The first thing you need to know is that not everyone is at risk for osteoporosis. About 8 million U.S. women and 2 million men have the disorder. Women over 50 are the most vulnerable because they can lose as much as 20 percent of their bone mass in the years around menopause. They’re also more likely to have it if they’re Asian or Caucasian, have a family history of osteoporosis or weigh less than 127 pounds. Some other risk factors: anorexia, a sedentary lifestyle, smoking and excessive alcohol use. Men get osteoporosis at a much lower rate—probably because they have bigger bones.
Osteoporosis can be devastating. “It can cause loss of mobility and independence and can lead to depression and death,” says Dr. Steven Petak, chancellor of the American College of Endocrinology. To diagnose it, your doctor may suggest a bone-mineral-density test. Routine screening is recommended at age 60 for those at high risk and for all women 65 and older. If the results indicate you are osteopenic—which means your bone mass is lower than normal but not so low as to be osteoporosis—many doctors urge changes in diet and exercise. That means eating foods that contain calcium and vitamin D. To strengthen bones at any age, engage in weight-bearing exercise for at least 30 minutes a day.
Not everyone needs medication. “But one in two women over 50 will suffer a fracture in her remaining years, so get evaluated, and treated if you need it,” says Dr. Ethel Siris, president of the National Osteoporosis Foundation (nof.org). Here are some of the most popular drugs.
Actonel and Fosamax: Typically, patients take these drugs, part of the bisphosphonate family, once a week to reduce the risk of both spine and hip fractures. Actonel just came out with a once-a-month dose, to be taken two days in a row. Oral bisphosphonates can irritate the esophagus, so they’re not recommended for patients with a history of esophageal ulcers or severe acid reflux. Published data indicate it’s safe to take Fosamax for a decade. (The drug goes generic next year.) Many patients quit taking these drugs after just a few months for a variety of reasons, including cost, side effects and not understanding how the medication is helping them because they don’t “feel” a change. Users can’t eat or drink for a half hour after using them. The FDA is reviewing Reclast, a new, intravenous, once-a-year option that also reduces spine and hip fractures and is already sold to treat the metabolic bone disorder called Paget’s disease.
Boniva: Boniva is a bisphosphonate that helps prevent bone loss and reduces the risk of spine fractures (but hasn’t been proved to reduce the risk of hip fractures). Patients can choose between an oral monthly dose and a four-times-a-year injection. Injections appeal to patients who can’t tolerate the pills because of heartburn or indigestion.
Evista: A so-called selective estrogen receptor modulator (or SERM), Evista (raloxifene) can reduce bone loss and the risk of breast cancer. But it may not help reduce the risk of hip fractures. Unfortunately, SERMs may increase the number and severity of hot flashes, so many postmenopausal women don’t want to take them, says Dr. Richard Hellman, president of the American Association of Clinical Endocrinologists.
Hormones: Estrogen reduces bone loss in women but may also increase the risk of heart disease and breast cancer. (For men, doctors may prescribe testosterone.) The benefits diminish quickly when you quit taking the hormones.
Forteo: The only bone builder on the market, Forteo is approved for osteoporosis patients, with markedly low bone density and prior fractures, to take for up to two years. It requires a daily shot for two years and costs $8,000 a year.
But remember, you can help your bones free of charge and without side effects by making lifestyle changes. Crisann Hillier, 48, who has a family history of osteoporosis, walks two miles a day, doesn’t smoke and drinks calcium-fortified orange juice. That’s a good prescription for anyone.
