What is osteoporosis?

Osteoporosis means that bones become less dense (or less solid). When bone density is low, bones become weak and easier to break. Bone density that is low enough for bones to break easily is called osteoporosis.

Who gets osteoporosis?

Half of all women 50 and older will have a broken bone from osteoporosis at some time during their life.

Osteoporosis is more likely for:

• Women after menopause, mostly because the body has less estrogen.
• Smaller and thinner women.
• White or Asian women.
• Women who have family members who had osteoporosis and broke a bone.
• Women who smoke tobacco or drink too much alcohol.
• Women who take certain medicines, like thyroid medicine or steroids.

Both men and women can have osteoporosis, but most of the research is about women.

What causes osteoporosis?

Bone is living tissue. Old and damaged bone is always being broken down and replaced with new bone. As you get older, your body loses minerals, like calcium. Calcium is needed to build new bone. If you have osteoporosis, it means your old bone is not being replaced fast enough by new bone.

Hormones in the body, like estrogen, help prevent bones from breaking down too fast. When you go through menopause, your body makes less estrogen. The loss of hormones is why women are more likely to have osteoporosis after menopause.

How do I know if I have osteoporosis?

To find out if you have osteoporosis, your doctor will do a bone density test. Often this is a special x-ray test called a DXA (dex-ah). It measures the thickness of your bones. It can tell if your bones are getting weak. It does not say for sure if your bones will break. Your doctor or nurse can tell you if your bone density is low enough to mean that you have osteoporosis.

Bone images used with permission from the International Osteoporosis Foundation

Spine

Cracks in the bones of the spine can cause these bones to crunch together (compression fracture). This can cause backaches and pain. In fact, loss of an inch or more of height may be the first sign of osteoporosis.

Hip

A broken hip almost always needs to be repaired with surgery. Recovery from the operation can take a long time. A broken hip can raise the risk of serious problems, even death.

Wrist

A broken wrist makes it hard to use the arm and hand. It can also require surgery.

Calcium and vitamin D

Many people do not get enough calcium and vitamin D. Calcium is the building block for bones. Vitamin D helps your bones use calcium. They work together to build bones.

Exercise

Exercise is good for bone health, muscle strength, and balance. Exercise can help lower the chance of falling. For many people with osteoporosis, falling is what leads to a broken bone.

Bisphosphonates

Bisphosphonate (biss-FOSS-fuh-nate) drugs include alendronate (Fosamax®), ibandronate (Boniva®), risedronate (Actonel®), and zoledronic acid (Reclast®). They stick to the surfaces of the bones and slow the breakdown of old bone.

SERMs

Selective estrogen receptor modulators (SERMs), like raloxifene (Evista®), slow the breakdown of old bone. They are not hormones but work on bone like the hormone estrogen.

Hormones

Estrogen (Premarin®) and estrogen plus progestin (Prempro®, Premphase®) pills add to the body’s natural hormones. They slow the breakdown of old bone.

Teriparatide (Forteo®) helps the body make new bone faster than old bone is broken down.

Calcitonin (Miacalcin®, Fortical®) slows the breakdown of old bone.

Esophagus and stomach problems

The esophagus (eh-SAW-fuh-gus) is the tube that connects your mouth and stomach. Problems with the esophagus and stomach can happen with any of the bisphosphonate pills. Problems include heartburn, nausea, and trouble swallowing. More serious problems include ulcers or bleeding.

Pain

Bisphosphonate medicines can cause pain in your muscles, bones, or joints. If you have pain after starting a bisphosphonate, tell your doctor or nurse. This pain may be a reaction to your medicine. It can start right away or happen after you’ve been on the medicine for a long time.

Breakdown of the jaw bone

You may have heard that bisphosphonates can cause a breakdown of the jaw bone. This rare problem is called osteonecrosis (OSS-tee-oh-neh-KRO-sis). It’s happened mostly with people who have cancer and were taking bisphosphonates. It’s happened with only a few people taking bisphosphonates for osteoporosis.

Blood clots and stroke

Raloxifene (Evista®) and pills containing estrogen (Premarin®, Prempro®, Premphase®) raise the risk of blood clots.

Pills containing estrogen (Premarin®, Prempro®, Premphase®) raise the risk of stroke.

Breast and uterine problems

Estrogen plus progestin pills (Prempro®, Premphase®) raise the risk of breast cancer.

Pills containing estrogen (Premarin®, Prempro®, Premphase®) can cause problems with uterine bleeding and breast pain or tenderness.

Nasal irritation

Calcitonin (Miacalcin®, Fortical®) when taken by nasal spray can cause nasal irritation.

Will the way the medicine is taken affect how well you stick with it?

The medicines in this guide are taken as a pill, nasal spray, a shot under the skin, or by IV. Some need to be taken once a day. Others are taken less often. Some come with special instructions.

Think about what will work best for you. You have a better chance of preventing fractures if you’re able to stick with your plan.

Have you ever had an ulcer or stomach bleeding?

All bisphosphonates have some risk for serious esophagus and stomach problems. Your doctor or nurse may suggest a different kind of drug if you’ve had these problems in the past.

Have you ever had a blood clot or stroke? Are you at risk for either?

Ask your doctor about your risks of blood clots and stroke. Pills containing estrogen (Premarin®, Prempro®, Premphase®) and the drug raloxifene (Evista®) make problems like these more likely.

Is cost important to you?

Use the Dose and Price of Medicines for Osteoporosis and Dose and Price of Vitamins and Minerals charts to compare the prices of drugs. If your health plan covers prescriptions, check with them about the cost. If you need help paying for your medicine, there may be a program for you. The Partnership for Prescription Assistance can tell you about these programs. Web site: www.pparx.org . Phone: (800) 477-2669.