Osteoporosis, or "porous bones," is a major cause of disability—even death. About 8 million American women and 2 million men suffer from it. But many only discover that they have it when they become one of the 1.5 million victims of a fracture, most commonly in the spine, hip or wrist.
You've got to start early in life to keep your bones strong. Women gain 98 percent of their skeletal mass by age 20. Teens especially should exercise regularly, get calcium in their diet and avoid smoking or excessive alcohol. Although this advice applies to women of any age, these steps are much more effective when taken long before menopause. That's when women stop producing sufficient estrogen to help maintain normal bone calcium levels. Some women lose up to 20 percent of their bone mass in the first five years after menopause.
Women 65 or older should be screened to determine if their bones contain enough calcium and other minerals. If you are especially vulnerable—you are thin, have a small frame, a history of fractures, or a calcium or vitamin D deficiency—you should be tested earlier. There is no cure for osteoporosis, and you may find conflicting advice on prevention and treatment. Traditionally, calcium with vitamin D supplements have been recommended to menopausal women. But now there is some doubt about their effectiveness in preventing broken bones. I still recommend that women at risk take at least 1,200 mg of calcium citrate and 1,000 international units of vitamin D daily.
There are several kinds of medication to treat osteoporosis for women who are not candidates for hormone therapy. The most commonly prescribed are the bisphosphonate drugs. These may have side effects: There's been a lot of press about possible links between these drugs and deterioration of bone in the jaw. However, this is relatively rare. Some research also has shown a higher incidence of atrial fibrillation, a disorder in cardiac rhythm. But none of this is conclusive, and studies continue.
One breakthrough: Zoledronic acid, an injectable bisphosphonate given once a year, recently was approved by the Food and Drug Administration. However, it is also subject to potential side effects.
Of great interest is the debate about whether any such therapy should be prescribed to prevent osteoporosis, especially in those having a less-severe form of bone loss called osteopenia. Some specialists believe it is premature to start a drug regimen for osteopenia. Discuss it with your doctor.
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