Osteoporosis

What is it?

Overview

What Is It?
Osteoporosis, which means "porous bones," is a preventable and treatable disease that thins and weakens your bones, making them fragile and more likely to break.

Osteoporosis, which means "porous bones," is a preventable and treatable disease that thins and weakens your bones, making them fragile and more likely to break. It is sometimes called a "silent disease" because it can develop gradually over many years without causing any symptoms. The National Osteoporosis Foundation (NOF) estimates as many as eight million women and two million men in the United States have osteoporosis.

Although men can also suffer from osteoporosis, the vast majority of individuals affected by osteoporosis are women. In fact, the annual number of osteoporotic fractures in women is greater than the number of heart attacks, strokes, and cases of breast cancer combined. Women are four times more likely to develop osteoporosis than men.

Although the disease can strike at any age, women are at greatest risk for osteoporosis after menopause. As many as 52 percent of non-Hispanic Caucasian and Asian women age 50 years and older have low bone mass, increasing their risk for osteoporosis. A major reason for this is that women's bodies produce less estrogen after menopause, and estrogen plays an important role in helping to prevent bone loss.

Although the average age for menopause in the United States is 51, some women experience menopause earlier due to natural causes or following surgery, illness or treatments that destroy the ovaries. For example, a total hysterectomy in which the ovaries and uterus are removed will immediately trigger menopause. When you have not had a menstrual period for more than 12 consecutive months, without another medical reason for the absence of your periods, you are postmenopausal.

The good news is that osteoporosis can be prevented and treated and bone health can be maintained. It is never too late to learn how to maintain and keep your bones healthy.

Bone Basics

Your bones are complex living tissue. They provide structure and support for your muscles, protect your organs and store 99 percent of the calcium used by the soft tissues of your body for their various functions.

Healthy bone is strong and dense with many interconnecting pieces. Bone affected by osteoporosis is porous, fragile and weak. Low bone mass affects as many as 34 million Americans, increasing their risk for osteoporosis as they age.

Bone is made mostly of collagen, a protein that provides a soft framework, and hydroxyapatite, a complex of calcium and phosphate, minerals that add strength and harden the framework. This combination of collagen and calcium makes bone strong yet flexible to withstand stress.

Bone changes regularly through a process called remodeling, in which the body breaks down old bone and replaces it with new, strong bone. This process continues throughout life, but varies significantly as you age.

From birth to age 25 or 30, the body builds more new bone than it breaks down. By age 30, your bones become the strongest they will ever be. This phase of bone development is called peak bone mass. The level of bone mass achieved at the peak is determined largely by genetics, but also by nutrition, exercise and menstrual function. Having healthy, strong bones at younger ages can be a critical factor in protecting against osteoporosis in the future.

After about age 30, your body breaks down old bone faster than it builds new bone. This process speeds up dramatically as menopause approaches and for several years after. In the first five to seven years following menopause, you can lose up to 20 percent of bone mass.

Bone loss continues at a slower pace throughout the remainder of your life and may accelerate again in your older years, usually after age 70. Rates of bone loss vary among individuals, but even slow rates of loss may be dangerous, especially in women who start with low bone mass prior to menopause. Often, the first symptom of osteoporosis is a broken bone, which is called a fracture. The common sites for these fractures are the hip, spine or wrist.

Diagnosis

Diagnosis

Osteoporosis develops gradually, usually without symptoms. A broken bone that occurs with minor trauma, such as a slight blow to the wrist, for example, is typically the first symptom. Approximately one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime.

Both hip and vertebrae fractures are associated with an increased risk of death. Vertebrae compression fractures occur when weakened vertebrae suffer the impact of a strain, bump or fall. They can lead to loss of height, severe and sometimes chronic pain, crowding of internal organs and stooped posture (called kyphosis or "dowager's hump"). They can also result in prolonged disability and increased mortality.

Hip fractures are another common consequence of osteoporosis, accounting for one-quarter of osteoporosis-related breaks. A hip fracture can lead to a downward spiral of declining health, decreased mobility and increased frailty. They almost always require hospitalization and major surgery and may require long-term nursing home care.

For some, this injury may cause prolonged or permanent disability or even death. The number of fractures due to osteoporosis is expected to rise to more than three million by 2025, according to the National Osteoporosis Foundation.

Your health care professional can make a diagnosis of osteoporosis based on your medical history with an assessment of your risk factors; a physical examination and laboratory tests; and a bone mineral density (BMD) test, a noninvasive test that measures your bone mass.

Common risk factors for osteoporosis are:

  • Small, thin frame (weighing less than 127 pounds)

  • Personal and/or family history of broken bones or stooped posture in adulthood

  • Previous history of osteoporotic fractures of the spine, hip or wrist

  • Low lifetime intake of calcium

  • Excessive thinness

  • Smoking

  • Excessive alcohol consumption ("Moderate drinking" for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day—one drink equals: a 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits. Moderate drinking is considered safe.)

