Make No Bones About It

Posted on Jul 25, 2011 in The Doctor Is In by eParisExtra

 

Old, frail woman, wrinkles on her face, holding a stick, hunched over….we have all seen the visual, and wondered if it will happen to us. I can’t help you much with the wrinkles, but maybe I can help you from getting osteoporosis and its complications. Even though weakening of the bones is a part of aging, with the proper measures, we can prevent its drastic consequences (fractures). Osteoporosis (bone loss) can be a silent disease, and it is important that we are proactive in diagnosing it, and managing our bone health.

 How common is it?

According to the World Health Organization, the prevalence of osteoporosis among U.S. white women past menopause is estimated to be 14% in those 50-59 years of age, 22% in those 60-69 years of age, 39% in those 70-79 years of age, and 70% in those 80 years of age and older.

 Am I at risk?

You may be at risk if:

• You are a woman (especially thin, or of advanced age).
• You are white or Asian, especially with a family member with osteoporosis.
• Postmenopausal (including if you had early or surgically induced menopause).
• If you have any of the following: Cigarette smoking, eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants.
• Have a parent that has/had osteoporosis. 

How is the diagnosis made?

Your doctor may recommend a specialized test called a bone mineral density test that can measure bone density in various sites of the body. This test is also known as a DXA scan.

The DXA (dual-energy X-ray absorptiometry) measures the bone density of the spine, hip, or total body. Similar to getting an X-ray done, the machine moves quickly over your lower spine and hip area.

The result of the bone mineral density is compared to two different standards, comparing your bone mineral density to others your age, and to young adults. The scores will help indicate if you have normal bone density, osteopenia (weak bones) or osteoporosis (at risk for fractures).

 I have osteoporosis. Now what?

The doctor will formulate a plan to manage your bone health. This will include a combination of dietary, exercise, and medication based approaches.

• Exercise. Weight-bearing physical activity strengthens bones.
• Good nutrition. Make certain that you’re getting enough calcium and vitamin D. Being underweight or losing a lot of weight unintentionally is associated with poorer bone health and a higher risk of fracture.
• Quit smoking. Smoking cigarettes speeds up bone loss.
• Limit alcohol. If you drink alcohol, consider limiting it to one drink a day or less. 

Which medications are commonly used?

Bisphosphonates are by far, the most common medications prescribed for osteoporosis treatment. These include:

• Alendronate (Fosamax) – orally weekly

• Risedronate (Actonel) – orally monthly
• Ibandronate (Boniva) – infused every 3 months
• Zoledronic acid (Reclast) – infused once a year

Hormones, such as estrogen, and some hormone-like medications, such as raloxifene (Evista), can also be used, but are prescribed less often now, due to their side-effects, and because bisphosphonates are so effective. 

How do I decide which drug to take?

The decision to take one drug over another often is often personal, and is based on your preference, convenience, and dosing schedule. Your doctor might recommend a monthly dose of medication if it’s going to be better tolerated or better accepted. But if you’re the type of person who might forget to take your medicine every month, you might do better taking it once a week. Some women prefer an injection given quarterly or yearly, which ensures that they are fully protected until their next treatment. What side effects can I expect?

• The most common side effect with bisphosphonates is stomach upset and heartburn (can be avoided by taking the medication on an empty stomach)
• Rarely, eye redness and eye pain can occur, and that needs to be evaluated immediately.
• Some people experience pain or aching in their bones.
• Bisphosphonates also have the potential to cause Osteonecrosis of the jaw. This is a rare condition in which a section of jawbone dies and deteriorates. This may occur after a dental extraction, after trauma to the jaw or sometimes even just spontaneously. It happens primarily in patients with cancer in the bones, who receive high doses of bisphosphonates.
• Note of Caution: Before starting a bisphosphonate, make sure your teeth are healthy, and practice good oral hygiene.

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Dr Chris Prakash is a contributing columnist for eParisExtra!’s The Doctor Is In column and a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children. He can be reached at 9037850031 or Sucharu.prakash@usoncology.com