Osteoporosis Treatment Guide

Transcription

1 Osteoporosis Treatment Guide An estimated 10 million Americans have osteoporosis. Another 34 million have low bone mass. If left untreated, osteoporosis can be both debilitating and painful. Fortunately, there are steps you can take to prevent osteoporosis from ever occurring. Or, if you already have the disease, early detection and proper medical care can help you slow or even reverse its progress and prevent fractures. Read on to educate yourself about osteoporosis. You can use this guide as a resource as you begin to learn about the disease. Your better understanding can help you communicate with your doctor so that, together, you can arrive at the right preventative and/or treatment options. Osteoporosis is responsible for more than 1.5 million fractures each year. Almost half of all women older than age 50 will break a bone because of osteoporosis. An estimated one in four men will, too.

2 WHAT IS OSTEOPOROSIS? Osteoporosis is a disease that weakens bones, making them more susceptible to sudden and unexpected fractures. Literally meaning porous bone, it results in an increased loss of bone mass and strength. Although we do not know the exact cause of osteoporosis, we do understand how the disease develops. When osteoporosis occurs, the bone s architecture is altered resulting in a weakened internal structure of the bone. Who is at risk? This microscopic image shows thinning bone, with large honeycomb holes, that put you at increased risk for fractures. A look inside your bones: Your bones are made of living, growing tissue. An outer shell of cortical or dense bone encases trabecular or spongy bone. The inside of healthy bone resembles a sponge. In addition to supporting the body and protecting vital organs, bones store calcium and other minerals. The major storehouse for calcium is the bone, which contains more than 90 percent of your body s total calcium. The bone is constantly remodeling, being broken down and built up in order to supply the body with needed calcium and repairing areas of damaged bone to keep the bones strong. Up until about age 25 to 30, a person normally builds more bone than he or she loses. In women at menopause, bone breakdown outpaces bone buildup, resulting in a loss of bone mass. In a person with osteoporosis, bone mass is lost at an accelerated rate. Bone loss in women accelerates after menopause. Women over age 50 have the greatest risk for developing osteoporosis, but the disease can strike at any age. Some people are more prone to developing osteoporosis. There are many risk factors which, when present, increase your chance of having osteoporosis: Female gender Thin and/or small frame Age (all women over age 65 should have a bone density test regardless of the presence of any risk factors) Family history of osteoporosis Premature menopause (younger than age 45) Absence of menstrual periods (amenorrhea) Anorexia nervosa or bulimia Diet low in calcium Use of certain medications, such as corticosteroids and anticonvulsants, aromatase inhibitors (used for breast cancer), and androgen deprivation therapy in men (used for prostate cancer) Low testosterone levels in men Inactive lifestyle Cigarette smoking Excessive alcohol use (more than three glasses of wine, beer or liquor per day) Being Caucasian or Asian, although African Americans and Hispanic Americans are at risk as well Diseases such as intestinal problems, kidney problems, hormonal problems, kidney stones, liver disease Organ transplant recipients