  • Inactive lifestyle

  • Estrogen deficiency caused by menopause and certain medical conditions such as polycystic ovarian syndrome and anorexia nervosa

  • Absence of menstrual periods or irregular menses as a young woman

  • Long-term use of some anticonvulsants and corticosteroids

  • Caucasian or Asian ethnic backgrounds, but African-Americans and Hispanic Americans are also at significant risk.

  • Certain chronic medical conditions including diabetes, hyperthyroidism, some hyperparathyroidism, some bowel diseases and rheumatoid arthritis

  • Depression. People with serious depression have increased rates of bone loss, as do people who take selective serotonin reuptake inhibitor (SSRI) antidepressants. More research is necessary to better understand the associations between depression and SSRIs and bone loss.

  • Use of proton pump inhibitors. The Food and Drug Administration (FDA) recently ordered new safety information on the labels of prescription and over-the-counter labels for proton pump inhibitors about a possible increased risk of fractures to the hip, wrist and spine for people using these medications. Proton pump inhibitors are used to treat a variety of gastrointestinal disorders. They are generally prescribed for a two-week course and are not to be used more than six weeks in a year. In observational studies, the risk rises with prolonged use and high doses of proton pump inhibitors. Further study is needed to verify any increased risk of fractures.

Next Steps

After discussing your individual concerns about osteoporosis with your health care professional, a series of laboratory tests may be recommended. These tests will help identify or rule out conditions other than menopause that may be causing low bone density. They include:

  • Complete blood cell count

  • Serum chemistry studies

If your medical history or physical findings suggest causes of bone loss other than menopause and age, then additional laboratory tests may be conducted.

The U.S. Preventive Services Task Force (USPSTF) recommends that women age 65 and older without previous fractures or other risk factors be routinely screened for osteoporosis using a bone density test. The USPSTF also recommends screening for women younger than age 65 who have a fracture risk equal to or greater than that of the typical 65-year-old woman. In addition, the National Osteoporosis Foundation and the International Society for Clinical Densitometry recommend DEXA screening in postmenopausal women and men 50 to 70 who have risk factors for the disease. The National Bone Health Alliance recently adopted new criteria that call for diagnosing osteoporosis in anyone over age 50 who has demonstrated an increased risk for fractures.

Talk to your health care practitioner about when you should be screened. And get your BMD performed at a hospital or osteoporosis center that does bone density testing regularly.

There are several types of BMD tests, including the following:

  • DEXA (Dual Energy X-ray Absorptiometry) measures bone density at the spine, hip or total body

  • QCT (Quantitative Computed Tomography) may be used to measure the spine as an alternative to DEXA. This test is rarely used, however, because it is expensive and requires a higher dose of radiation. The International Society for Clinical Densitometry (ISCD) recommends DEXA as the preferred method for diagnosis or treatment decisions. QCT may be used when DEXA is not available, but results are hard to compare with those from DEXA.

  • Ultrasound uses sound waves to measure bone density, and it may be used to measure bone density at the heel, which may be useful in determining a person's fracture risk. Ultrasound is used less often than DEXA because there are no guidelines that use ultrasound measurements to predict fracture risk or diagnose osteoporosis. The ICSD doesn't recommend use of ultrasound for diagnosis or treatment decisions, but it may be used measure bone density when DEXA is not an option.

Results of BMD tests done on postmenopausal women and older men are usually expressed as "T-scores," a measure of how far your bone density deviates above or below the average bone density value for a young, healthy, Caucasian woman. For children and young women and men, the better comparison is with individuals of the same age.

  • A T-score between +1 and -1 indicates normal bone density.

  • A T-score between -1 and -2.5 usually signals low bone density.

  • A T-score at or below -2.5 usually signals osteoporosis.

Your bone density is also compared to an "age matched" standard. The age-matched reading (Z-score) compares your bone density to the "norm" for your age, sex and size.

Your T-score will help your health care professional determine whether you are at risk for a fracture. Generally, the lower your bone density, the higher your risk for fracture. However, your health care professional will consider your BMD score along with your personal health history, osteoporosis risks and lifestyle, including whether you exercise and are getting adequate calcium. Your health care professional may also use FRAX, which stands for "Fracture Risk Assessment Tool." Your FRAX score, which is based on your age, weight, height, medical history and other risk factors, as well as your

Some tests for osteoporosis risk, such as those available at community health fairs, provide a starting point for assessing your bone health—but definitely require follow-up. If you have one of these types of tests, be sure to discuss the results with your health care professional, especially if your results indicate low bone density.

Medicare and most commercial insurers pay for BMD testing for individuals at risk or already suffering from osteoporosis.

Treatment

Treatment

The primary goal of osteoporosis therapy is to reduce the risk of fractures. A comprehensive osteoporosis treatment program focuses on nutrition, exercise and safety precautions to prevent falls that may result in fractures and, if necessary, medication to slow or stop bone loss, increase bone density and reduce fracture risk. If you are at risk for or have osteoporosis, your health care professional may recommend several treatment and preventive measures, including:

  • Adequate amounts of calcium and vitamin D, either from diet or supplementation

  • Regular weight-bearing exercise

  • Avoiding smoking and excessive alcohol consumption ("Moderate drinking" for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day—one drink equals: 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine or 1.5 ounces of 80-proof distilled spirits. Moderate drinking is considered safe).

