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7 Things No One Tells You About Osteoporosis

Ten million people currently have osteoporosis in the U.S., and 18 million more are at risk of developing the disease. Thanks to its link to declining estrogen, women entering menopause are most at risk.

Osteoporosis is characterized by low bone mass leading to an increased risk of fracture of the hip, wrist, or spine. It's said to be the most common disease in humans, and can actually shorten people's lifespan.

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Another 34 million Americans are at risk of osteopenia, low bone density, which also can lead to fractures and ultimately develop into osteoporosis.

We consulted two in-the-know doctors to lay out the myths and realities of these conditions and the drugs that treat them.

1. You may not know if you have osteopenia or osteoporosis.

Cigarette smoking is a risk factor for osteopenia and osteoporosis.
dra schwartz/Getty Images

Osteoporosis is silent. Your first indication of either may be a fracture or loss of more than 2 inches in height(!). There are many known risks, including being on high doses of steroids, having an eating disorder like anorexia, or weighing less than 127 pounds. A family history, fair skin, and poor nutrition, especially a lack of dairy foods high in calcium are also risk factors, as are cigarette smoking and high alcohol consumption.

MORE: The Bizarre Thing That Ups Your Risk Of Broken Bones

2. Drugs can stop or reverse the problem...
There's a class of drugs, called biphosphonates, that are meant to treat low bone density. These drugs, which include Fosamax, Actonel, Boniva, and Reclast and the newly released romosozumab, prevent bone loss by inactivating the osteoclast, a type of bone cell that reabsorbs bone tissue, or by preventing its formation. Other medications, like Forteo, promote bone growth—they can actually make new bone.

The FDA has made frequent warnings about these drugs, including bone, joint, and/or muscle pain, esophageal erosions, heartburn, arrhythmias, or rapid heart beat.

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"You're balancing the risks and benefits," says Mary Jane Minkin, MD, clinical professor in the department of obstetrics, gynecology and reproductive sciences at Yale Medical School in New Haven, CT. "Oral bisphosphonates, like Fosamax and Actonel, can bother the esophagus. That category also carries a very slight risk of jaw problems, and so-called atypical fractures. But they're very rare."

3. ...but there's a time limit on taking them.
"Most drugs are only safe within the window of study by the FDA and that is usually 3 years," says Joseph Lane, MD, professor of orthopedic surgery and chief of The Metabolic Bone Disease Service at the Hospital For Special Surgery/Weill Cornell Medical College in New York. "Beyond that point, the skeleton is altered and adverse events can occur, such as femoral fractures and osteonecrosis of the jaw, or weakening, and ultimately death, of the jaw bone. Patients who have been taking these drugs should be carefully reviewed after 3-5 years and a new decision made as to whether they should be continued, stopped, or changed." Doctors commonly have patients take a "drug holiday" if they've been on meds for a while.

4. If you have osteopenia you probably don't need medication.

Weight training can help build bone density.
Peathegee Inc/Getty Images

Patients diagnosed with osteopenia, not osteoporosis, are rarely prescribed drugs, with the exception of people with breast cancer, who are on aromatase inhibitors for therapy and are at higher risk for bone loss. "In general, when I diagnose osteopenia in my patients, we sit down and have a good talk," says Minkin. "If she's smoking, can she stop or at least cut down? Is she getting in calcium-rich foods? Is she taking her vitamin D? Is she doing weight bearing exercises regularly—I'm a big nut on strength training. I encourage all my patients to go to the gym and exercise."
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MORE: 5 Essential Strength-Training Moves Every Woman Needs

5. Think area rugs, thyroid, and everything in between.

Getting enough Vitamin D can make you less likely to experience osteoporosis.
i love images/Getty Images

Good diet, exercise, adequate calcium intake, normal vitamin D levels, and taking precautions at home so you don't fall are important. "Good habits around the house help—don't set yourself up for fractures: Keep throw rugs out of the way, wear sensible shoes, etc," says Minkin. Parathyroid hormone and thyroid levels can also impact bone health. "Hyperparathyroidism is amazingly common, and the surgery to remove the overactive gland is usually quite successful," says Minkin. "I recently received a letter from a patient who had her overactive parathyroid removed a few months ago—she hasn't felt this good in ages because her calcium had been high, and a high calcium can make you feel crummy. So that's a long way of saying there is a lot of management other than medications."

MORE:10 Dairy-Free Ways To Get More Calcium

6. Having low bone density doesn't mean you're destined for fractures.
While the bone density does correlate with fracture risk, Lane contends that it only accounts for 20 to 60% of the risk. "There are many factors that contribute to fractures, and you don't have to have osteoporosis to fracture a bone," says Minkin.

MORE: Ask Dr. Weil: What Should I Do For Better Bones?

7. Osteoporosis drugs can actually make bones more brittle and breakable.
"Improving bone density lowers risk, but does not totally prevent fractures," says Lane. "Prolonged use of osteoporosis drugs is associated with loss of bone toughness and brittleness in some people.






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Date: 12.12.2018, 15:12 / Views: 83283