the bones. Low levels of estrogen cause a
weakening of the bones.
Osteoporosis is most common in white and Asian women,
especially slender women, but it can occur in women of any
race. You are also at higher risk if you have a family
history of osteoporosis.
In addition to aging, other causes of osteoporosis are:
- long-term use of certain medicines, such as steroids used
to treat asthma or arthritis, anticonvulsants, certain
cancer treatments, and aluminum-containing antacids
- chronic diseases that affect the kidneys, lungs, stomach,
or intestines or alter hormone levels (examples of
such diseases are diabetes, hyperthyroidism, and
congestive heart failure)
- lifestyle habits such as:
- smoking
- having more than 1 drink of alcohol a day
- too little calcium in the diet
- not enough weight-bearing exercise such as walking,
dancing, or lifting weights
- surgical removal of the ovaries, which reduces estrogen
levels
- intense exercise (such as marathon running), which
reduces estrogen levels
- long periods of bed rest during serious illness
- eating disorders or too much dieting.
What are the symptoms?
You may have no symptoms until a bone breaks. Broken bones
are the most common problem for people with osteoporosis.
Often it's the hip, arm, or wrist that breaks.
The bones of the spine are also a common area of thinning.
Often, over time, the bones of the spine (vertebrae) collapse
on themselves, one at a time, causing loss of height, back
pain, and a stooping posture.
How is it diagnosed?
Your health care provider may discover you have osteoporosis
from an x-ray taken for some other problem. Otherwise, the
diagnosis might be made from a review of your medical
history and symptoms, a physical exam, x-rays, and blood
tests. You may have a test to measure your bone mineral
density, such as a DEXA scan.
How is it treated?
Treatment does not cure osteoporosis, but medicines can slow
down the loss of bone and rebuild some bone.
The most effective treatment for osteoporosis in older women
is estrogen (hormone replacement therapy, or HRT). Women
begin to produce less estrogen before menopause. Without
this hormone to help bones stay strong, women are more
likely to have osteoporosis. Starting HRT around the time
of menopause is the best way to slow calcium loss from the
bones and keep the bones strong. The greatest loss of bone
density occurs in the first years of menopause. For this
reason your health care provider may suggest prescribing
estrogen for you if you are close to menopause.
There are pros and cons for taking estrogen. Estrogen helps
slow the loss of bone and may also decrease your risk of
colon cancer. However, estrogen taken alone, without the
hormone progesterone, may increase the risk of uterine
cancer. A recent large study of women taking a form of
estrogen combined with progesterone (Prempro) showed an
increase in the risk of breast cancer. The same study
showed an increased risk of heart attack, strokes, and blood
clots. You and your health care provider need to discuss
your particular situation.
Treatment also includes increasing the calcium your body
gets, usually through diet and supplements. Calcium is
helpful in the treatment of osteoporosis, especially if you
are not taking estrogen, but it is not nearly as helpful as
estrogen. Most adult women should have 1000 mg of calcium a
day. Women who are pregnant or who are breast-feeding need
1200 to 1500 mg per day. Postmenopausal women who are not
taking estrogen supplements also need 1200 to 1500 mg a day.
Other medicines for osteoporosis are:
- bisphosphonate medicines, such as alendronate (Fosamax)
and risedronate (Actonel)
- raloxifene (Evista)
- calcitonin (Miacalcin).
These medicines are most often prescribed for women who do
not take estrogen or who have already had a fracture due to
osteoporosis.
Weight-bearing exercise, such as walking or stair climbing,
also helps keep your bones strong. Doing this kind of
physical activity every day may help stop further weakening
of your bones.
How long will the effects last?
The risk of a broken bone resulting from osteoporosis
increases with age. Once menopause begins, most women,
especially Caucasian and Asian women, need to take
precautions for the rest of their lives to prevent
osteoporosis.
How can I take care of myself and help prevent osteoporosis?
- Follow the treatment prescribed by your health care
provider.
- If you are taking medicine to treat your osteoporosis, be
sure to take it as directed. For example, medicines such
as alendronate must usually be taken in the morning on an
empty stomach, and you must remain upright for at least a
half hour after taking it.
- Eat healthy foods, especially low-fat milk and dairy
products, green leafy vegetables, citrus fruits,
sardines, and shellfish.
- Take a daily calcium supplement if your health care
provider recommends it. You also need 400 to 1000 IU of
vitamin D each day to help your body absorb calcium. You
can get vitamin D by drinking milk, taking supplements,
or spending time in sunlight.
- Do weight-bearing physical activity, such as walking,
regularly. Be sure to exercise your upper body also.
- Stop smoking. Smokers may absorb less calcium from their
diet.
- Do not have more than 1 drink of alcohol a day. One
drink is 1 ounce of hard liquor, one 12-oz serving of
beer, or one 4-oz glass of wine.
- Talk with your health care provider about hormone
replacement therapy or other medicines when you reach
menopause.
What can I do to reduce my risk of injury?
If you have osteoporosis, you can reduce the risk of injury
and broken bones if you:
- Avoid lifting heavy objects.
- Avoid unusually vigorous physical activity. Build your
activity level gradually.
- Wear shoes that provide good support (such as running or
walking shoes).
- Use support for walking, such as a cane, if you need
it.
- Keep areas where you will be walking well lit and
uncluttered.
- Avoid putting throw rugs on your floors at home.
- Be cautious about going outdoors when roads and
sidewalks are icy.
For more information, call or write:
National Osteoporosis Foundation
1232 22nd Street NW
Washington, DC 20037-1292
800-223-9994
202-223-2226
Web site: http://www.nof.org
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