  • Medications to stop or slow bone loss, improve bone density and prevent fractures.

  • Surgery to repair fractured bones that result from osteoporosis. For example, patients with an acute vertebral fracture and pain that does not respond to standard treatment approaches—medication, increased calcium intake and back-strengthening exercises to improve muscle support—may be candidates for balloon kyphoplasty.

    Balloon kyphoplasty is similar to a technique known as vertebroplasty, in which acrylic cement is injected into the fractured vertebral bone to stabilize it and relieve pain. During balloon kyphoplasty, however, a small orthopedic balloon is inserted into the vertebrae and inflated with liquid. The balloon is then deflated and removed, creating a cavity into which bone cement may be applied.

  • Hip protectors or pads, especially if you are thin or have fallen before.

Medical Approaches to Treating Osteoporosis

The U.S. Food and Drug Administration (FDA) has approved several medications for postmenopausal women to help slow or stop bone loss, build bone and reduce the risk of fractures. These medications work well, but only when they are taken regularly. Plus, as with any medication therapy, there are certain risks and side effects.

  • Menopausal Estrogen Therapy and Combination Estrogen-Progestin Therapy

    Although not approved by the Food and Drug Administration (FDA) for the treatment of osteoporosis, oral and transdermal forms of estrogen, called estrogen therapy (ET), and combined estrogen-progestin, called hormone therapy (HT), are approved for preventing bone loss in recently menopausal women.

    Studies find that ET increases bone mass and reduces the incidence of vertebral, wrist and hip fractures. However, because of the long-term risks associated with hormone replacement therapy—risks identified within the last several years by the federal Women's Health Initiative—the FDA recommends that women first consider other osteoporosis medications and warns that hormone therapies should be used at the lowest possible dose for the shortest possible time.

  • Raloxifene (Evista)

    Available in pill form, this medication is approved for the prevention and treatment of osteoporosis in postmenopausal women. Raloxifene has positive estrogen-like effects on bone but not on the breast or lining of the uterus and may reduce the risk of estrogen-dependent breast cancer by 65 percent over four years.

    It is part of a class of drugs called selective estrogen receptor modulators (SERMs) that appear to prevent bone loss at the spine, hip and other points in the body. Studies find that raloxifene reduces the risk of spinal fracture in women with osteoporosis, but there are no data confirming that it reduces the risk of any other fractures. Possible side effects include hot flashes, blood clots in the veins (similar to estrogen) and leg cramps. The pill is taken once a day, with or without meals.

  • Alendronate (Fosamax and other brands, including generics)

    From the bisphosphonate class of drugs, this is a bone-specific medication approved by the FDA to treat and prevent osteoporosis. Studies find alendronate increases bone mass and reduces the risk of spine, hip, wrist and other fractures by up to 50 percent in women with osteoporosis.

    Alendronate has also been approved for the treatment of glucocorticoid-induced osteoporosis and the treatment of osteoporosis in men. Alendronate tablets should be taken on an empty stomach in the morning and with eight ounces of water at least 30 minutes before the first food, beverage or medication of the day. To minimize side effects—which can include heartburn or irritation of the esophagus—remain upright for at least 30 minutes after taking this medication. Alendronate can be taken daily or as a weekly medicine regimen.

  • Risedronate (Actonel)

    Another type of bisphosphonate drug, this medication is approved to treat and prevent osteoporosis in postmenopausal women and to prevent and treat glucocorticoid-induced osteoporosis in women and men. It can be taken once per day, once per week or once per month.

    Studies find it increases bone mass and reduce the risk of spinal, wrist, hip and other non-spinal fractures in women with osteoporosis.

    Take on an empty stomach in the morning with eight ounces of water, 30 minutes before eating or drinking. To minimize side effects—which can include heartburn or irritation of the esophagus—remain upright for at least 30 minutes after taking. Take any vitamins, calcium and antacids at least 30 minutes after you take risedronate.

  • Ibandronate (Boniva)

    This is another biphosphonate that has been approved by the FDA for prevention and treatment of osteoporosis in postmenopausal women. It reduces the incidence of vertebral fractures by about 50 percent and increases bone mineral density throughout the skeleton. Ibandronate also prevents bone loss in recent menopausal women but who do not yet have osteoporosis. Ibandronate must be taken once a month on an empty stomach, first thing in the morning, with eight ounces of water (no other liquid) at least 60 minutes before eating or drinking. Patients must remain upright for at least one hour after taking this medication. Ibandronate also may be given intravenously once every three months.

  • Zoledronic acid (Reclast)

    Reclast has recently been approved by the FDA to prevent postmenopausal osteoporosis for two years with a single dose. A once-yearly infusion of Reclast was approved in 2007 to treat postmenopausal osteoporosis, and the 2009 approval allows it to also be used to prevent onset of osteoporosis in postmenopausal women with low bone mass. Reclast works by strengthening bones and protecting against osteoporosis-related fractures, including those of the spine and hip. A study published in the New England Journal of Medicine found that Reclast reduced hip fractures by 41 percent and spine fractures by 70 percent. Reclast is given only once a year or once every two years (depending on the diagnosis) as a 15-minute intravenous infusion. Side effects include transient fever, muscle pain, pain in the bones or joints, flu-like symptoms and headache. These symptoms usually set in within the first three days of receiving Reclast and generally go away within three to four days.

