Understanding Osteoporosis

By Mark Jacobs, Pharm.D.

Over the past several years, the public has become very familiar with the terms osteoporosis, as it is written about in the daily papers and the term is used in advertisements on TV. Simply stated, Osteoporosis is a systemic skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk for fracture. Women AND MEN, and the public is often unaware that men are also affected, can show effects of this disorder. However, because women generally have smaller skeletal size then men and because their bone loss rate is accelerated by the onset of menopause, they not only exhibit higher rates of osteoporosis but seem to get all the publicity
relating to it.

Bone loss begins during ones 4th decade of life at a rate of 0.5% per year, whereas postmenopausal bone loss is 3-5% per year as circulating estrogen levels decrease. The risk factors for osteoporosis include : current smoker, low body weight (<125 lbs), history of osteoporotic fracture in first degree relatives, and/or a personal history of a fracture as an adult after 40 years of age. Screening for osteoporosis is important but does NOT provide a true diagnosis. On the other hand, Central Bone Densitometry can confirm a definite diagnosis.  Many different drugs can accelerate the onset of osteoporosis by increasing bone loss, including glucocorticoids (e.g. Prednisone), anticonvulsants, lithium, and many more. This list also includes inhales steroids, such as Advaiar, Pulmicort and many others.

For example, if a patient will be using 5mg/day of Prednisone (or its equivalent) for MORE than 3 months, therapeutic intervention should be considered.  These include calcium and vitamin D intake, lifestyle modifications, weight-bearing exercises and biphosphonate therapy. Biphosphonate therapy includes Fosamax®, Actonel® and Boniva®. Although other therapies can be prescribed, the above are usually considered first line therapies. Calcium intake is imperative, therefore it is important to choose the correct calcium product. However, the best source of calcium is obtained by ones diet, which typically includes about 700-800mg of calcium per day. This is particularly important in individuals whose childhood calcium intake was less than ideal or presently are drinking so called “diet” colas, which tend to wash out calcium. Even when taken as part of the diet, this amount is below the amount needed for osteoporosis prevention or treatment.  Moreover, do not take your calcium vitamin with foods that they are rich in calcium because the absorption of the calcium will be decreased. Separate the calcium product from the dietary calcium by several hours. If you are not sure which calcium product is best for you, ask your physician or pharmacist. In order to get the best absorption of calcium, some vitamin D (equivalent to 400-1000iu/day) is needed, along with some Sunlight, and zinc and magnesium, as these latter two minerals enhance calcium absorption.

The above provides a brief description of some life style modifications and products used for osteoporosis. For more information, please ask your doctor or pharmacist or go to the web and search for osteoporosis.