3 What are the symptoms? Osteoporosis is often called a silent disease because bone loss occurs without symptoms. The first symptom is often a fracture (break) including a collapsed vertebrae (bones in the spine). Collapsed vertebrae might initially be felt or seen in the form of severe back pain, loss of height or stooped posture (a kyphosis, often called a dowager s hump). Why are fractures such a big concern? Men Get Osteoporosis, Too Osteoporosis is more common in women, but it is not just a women s disease. In fact, 20 percent of cases of osteoporosis are in men that s 2 million American men. One in eight men over the age of 50 is at risk for developing osteoporosis. Osteoporosis is not as common in men because men s skeletons are larger. Any bone loss men have starts later and isn t as rapid. They also lack any drastic hormonal changes coinciding with the bone loss (as in women and menopause). However, it is just as important for men to seek prevention and treatment because the disease, left untreated, can lead to real consequences. For instance, an estimated 80,000 men will fracture a hip each year and they are more likely than women to die within a year from a problems related to that injury. In some studies, about 20 percent of women and double that number of men will die in the first year after hip fracture. Breaking a bone is serious, especially if you are older. Osteoporosis can cause a break in any bone, but those in the hip, spine and wrist are the most common. Hip fractures are a particularly dangerous health consequence of osteoporosis. Roughly 20 percent of patients die within the first year after being diagnosed with a hip fracture. Hip fractures often result in a loss of independence and the need for nursing home care. It is best to get evaluated at an early stage, so you can begin a prevention or treatment strategy before suffering a fracture or any other symptom of osteoporosis, How can I know if I have osteoporosis? Painless and accurate medical tests can provide you with information about your bone health before problems begin. Bone mineral density tests (BMD tests), also known as dual energy X-ray absorptiometry (DXA) scans, are X-rays that use very small amounts of radiation to determine the bone density most often of the spine, hip, wrist. These tests help detect the presence of osteoporosis, determine how quickly you are losing bone mass and predict your risk of fracture. They also are used to follow the course of the disease and monitor the effects of various treatments. All women over age 65 and men at age 70 should have a bone density test. Patients with risk factors for low bone mass and bone loss should be tested at a younger age. Your physician can order these tests for you.

4 DXA (Dual Energy X-ray Absorptiometry) How you can prevent osteoporosis Building strong bones before age 25 to 30 is the best defense against developing osteoporosis later in life. But, good nutrition and a healthy lifestyle at any age can help prevent osteoporosis or minimize its effect on your life. Follow these guidelines to build and maintain strong bones: Eat a balanced diet rich in calcium and vitamin D. Pre-menopausal women need 1,000 1,200 milligrams of calcium each day, while post-menopausal women need 1,200 1,500 milligrams daily. Calcium supplements are an effective alternative for those with low dietary calcium intake. Vitamin D helps the body absorb calcium. The body manufactures vitamin D when it is exposed to sunlight. The vitamin is also available in fortified milk, the National Osteoporosis Foundation recommends 800 to 1,000 IU per day. Exercise regularly. Do 30 minutes of weight-bearing exercise such as walking or jogging three to four times a week. Maintain a healthy lifestyle. Both smoking and excessive alcohol intake reduce bone mass. It s best to avoid smoking altogether and consume no more than three alcoholic drinks per day. Prevent falls so you can stay active. Accidental falls and the broken bones that often result can limit your activity and threaten your independence. If you have osteoporosis, it is important to protect yourself against falls. This is especially important if you feel unsteady on your feet or have a history of falls. The most accurate test available for the detection of osteoporosis is the dual energy X-ray absorptiometry (DXA). The test measures the bone density (the amount of calcium) in your hips and spine and takes about 10 to 15 minutes. Radiation exposure is a fraction (one-tenth) of the amount in a standard chest X-ray. The procedure is similar to getting an X-ray taken: You will wear a hospital gown and be asked to lie on your back while they perform the test. No needles or injections are involved. Results are performed by specially trained certified technologists and reviewed by boardcertified physicians. Test results are provided to your physician, who will then discuss the results with you. You may find an ultrasound machine in retail stores that measure bone mass in your heel. However, while ultrasound is a reasonable predictor of your risk for fracture, it is not as good as the DXA and can t measure bone in your hips and spine, where the most common debilitating fractures occur. In addition, ultrasound is not approved for repeat testing to follow changes in bone density over time. Take the following precautions to make your home safe: Remove loose household items, keeping your home free of clutter. Remove wires across open floor. Install grab bars on tub and shower walls and beside toilets. Install proper lighting. Apply treads to floors and remove throw rugs. Buy hip pad protectors if you are a frequent faller. Physical therapy and balance training also may help to prevent falls.