  • Calcitonin (Miacalcin)

    This is approved for the treatment of osteoporosis in women who are five years postmenopausal and cannot tolerate estrogen therapy. Studies find that this medication helps slow bone loss, increases spinal bone density and may relieve fracture pain. Because calcitonin is a protein, it cannot be taken orally, so it is taken as a nasal spray or, in some instances, an injection. Possible side effects include nasal irritation and inflammation, bloody nose, headache and backache. Injectable calcitonin may cause an allergic reaction and flushing of the face and hands, frequent urination, nausea and skin rash. Calcitonin isn't as potent as bisphosphonates, so it is usually reserved for people who can't take other drugs.

  • Teriparatide (Forteo)

    A form of parathyroid hormone, this is the first medication that stimulates bone formation instead of slowing the breakdown of bone. It is approved for postmenopausal women and for men at high risk for fractures. It increases bone mineral density and reduces fractures in postmenopausal women. The drug is administered by injection once a day (for up to 24 months). Side effects may include nausea, dizziness and leg cramps.

  • Denosumab (Prolia)

    This injectable treatment, approved by the FDA in 2010, is a fully human monoclonal antibody. It offers another option for postmenopausal women with osteoporosis who are at high risk for fracture. It works to decrease the destruction of bone and increase bone mass and strength. An injection is recommended every six months. Side effects may include back pain, pain in the extremities, musculoskeletal pain, high cholesterol levels and urinary bladder infections. Serious adverse reactions include low calcium levels in the blood, serious infections and skin reactions such as dermatitis, rashes and eczema. Denosumab causes significant suppression of bone turnover, which may contribute to the occurrence of atypical fractures, slow fracture healing and osteonecrosis of the jaw (ONJ), a severe bone disease affecting the jaw.

There have been some recent reports in the news about concerns over ONJ and atypical fractures related to osteoporosis medications, particularly bisphophonates. The news reports suggested that there was a small possibility of an increased risk of a certain type of thigh fracture in people with osteoporosis who take bisphosphonates for a long time. The FDA reviewed data and found no clear connection between bisphosphonate use and increased thigh factures. A task force is studying the concerns, but based on current information, most health care professionals are not recommending that women stop taking bisphosphonate medication. Because bisphosphonates accumulate in bone, some studies recommend a "drug holiday" after 5 to 10 years of bisphosphonate treatment.

An earlier task force also reviewed reports about ONJ related to bisphosphonates and found that nearly all cases were in patients who were receiving very high doses of bisphosphonates for cancer complications, not in women being treated for osteoporosis.

The risk of hip fracture is a much more serious threat to women with osteoporosis. Talk to your health care provider about the benefits and risks of taking osteoporosis medication, and discuss what treatment and prevention options are best for you, with your health history in mind.

Keep in mind that osteoporosis medication is one of several strategies for prevention or treatment of this common condition. Weight-bearing exercise, a diet high in calcium and/or calcium supplements and vitamin D intake also are important to help keep your bones strong.

One medication that most U.S. medical organizations do not endorse and the FDA has not approved is strontium renelate. It is approved for treatment of osteoporosis in much of Europe, and some U.S. women take it and other forms of strontium. Health professionals in this country, however, advise against use of strontium because it can make it difficult to monitor bone mineral density.

Preventing Falls Is Key

Falls due to weakness are one of the most common causes of hip, wrist and vertebral fracture in people over age 60.

Environmental hazards, such as slippery floors or loose carpeting, can increase your risk for falls. Physical issues such as impaired vision and/or balance; chronic diseases that impair mental or physical functioning; and certain medications may also put you at risk.

Consider making some of these changes to help eliminate environmental factors that could lead to falls:

  • Indoors: Keep floor surfaces smooth but not slippery and clear of clutter and loose wires; wear supportive, low-heeled shoes even at home; avoid walking in socks, stockings or slippers; be sure stairwells are well lit and that stairs have handrails on both sides; install grab bars on bathroom walls near tub, shower and toilet; and use a rubber mat in the shower or tub.

  • Outdoors: If necessary, use a cane or walker for added stability; wear rubber-soled shoes for traction; walk on grass when sidewalks are slippery; use caution on highly polished floors that are slick when wet. Use plastic or carpet runners when possible. Some older women at high risk of falls and hip fracture might want to consider hip protectors. These devices are thin shields that can be incorporated into underwear.

Muscle-strengthening and balance-retraining programs are also effective in preventing falls.

Prevention

Prevention

The importance of beginning bone loss prevention at a very young age is now well understood. Bone health programs are being developed and implemented that target girls as young as nine to 12 years of age and their parents, focusing on promoting good nutritional choices and participating in regular physical activity.

Nearly one-third of bone loss can occur before a diagnosis of osteoporosis is made. However, you can prevent future bone loss caused by osteoporosis with early detection. Also, once you've had a fracture due to osteoporosis, your risk of future fractures is increased.

