Osteoporosis

Can men get osteoporosis?

DEAR DOCTOR K: Do men need to worry about osteoporosis? Doesn't it affect mostly women?

DEAR READER: Osteoporosis is a disease that weakens bones and makes them more susceptible to breaks. You're correct that women are more likely than men to develop osteoporosis, but that doesn't mean men don't have to worry about it. In fact, about 2 million men in the United States have osteoporosis.

Would I know if I had osteoporosis?

DEAR DOCTOR K: I'm 65, and my doctor says it's time for me to be screened for osteoporosis. But isn't this condition painful? Wouldn't I know it if I had it?

DEAR READER: Osteoporosis is a condition in which bones become less dense, weaker and more likely to break. But unless it leads to a broken bone, osteoporosis is not painful. Osteoporosis is a disease that causes no symptoms for many years -- until it suddenly does.

How much calcium do I really need?

DEAR DOCTOR K: I'm a 65-year-old woman. My doctor says my bones are strong, and he wants to keep them that way. So, for years I've been taking a daily 1,200 milligram calcium supplement. Now I hear that might be too much. How much calcium do I really need?

DEAR READER: I've gotten this question from so many patients. As I assume is true for you, their bones have normal amounts of calcium. That is, they do not have osteoporosis (or "thin bones"). To prevent osteoporosis, they have been taking the recommended amount of calcium -- 1,000 milligrams (mg) a day for women ages 50 and younger and 1,200 mg for women over 50 -- in an effort to preserve their bones.

Can osteoporosis medications cause bone fractures?

DEAR DOCTOR K: I'm taking a pill for osteoporosis because my doctor says that stronger bones will reduce my risk of fractures. But a friend recently told me that some osteoporosis medicines actually cause fractures. Can you un-confuse me?

DEAR READER: I know what you're referring to, and it is confusing -- even for doctors. So let me try to make it less confusing. Osteoporosis does make your bones more susceptible to fractures, and a group of drugs called bisphosphonates do successfully treat osteoporosis. These drugs include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel) and zoledronic acid (Reclast). People typically remain on these drugs for years.

I have osteoporosis — should I stop exercising to avoid another bone break?

DEAR DOCTOR K: Last year I broke my ankle while jogging. It turns out I was vulnerable to breaking a bone because I have osteoporosis. Should I stop exercising to avoid another break? If I should exercise, are there particular types of exercise I should do?

DEAR READER: Once you've broken a bone, it's natural to be cautious about exercise for fear of another injury. It's true that osteoporosis, a bone-thinning disease, increases your risk of bone fracture. But staying active is exactly what you should be doing right now. Why? Because the right exercises, done properly, will build up your bone strength and reduce the likelihood of another fracture.

I’m at risk for osteoporosis, are there any foods I should avoid?

DEAR DOCTOR K: I am at increased risk for osteoporosis. Are there any foods or drinks I should avoid?

DEAR READER: Osteoporosis is a bone-weakening condition that increases your risk of fractures. Though your bones may seem unchanging, they are continuously being broken down and rebuilt. (I've put an illustration of this process below.) Osteoporosis occurs when more bone is broken down than is rebuilt. Osteoporosis is most common in postmenopausal women, but other people are also at risk.

How does strength training slow bone loss?

DEAR DOCTOR K: I was recently diagnosed with osteopenia. My doctor advised strength training because it can help slow bone loss. How does it do that?

DEAR READER: Osteopenia is a thinning of the bones. It is often a precursor to osteoporosis, a more severe thinning of the bones. Osteoporosis puts you at risk for disabling, and sometimes debilitating, fractures. Bones are filled with cells. Some cells build up new bone; other cells tear down old bone. In most people, those two processes are in good balance.

When should I go back on a bisphosphonate drug?

DEAR DOCTOR K: I am currently on a bisphosphonate "drug holiday." How will I know if, or when, I should go back on the drug?

DEAR READER: After menopause, loss of bone (osteoporosis) can lead to crippling bone fractures. Drugs called bisphosphonates slow bone loss. Below, I've put a table with detailed information about these drugs. But bisphosphonates can cause troubling side effects. The pills can cause burning in the esophagus. And a small number of users have developed bone loss in the jaw and in the large bone in the upper legs (the femur), causing the femur to break.

My DEXA scan showed my T-score is minus 2.7– what does this mean?

DEAR DOCTOR K: I'm a 63-year-old woman, and recently I had a screening test for osteoporosis. My "T-score" was minus 2.7. What does this mean?

DEAR READER: In the past, osteoporosis -- a thinning of the bones -- was frequently diagnosed only after a bone fracture. Today, osteoporosis can be detected earlier with a bone mineral density test. Several tests can assess bone density. The most common, considered the gold standard for osteoporosis screening, is known as "dual energy X-ray absorptiometry" (DEXA). For this test, a machine sends X-rays through your bones in order to calculate bone density.

Do “hip protectors” really reduce the risk of hip fractures for people with osteoporosis?

DEAR DOCTOR K: I have osteoporosis. I've heard about "hip protectors" that reduce the risk of hip fracture if you fall. Are they worthwhile?

DEAR READER: Osteoporosis contributes to about 300,000 hip fractures in the United States each year. The hip is not the most common site of an osteoporosis-related fracture (it follows behind the spine and wrist). But a hip fracture can have particularly devastating consequences. Hip fractures can impair your ability to walk or perform everyday activities, such as dressing yourself or rising from a chair.