Diagnosis
Diagnosis begins with a medical history to deter-
mine whether what risk factors the individual has. The
physician may order blood and urine tests to rule out
other disorders. The definitive test for osteoporosis is a
bone mineral density (BMD) test. The most com-
monly used BMD is called a dual-energy x-ray absorp-
tiometry (DXA)test. This test measures the density of
bone in the hip and spine. It is similar to an x ray, only
with less exposure to radiation, and it is painless.
Results are given as a T-score, with negative numbers
indicating low bone mass. Occasionally the physician
may order a bone scan. A bone scan checks for bone
inflammation, fractures, bone cancer, and other
abnormalities, but it does not measure bone density.Treatment
Osteoporosis cannot be cured but it can be treated
with exercise (see Therapy), diet, and sometimes with
medication. There are several types of prescription
medications approved by the United States Food and
Drug Administration for the treatment of osteoporosis.
Antiresorptive medications slow or prevent bone
from being broken down. These include alendronate
sodium (Fosamax), ibandronate sodium (Boniva),
etidronate (Didronel), and risedronate sodium
(Actonel). If drug therapy is used, these medication
are often the first choice.
In women, estrogen therapy and hormone replace-
ment therapy drugs increase the level of estrogen in
the body and improve bone health. Because of side
effects such as the increase in breast cancer, heart
attacks, and stroke, these drugs are used less fre-
quently. Most often they are used to treat other
symptoms of menopause rather than specifically to
treat osteoporosis.
Selective estrogen receptor modulators (SERMs)
such as raloxifene (Evista). These drugs are being
developed to replace estrogen and hormone therapy
drugs. They act on estrogen receptors in bone in a
way that prevents the bone from being broken down.
Parathyroid hormone stimulates the formation of
new bone by activating more new osteoblasts. It is
marketed as teriparatide (Forte ́o)
Calcitonin (Miacalcin, Calcimar, Cibacalcin) is a
hormone that slows bone breakdown by inhibiting
osteoclast activity.Nutrition/Dietetic concerns
Calcium and vitamin D are both essential to
building and maintaining strong bones. Dairy prod-ucts are a good source of these nutrients. Calcium
supplements are recommended for many women who
have difficulty getting enough calcium in their diet.
Recommended dietary allowances (RDAs)and lists
of foods that are high in calcium and vitamin D can
be found in their individual entries.Fluoridealso is
needed to develop healthy bones and teeth.
People with the eating disorderanorexia nervosa
are at especially high risk of developing osteoporosis
later in life because they have poor, unbalanced diets.
The menstrual cycle in girls with anorexia is often
delayed in starting or if it has started, stops. In addi-
tion, people with anorexia almost never get enough
calcium to build strong bones during adolescence and
they make unusually larger amounts of cortisol, a
corticosteroid made by the adrenal gland that causes
bone loss. Although the effect of this eating disorder
on bones will not be seen until the individual is older,
failure to build strong, dense bones during the teen
years substantially increases the risk of osteoporosis
later.Therapy
Physical therapy involving weight-bearing exer-
cises an help individuals of any age, even those who
are frail or have chronic illnesses slow bone loss and
regain muscle mass. Physical therapy exercises that
emphasize improving strength, flexibility, coordina-
tion, and balance also decrease the risk of falls and
fractures in individuals who have osteoporosis.Prognosis
Osteoporosis cannot be cured but preventive
behaviors and treatment can slow its progression.
Falls that result in hip and spine fractures present the
greatest risk of complications. Almost one-fourth of
people over age 50 who have hip fractures die within
one year. Although women have two to three times
more hip fractures than men, men with hip fractures
die twice as often as women. One study found that six
months after a hip fracture, only about 15% of indi-
viduals could walk across a room unaided. Many
require long-term care. About 20% end up in nursing
homes. Quality of life is greatly affected by
osteoporosis.Prevention
Prevention should begin in childhood and the
teenage years with healthy diet and plenty of physical
activity to build strong bones. The higher the bone
mass density in early adulthood, the greater the chance
of avoiding or delaying the effects of osteoporosis.Osteoporosis