Thus, it is important to prevent the first fracture. Taking preventive steps and reviewing risk factors now are especially helpful approaches for women of all ages.

There are five simple steps to reduce your risk for osteoporosis:

  • Increase the amount of calcium and vitamin D in your diet.

  • Exercise regularly; bones and muscles respond to physical activity by becoming stronger. Weight-bearing exercises like walking and weight lifting are the most beneficial.

  • Maintain a healthy body weight. Being underweight or losing weight increases your risk of bone loss and fracture, and ultimately, of developing osteoporosis.

  • Quit smoking. Cigarette smoking (nicotine) can reduce bone mass and increase the risk of fracture, thus increasing your risk for osteoporosis. Ask your health care professional to recommend methods to help you quit.

  • Drink alcohol in moderation, if you drink. Excessive consumption of alcohol increases your risk of osteoporosis and fractures from falls.

For some women, medication may also be helpful for preventing additional bone loss. Ask your health care professional what the best osteoporosis prevention strategy is for you.

Dietary Strategies for Osteoporosis Prevention

Many vitamins and minerals are important to maintaining healthy bones. That is why it is important to eat a well-balanced diet every day consisting of a variety of foods, including grains, fruits, vegetables, nonfat or low-fat dairy foods or other calcium-rich foods, as well as meat and beans.

Most Americans do not get enough calcium in their diets so adding calcium to your diet may be the easiest health-related change you can make. It's an important one, too. Calcium may reduce fractures caused by osteoporosis by as much as 50 percent. The Institute of Medicine recommends these calcium guidelines based on age:

  • Girls ages nine to 18: 1,300 mg/calcium/daily

  • The average woman age 19 to 50: 1,000 mg/calcium/daily

  • Women 51 or older: 1,200 mg/calcium/daily. Postmenopausal women should take adequate supplemental elemental calcium (generally 500 to 1,000 mg per day) in divided doses, at mealtime, such that their total calcium intake, including calcium from food, approximates 1,500 mg/day.

If you have asthma, allergies, a thyroid condition or other chronic medical condition, you may need an even higher daily calcium intake. Your intake should not exceed 2,000 mg/day, however.

Good sources of calcium include:

  • Low-fat or nonfat dairy products, such as milk, yogurt, cheese and ice cream. Three eight-ounce glasses of milk plus calcium from a normal diet will meet daily calcium requirements.

  • Dark green, leafy vegetables such as broccoli, collard greens, bok choy and spinach

  • Sardines and salmon with bones

  • Fortified tofu (a soybean product made from curdled soy milk)

  • Soy milk

  • Almonds

  • Calcium-fortified foods and beverages such as orange juice, cereals and breads

Difficulty digesting milk, which is called lactose intolerance, and stomach upset caused by dairy products may be more common as you age. If that's the case, yogurt with active cultures, buttermilk, and cheddar and Swiss cheeses are high in calcium but low in lactose, the sugar found in milk and milk products.

Many people mistakenly believe they are lactose intolerant when a simple sensitivity to dairy products or some other food substance is really the case. So check with your health care professional before you avoid dairy products. Products that don't contain lactose (such as Lactaid) can help people with lactose intolerance to consume dairy products.

When your diet doesn't provide enough calcium, you may wish to take calcium supplements. The most common and least expensive is calcium carbonate, found in antacid preparations for treating heartburn. However, in clinical studies, researchers found that the formulations of calcium supplements greatly affected the level of absorption. Calcium citrate was better absorbed than calcium carbonate. In addition, calcium carbonate is absorbed best when taken with food, while calcium citrate can be taken any time.

Multivitamins generally do not provide enough calcium to meet the daily needs of a postmenopausal woman. In fact, calcium, which is a mineral, isn't always included in a multivitamin preparation, so be sure to read the label if you are relying on your vitamin supplement to meet your calcium requirement.

Your diet should also be rich in vitamin D. This nutrient helps your body absorb calcium more efficiently and minimize bone loss. Although the use of dairy products fortified with vitamin D and adequate sun exposure have helped reduce the incidence of vitamin D deficiency, many Americans—particularly older Americans and Americans who live in certain parts of the country—do not get adequate sunlight and are therefore deficient in vitamin D.

This essential vitamin is found in fortified milk and cereals, as well as vitamin supplements. If your exposure to sunlight is limited due to use of sun block or the climate where you live, you may want to consider increasing your average intake of vitamin D. At least 800 to 1,000 units (IU) of vitamin D daily is recommended for women ages 50, and some people may require more. Check with your health care provider to see how much you need.

Exercise Strategies

Bone and muscle respond to physical activity by becoming stronger. Although all exercise is beneficial to overall good health, two kinds of exercise are most effective for preventing osteoporosis: Weight-bearing, in which you work against gravity, and resistance exercises, such as weight lifting.

Weight-bearing exercise is any exercise in which your feet and legs bear your weight while you perform it, such as brisk walking, dancing, racket sports and aerobics. This creates high pressure on the bone that helps to build and maintain its strength.

