Osteoporosis
In this condition factsheet:
Diagnosing Osteoporosis
The key steps for diagnosing osteoporosis involve assessing your risk for fracture and evaluating your bone density.
If your doctor determines that you do have risk factors for fracture or osteoporosis (such as being 65 years or older or having had a fracture in the past), there are several effective and relatively quick tests that measure bone mineral density (BMD). If the results show that your bone density is too low, your doctor will likely diagnose you with osteoporosis.
Bone density measurement by a method called DXA (dual energy X-ray absorptiometry) is the most effective way to assess osteoporosis risk. Scanning parts of the body such as the hips or spine using a special type of X-ray machine can confirm you have an increased risk of fractures. The test compares your bone density to that of a typical healthy adult at age 25, the usual age of maximum bone density.
Sometimes a computerized tomography (CT) scan or a heel ultrasound may also be used to check the condition of the bones.
Following the diagnosis of osteoporosis, further studies are needed to look for possible causes. An examination to determine such causes might involve blood and urine tests to measure the levels of certain hormones produced in the body, as well as questionnaires on lifestyle and diet, to help determine your daily intake of calcium and vitamin D.
There are also two tools (CAROC and FRAX) available in Canada for your doctor to use to calculate an estimate of future risk of fracture or bone breaking in the next 10 years. To determine your personal risk of fracture over the next 10 years, your doctor will take into consideration key risk factors which may include: age, gender, body mass index, fracture history, family history, use of corticosteroids, smoking status, and alcohol intake.
If your doctor decides that you require medication to treat osteoporosis, BMD testing may be conducted every 1 to 3 years to see if the therapy is working. Once the medication is shown to be effective, you may not need to be tested as often. BMD testing may also be repeated to monitor for rapid bone loss in people who are not started on medications for osteoporosis but are at risk for developing the disease.
Treating and Preventing Osteoporosis
Treatment of osteoporosis is aimed at preventing or reducing bone fractures and maintaining or increasing bone density. There are several treatments for osteoporosis, but prevention is still very important. Many of the treatment and prevention strategies for osteoporosis are similar.
Maintenance of good bone strength requires that you have a regular intake of calcium and vitamin D. Osteoporosis Canada recommends 1,000 mg of elemental calcium daily (diet plus supplements) for men and women between the ages of 19 and 50 years, and 1,200 mg for men and women over the age of 50 years. They recommend 400 IU to 1,000 IU of vitamin D daily for adults between the ages of 19 and 50 years who are not at high risk of osteoporosis, and 800 IU to 2,000 IU for both adults over the age of 50 and people at high risk of osteoporosis. Vitamin D supplements are widely available.
Osteoporosis Canada also recommends a healthy lifestyle with no smoking or excessive intake of alcohol, as well as four types of exercise: strength training, balance exercises, posture awareness, and aerobic activity.
Strength exercises, also known as resistance training, can be done with weights or exercise bands. These exercises play a role in strengthening muscles and bones. Posture and balance can be improved through exercise and can significantly reduce the risk of bone fractures. Aerobic physical activities (e.g., walking, dancing, or jogging) for at least 150 minutes per week are also recommended.
There are several medications that can be used to treat osteoporosis. Many of these treatments may also be used to prevent osteoporosis for people who are at high risk of developing it. The following are some of the osteoporosis medications available in Canada:
- bisphosphonates (e.g., alendronate, etidronate, risedronate, zoledronic acid): These are one of the main groups of medications that may be used to prevent and treat osteoporosis. These medications slow down bone loss and help repair bone, reducing the chance of fracture.
- selective estrogen receptor modulators (SERMs; e.g., raloxifene): These may also be used to prevent and treat osteoporosis in women.
- denosumab: Given as an injection, denosumab is part of a class of medications called RANK ligand inhibitors. It stops the breakdown of bone, helping to strengthen your bones and lowering the chances of fracture.
- testosterone: This is not recommended for the treatment of osteoporosis in most men. However, in some cases where osteoporosis in men is the result of hypogonadism, which is a condition of low levels of the male hormone testosterone, testosterone replacement therapy (androgen) may be used alone or with a bisphosphonate.
- hormone-replacement therapies (HRTs): A variety of HRTs are available for women who have reached menopause. Estrogen replacement helps to preserve bone and manage menopausal symptoms, but the therapy has a number of health risks. If you are taking or are considering taking HRT, talk to your doctor about the risks and benefits.
- parathyroid hormone analogues (e.g., teriparatide): This class of medication builds new bone faster than it breaks it down, and can be used to treat severe osteoporosis.
- romosozumab: This belongs to a new class of medications called sclerostin inhibitors. It is an injectable given monthly that reduces fracture risk by increasing bone formation and decreasing bone resorption.
Two or more medications may also be used in combination to treat some cases of osteoporosis. In addition, doctors usually recommend that you continue to get enough calcium and vitamin D.
All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Osteoporosis
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