OSTEOPOROSIS

There are four types of osteoporosis: primary, secondary, osteogenesis imperfecta, and idiopathic juvenile.

Primary osteoporosis

Primary osteoporosis is the most common type of osteoporosis. It is more common in women than men. A person reaches peak bone mass (density) at about age 30. After that, the rate of bone loss slowly increases, while the rate of bone building decreases. Whether a person develops osteoporosis depends on the thickness of the bones in early life as well as health, diet, and physical activity at all ages.

Secondary osteoporosis

Secondary osteoporosis has the same symptoms as primary osteoporosis. But it occurs as a result of having certain medical conditions, such as hyperparathyroidism, hyperthyroidism, or leukemia. It may also occur as a result of taking medicines known to cause bone breakdown, such as oral or high-dose inhaled corticosteroids (if used for more than 6 months), too high a dose of thyroid replacement, or aromatase inhibitors (used to treat breast cancer). Secondary osteoporosis can occur at any age.

Osteogenesis imperfecta

Osteogenesis imperfecta is a rare form of osteoporosis that is present at birth. Osteogenesis imperfecta causes bones to break for no apparent reason.

Idiopathic juvenile osteoporosis

Idiopathic juvenile osteoporosis is rare. It occurs in children between the ages of 8 and 14 or during times of rapid growth. There is no known cause for this type of osteoporosis, in which there is too little bone formation or excessive bone loss. This condition increases the risk of fractures.

There typically are no symptoms in the early stages of bone loss. But once bones have been weakened by osteoporosis, you may have signs and symptoms that include:

• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone fracture that occurs much more easily than expected

DIAGNOSIS

If your doctor suspects that you have osteoporosis, he or she may measure you to check for a loss of height. The vertebrae are often the first bones affected, causing a loss in height of half an inch or more over time. Your doctor may also recommend that your bone density be measured by:

• X-ray is limited for early screening of osteoporosis.
• A bone density scan, also known as a DEXA scan, is the most common tool used to measure bone density and diagnose bone loss and osteoporosis at an early stage.
• Quantitative computerized tomography is also an accurate method of measuring bone density anywhere in the body, but it uses higher levels of radiation than other bone density tests. Ultrasound — typically of the heel of your foot — can also detect early signs of osteoporosis.

In addition to these bone density tests, you may be asked to supply blood or urine samples for analysis so that disease-related causes for the bone loss can be ruled out.

RECOMMENDED MEDICATIONS

Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or increase bone thickness. Even small amounts of new bone growth can reduce your risk of broken bones.

Medicine for treatment and prevention

• Bisphosphonates. These include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast).
• Calcitonin (Calcimar or Miacalcin). Calcitonin also relieves pain caused by spinal compression fractures.
• Denosumab (Prolia). It’s used to treat people who are at high risk for bone fractures related to decreased bone density.
• Teriparatide (Forteo). It’s used for the treatment of men and postmenopausal women who have severe osteoporosis and who are at high risk for bone fracture.
• Raloxifene (Evista). This medicine is a selective estrogen receptor modulator (SERM).

Hormone therapy

Hormone therapy is typically not recommended for most women who have osteoporosis. But if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances.

Hormone therapy for osteoporosis in women includes:

• Estrogen. Estrogen without progestin (estrogen therapy, or ET) may be used to treat osteoporosis in women who have gone through menopause and do not have a uterus. Because taking estrogen alone increases the risk for cancer of the lining of the uterus (endometrial cancer), ET is only used if a woman has had her uterus removed (hysterectomy).
• Estrogen and progestin. In rare cases, the combination of estrogen and progestin (hormone therapy, or HT) is recommended for women who have osteoporosis.

Medicine for pain from fractures

Compression fractures and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines to relieve this pain include:

• Nonprescription acetaminophen, such as Tylenol.
• Nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
• A narcotic pain reliever, such as codeine or morphine.
• Calcitonin, such as Calcimar or Miacalcin.