Resistance exercises that strengthen muscle may also be beneficial, particularly for the large muscles of the shoulder, pelvis, hips, back and trunk. Because falls are the most common cause of fractures, balance-improving activities, such as tai chi and strength training, may also significantly reduce your risk for falls. A study of over 61,000 women conducted at Brigham and Women's Hospital and Harvard Medical School showed that women who walked four hours or more per week had a 41 percent lower risk of hip fracture than women who walked less than an hour a week.

The National Osteoporosis Foundation recommends a total of 30 minutes of weight-bearing physical activity on most days of the week. Bicycling and swimming are non-weight–bearing exercises and won't maintain and build new bone, but they are still good for the cardiovascular system.

For muscle strengthening, you can use stationary weight machines at health clubs and gyms and free weights or elastic bands in the gym or at home. The important thing to remember is that you don't have to lift heavy weights to benefit from strength training. You should start with a light weight and gradually increase your repetitions and/or resistance as your strength increases. The goal is to build bone strength—not muscle mass, which requires numerous lifts with heavy weights.

In a study whose results surprised even the researchers who conducted it, gardening went a long way to help reduce the risk for osteoporosis among the 3,310 women age 50 and older involved in the study. Gardening activities such as raking, thrusting a shovel into the ground and moving a wheelbarrow filled with dirt, weeds or mulch are all considered weight-bearing exercises. Be careful not to lift heavy pots or heavy bags of mulch or dirt.

If you do not routinely exercise, before you start, ask your health care professional to recommend a simple, safe program and start soon.

Facts to Know

Facts to Know

  1. As many as 8 million American women already have osteoporosis, and 34 million have low bone density, putting them at risk for developing the disease. Half of all women over age 50 will have an osteoporosis-related fracture in the years ahead.

  2. Significant risk of osteoporosis has been reported in people of all ethnic backgrounds.

  3. Osteoporosis contributes to more than 1.5 million fractures annually, including approximately 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites.

  4. The number of people beyond age 65 years in the United States is expected to increase dramatically over the next few decades. This will drive up the national cost of osteoporosis, which was estimated at $19 billion in 2005, according to the National Osteoporosis Foundation. By 2025, the national cost may be as high as $25.3 billion.

  5. Smoking, abusing alcohol and excessive thinness increase your risk for developing osteoporosis. Likewise, your risk for developing osteoporosis increases if you don't exercise or if you exercise too much.

  6. Bones that are calcium rich are less likely to break. Be sure your diet provides at least 1,000 to 1,500 mg of calcium and 400 to 1,000 IU of vitamin D daily, depending on your age, to help keep your bones strong. Drinking or eating three dairy products a day provides the recommended daily intake of calcium, but most women fall short of this requirement. If you are unable to get enough calcium and vitamin D from your diet, your health care professional may recommend a supplement.

  7. Menopause increases your risk for developing osteoporosis because your body's natural production of the hormone estrogen declines, and estrogen helps keep bones strong.

  8. Several types of medications, including calcitonin (Miacalcin), raloxifene (Evista), teriparatide (Forteo) and bisphosphonates (Actonel, Fosamax, ibandronate), are effective in preventing and/or treating osteoporosis. And recently approved Reclast is a single infusion that prevents postmenopausal osteoporosis for two years or treats osteoporosis for a year.

  9. Women lose the most bone mass—as much as 20 percent—in the first five to seven years after menopause. Because of declining estrogen levels after menopause, a woman's ability to naturally maintain bone structure is seriously depleted. However, not everyone needs to seek treatment. Bone density testing helps target those at greatest risk for bone loss and osteoporosis.

  10. A bone mineral density (BMD) test measures the strength of your bones to determine your risk of developing osteoporosis. This test is not usually performed until after menopause, unless you have an unusual clinical situation or are at high risk for osteoporosis. It is quick, painless and noninvasive.

  11. Bone loss rates can be slowed by regular weight-bearing and muscle-strengthening exercises. Activities such as walking, gardening, jogging and playing tennis help to strengthen bones and connective tissue.

  12. There is no cure for osteoporosis. However, it is preventable and treatable. You can help prevent bone loss and fractures from osteoporosis with proper diet, exercise and medications, when necessary.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about osteoporosis so you're prepared to discuss this important health issue with your health care professional.

  1. Am I at risk for osteoporosis?

  2. Do any of my medications increase my risk for developing osteoporosis?

  3. What options are available to prevent or treat osteoporosis?

  4. How can I tell if I have fractured a bone in my spine?

  5. When and how often should I have a bone density scan?

  6. How much calcium should I consume each day and how much vitamin D?

  7. Do any of my medications interfere with calcium absorption?

  8. Can I get my daily calcium requirements from my diet?

  9. If I have osteoporosis or low bone mass, is there anything I can do to help lessen its severity?

  10. What kinds of exercise are best for me and how often should I exercise?

Key Q&A

Key Q&A

  1. Why is osteoporosis called a "silent disease"?

    Osteoporosis is sometimes called a "silent disease" because it can occur gradually over many years without your knowledge. Often, the very first symptom of osteoporosis is a broken bone, also called a fracture, which typically happens at the hip, spine or wrist. Osteoporosis thins and weakens your bones, making them fragile and more likely to break. However, the good news is that osteoporosis can be prevented and treated. Early detection is important; therefore, you should ask your health care professional for more information about osteoporosis.