5 How is osteoporosis treated? Treatment plans typically include a diet rich in calcium or calcium supplements and vitamin D, a weight-bearing exercise program and possibly drug therapy. The drugs approved to treat osteoporosis fall into two types: antiresorptives (which slow the breakdown of bone) and anabolics (which speed up your rate of bone formation). Alendronate (Fosamax ), ibandronate (Boniva ), zoledronic acid (Reclast ), (risedronate (Actonel ), raloxifene (Evista ), denosumab (Prolia ) are antiresorptive agents and teriparatide (Forteo ) is an anabolic agent, and are already approved for preventing or treating osteoporosis. Many other options are currently under investigation. Your doctor will help determine what medication is right for you based on factors including the severity of your osteoporosis, your gender, known side effects and any other medical conditions you may have. Eat and drink this: The best dietary sources of calcium are: Dairy products, including milk, cheese, yogurt, cream soups and pudding Green vegetables, such as broccoli, spinach and greens Seafood Dried peas Beans Vitamin D helps your body use calcium. Adequate amounts of this vitamin can be obtained through exposure to the sun and the following foods: Eggs Fish Fortified milk At a glance: Approved osteoporosis drugs Drug name Type How it s taken Alendronate (Fosamax ) Antiresorptive Daily or weekly pill or weekly liquid Ibandronate (Boniva ) Antiresorptive Monthly pill or 4x/yr IV infusion Zoledronic acid (Reclast ) Antiresorptive Once yearly IV infusion Risedronate (Actonel ) Antiresorptive Daily, weekly, monthly, or twice-monthly pill Raloxifene (Evista ) Antiresorptive Daily pill Denosumba (Prolia ) Antiresorptive Injection every 6 months Teriparatide (Forteo ) Anabolic Daily injection Physical therapy can teach you to improve your function. A physical therapist can show you the best way to move from one position to another and how to best prevent falls. They also can teach you how to use walking aids such as crutches, a walker or a cane, when needed. For patients with recent spine fractures, our doctors can refer you to a spine surgeon who will perform an evaluation to determine if you are a candidate for a surgical procedure. Kyphoplasty is one procedure used that may relive pain and may restore collapsed vertebrae to nearly normal height if performed soon after fracture.

6 About Cleveland Clinic s Center for Osteoporosis and Metabolic Bone Disease Improving your infusion experience Cleveland Clinic s Department of Rheumatic and Immunologic Disease offers convenient infusion locations throughout the region, including the recently opened eight-bed Infusion Center located on the fifth floor of the Cleveland Clinic Main Campus Crile building. The state-of-the-art center at the main campus was specially designed to improve both comfort and patient experience of rheumatology patients who require infusion therapy, such as osteoporosis medications. For more information, call We offer flexible scheduling from 8 a.m. to 5 p.m. Monday through Friday. If you are concerned about your risk for osteoporosis or have been diagnosed with the disease, the Cleveland Clinic Center for Osteoporosis and Metabolic Bone Disease can help. Our center is devoted to the evaluation and treatment of patients with osteoporosis and other forms of diseases that affect bone. Its nationally recognized osteoporosis team includes specialists in rheumatology, endocrinology and radiologists who collaborate with experts in other Cleveland Clinic specialties, including orthopaedic surgery, internal medicine, physical rehabilitation, physical therapy, pain management and geriatrics, as needed. We utilize a state-of-the-art bone densitometer, which assessed bone density in the hip and spine, as well as radius and total body, if needed. This technique allows the physicians to evaluate the degree of bone loss, to diagnose osteoporosis and the risk for future fracture. Our researchers pioneered research in preventing bone loss and remain at the forefront of testing new osteoporosis treatments. If you have osteoporosis, you may be able to participate in one of our clinical trials to determine the effectiveness of new medications. The Cleveland Clinic Department of Rheumatology is ranked # 2 in the nation by U.S.News & World Report. To learn more about the Osteoporosis and Metabolic Bone Disease Center and to meet our staff, visit clevelandclinic.org/rheum. For appointments, call RHE-690