  2. Can't I just take a multi-vitamin to prevent osteoporosis?

    No. Most multivitamins contain only minimal quantities of calcium. Calcium carbonate and calcium citrate are available over-the-counter as supplements if your diet is low in this essential mineral. Girls age nine to 18 need 1,300 mg/calcium/daily. The average woman age 19 to 49 needs 1,000 mg/calcium/daily, and women 50 and older should be getting 1,200 mg to 1,500 mg/calcium/daily. Postmenopausal women who do not take estrogen should aim for 1,500 mg. In addition, be sure your diet (or supplement) also provides between 400 IU (international units) and 1,000 IU of vitamin D (400 to 800 IU for adults under 50 and 800 to 1,000 IU for adults 50 and over), which helps your body absorb calcium. Taking the recommended daily amount of calcium and vitamin D can cut your risk of fracture by as much as 50 percent, particularly in older women. One cup (8 ounces) of fat-free milk contains 306 mg of calcium. Calcium is also found in other dairy products, such as yogurt, cheese and some soy products. Fortified orange and other juices, fortified grains, dark greens and some seafoods are other sources.

  3. If I've already reached menopause, isn't it too late to do anything about osteoporosis?

    It's never too late to make lifestyle changes to improve your bone health and receive the appropriate treatment for osteoporosis, if you have it. Although you can't restore all the bone that has already been lost, you can build some new bone and prevent bone loss with a diet rich in calcium and vitamin D, a program of weight-bearing exercise and, in some cases, medications.

  4. Isn't it true that we get shorter as we age?

    Substantial loss of height and a stooped posture are not normal results of growing older. Instead, they can be signs of multiple vertebral compression fractures in the spine. Height loss of one- to one-and-one-half inches may be due to degenerative disc disease, however, not necessarily osteoporosis. Frequently, you may not know you have osteoporosis until your bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. It is these collapsed vertebra that lead to loss of height, stooped or rounded posture (called kyphosis, but also known as "dowager's hump") and other spinal deformities.

  5. If I have one or more of the risk factors for osteoporosis, does that mean that I probably have the disease but don't know it?

    Not necessarily. Your health care professional will take into account a number of factors in determining your likelihood of developing osteoporosis. These include your personal health history, your individual osteoporosis risks, your lifestyle—including whether you exercise and are getting adequate calcium—and the results of a bone mineral density (BMD) test.

  6. Is the test for osteoporosis painful?

    No! A BMD test is safe, quick and painless. Simple measurements are usually taken of the bones in your hip, wrist and spine. You typically remain clothed during the procedure. There are several types of BMD tests; some may use a very small amount of radiation. Talk with your health care professional to learn more about the procedure and to further alleviate any fears you may have about this simple exam and be sure to ask your health care professional what your test results mean when you get them.

  7. My health care professional recommended that I start working out with weights, but I'm afraid of lifting heavy weights. What should I do?

    Good news: You don't have to lift heavy weights to benefit from strength training. You should lift a light amount of weight and gradually increase your threshold as your strength increases. The goal is to build bone and muscle strength—not muscle mass, which requires numerous lifts with heavy weights. So enjoy this important activity and work at your own pace. Just remember, if you do not routinely exercise, ask your health care professional to recommend a simple, safe program and start soon.

  8. What medications are available to prevent and treat osteoporosis?

    There are several medications approved by the U.S. Food and Drug Administration for the prevention and/or treatment of osteoporosis. These medications may postpone or stop bone loss indefinitely, but only when they are taken regularly. Medications currently available include menopausal hormone therapy and the drugs alendronate (Fosamax), calcitonin (Miacalcin), raloxifene (Evista), risedronate (Actonel), teriparatide (Forteo) and Reclast. As with any medication therapy, there are risks and side effects associated with each of these medications. Hormone therapy was once the mainstay of osteoporosis treatment, but it has, for the most part, been replaced with other therapies. Ask your health care professional for more information.

Lifestyle Tips

Lifestyle Tips

  1. Get active and get stronger.

    Remaining—or becoming—physically active can help prevent osteoporosis. Bones and muscles respond to activity by getting stronger. Two kinds of exercise are the best bet for preventing osteoporosis: weight-bearing, in which you work against gravity, and resistance exercises such as weight lifting. The more you use your bones to walk, run or lift weights, the heavier and stronger your bones will be. Because falls are the most common cause of fractures, balance-improving activities, such as tai chi and strength training, may also significantly reduce your risk.

  2. Turn your thumb green and help prevent osteoporosis.

    Wondering what type of physical activity to pursue to help keep your bones strong? One research study says gardening can give you the biggest bang for your exercise buck in terms of preventing osteoporosis. Pushing a lawnmower, raking and lifting a wheelbarrow filled with mulch or weeds all are great weight-bearing exercises.

  3. Make your living space "fracture safe".

    Keep stairways and living areas well lighted and make sure stairs are not slippery. Clear away clutter and repair any loose floorboards or carpeting. Make sure that all electrical and extension cords are out of the way so you won't trip on them. Tack or tape down throw rugs. Install grab bars in showers, bathtubs and beside the toilet. And, don't stand on stools or chairs to get those out-of-reach items—keep things you use regularly where you can get to them easily and safely.

  4. Break a bone recently? Speak up!

    If you are middle aged or older and fracture a bone, talk to your health care professional about a bone density scan to test for osteoporosis. Fractures at this age are red flags that warrant further investigation for underlying health problems. Don't just get your cast on and go home!

  5. Get creative with calcium.

    It can be challenging to get the calcium you need from your diet. You need 1,000 to 1,500 milligrams of calcium daily, depending on your age. Try adding powdered milk to soups, casseroles and drinks. Just one tablespoon of nonfat powdered dry milk contains 52 mg of calcium. You can easily add two to four tablespoons to many recipes. Also buy juices, cereals, breads, grains and bottled water fortified with calcium, and sprinkle half a cup of diced figs over an eight-ounce serving of yogurt. The combination will provide more than half of an adult's daily calcium needs.

  6. Getting adequate vitamin D is also important.

    Vitamin D helps your body absorb calcium by allowing it to enter the bloodstream via the intestines. Without it, the kidneys would excrete calcium that otherwise could be used. Women age 50 and over should consume 1,200 to 1,500 mg of calcium per day and 800 to 1,000 units of vitamin D.

Organizations and Support

Organizations and Support

For information and support on coping with Osteoporosis, please see the recommended organizations, books and Spanish-language resources listed below.

American Academy of Orthopaedic Surgeons (AAOS)
Website: http://www.aaos.org
Address: 6300 North River Road
Rosemont, IL 60018
Phone: 847-823-7186

American Society for Bone and Mineral Research (ASBMR)
Website: http://www.asbmr.org
Address: 2025 M Street, NW, Suite 800
Washington, DC 20036
Phone: 202-367-1161
Email: asbmr@asbmr.org

Bone and Joint Decade
Website: http://www.usbjd.org/index.cfm
Address: 6300 North River Road
Rosemont, IL 60018
Phone: 847-384-4010
Email: usbjd@usbjd.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Website: http://www.niams.nih.gov
Address: National Institutes of Health
Bldg. 31, Room 4C02 31 Center Dr. - MSC 2350
Bethesda, MD 20892
Hotline: 1-877-22-NIAMS (1-877-226-4267)
Phone: 301-496-8190
Email: niamsinfo@mail.nih.gov

National Osteoporosis Foundation (NOF)
Website: http://www.nof.org
Address: 1232 22nd Street N.W.
Washington, DC 20037
Hotline: 1-800-231-4222
Phone: 202-223-2226

NIH Osteoporosis and Related Bone Diseases National Resource Center
Website: http://www.niams.nih.gov/Health_Info/bone/default.asp
Address: 2 AMS Circle
Bethesda, MD 20892
Hotline: 1-800-624-BONE
Phone: 202-223-0344
Email: niamsboneinfo@mail.nih.gov

Orthopaedic Research and Education Foundation (OREF)
Website: http://www.oref.org
Address: 6300 N. River Rd., Suite 700
Rosemont, IL 60018
Phone: 847-698-9980
Email: communications@oref.org

Paget Foundation
Website: http://www.paget.org
Address: 120 Wall Street, Suite 1602
New York, NY 10005
Hotline: 1-800-23-PAGET (1-800-237-2438)
Phone: 212-509-5335
Email: pagetfdn@aol.com

Mind Over Menopause: The Complete Mind/Body Approach to Coping With Menopause
by Leslee Kagan, Herbert Benson, and Bruce Kessel

Osteoporosis Handbook: Every Woman's Guide To Prevention & Treatment
by Sydney Lou Bonnick

Better Bones, Better Body: Beyond Estrogen and Calcium
by Susan Brown, Susan E. Brown PhD, and Russell Jaffe MD

The Whole-Body Approach to Osteoporosis: How to Improve Bone Strength and Reduce Your Fracture Risk
by Keith Mccormick

Outwitting Osteoporosis: The Smart Woman's Guide To Bone Health
by Ronda Gates and Beverly Whipple

Smart Women, Strong Bones
by Ronda Gates and Dr. Beverly Whipple

Strong Women Stay Young
by Miriam Nelson and Sarah Wernick Ph.D.

Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat, and Beat Osteoporosis
by Miriam E. Nelson and Sarah Wernick

Walk Tall! An Exercise Program for the Prevention & Treatment of Osteoporosis
by Sara Meeks

Medline Plus: Osteoporosis
Website: http://www.nlm.nih.gov/medlineplus/spanish/osteoporosis.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

National Osteoporosis Foundation
Website: http://www.nof.org/spanish/index.htm
Address: 1150 17th Street NW, Suite 850
Washington, D.C. 20036
Hotline: 1-800-231-4222
Phone: 202-223-2226

Last date updated: 
Tue, 2014-03-11

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Last date updated: Tue 2014-03-11

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