The Battle Against Bone Loss

Know the risks and options.

Content courtesy of National Women's Health Network

November 19, 2009


Osteoporosis is a disease, more common in women, that causes bones to become fragile and more susceptible to breaking.

The disease can have serious effects on women's health and quality of life. Some women - most commonly those who don't have good access to health care - experience fractures that could have been prevented if their osteoporosis had been treated. At the same time, not every woman who is warned about bone thinning needs to be worried.

In recent years, many new osteoporosis drugs have become available, creating a dilemma for women trying to decide which, if any, of these medications they need. Specifically, women want to know when it is appropriate to take a drug for osteoporosis, and which treatments are safest and most effective.

What is Osteoporosis?
Osteoporosis literally means porous bone. Throughout life, natural process breaks down bones and builds them back up again at the microscopic level. Pregnant women release bone to transfer needed minerals to the developing fetus and then build their own bone strength up again after giving birth.

After age 35-40 all adults begin to lose bone as the breaking down process overwhelms the building process. For a few years around the time of menopause, women lose bone more quickly, possibly because they no longer need extra stores of minerals to support a developing fetus.

Osteoporosis occurs when the natural process of aging goes too far and bones become weak and fragile. Osteoporosis has several causes - age alone can be a cause of osteoporosis, especially in people who didn't build up their bones to their fullest potential during childhood and young adulthood. Removing women's ovaries increases their risk of getting osteoporosis. People who have osteoporosis are at greater risk for fracturing their bones, especially in the hip, vertebrae ( spine) and wrist. Hip fractures lead to hospitalization, can take a long time to heal, and many women never fully recover from them.

Osteoporosis Screening
The most common screening tool is a DEXA X-ray scan, which measures bone mineral density in the hip or spine. DEXA results compare a woman's bone density to that of a healthy young adult (almost guaranteeing the scan will reveal bone loss, since everyone loses bone with age). If a woman's bone density is significantly lower than a young adult's, she is diagnosed with osteoporosis.

Drug Treatments
Women diagnosed with osteoporosis are usually told they need to take prescription medication to prevent further bone loss and reduce the risk of fractures. The most common drugs are:

The Food and Drug Administration (FDA) has approved estrogen and progestin treatment to prevent osteoporosis -- but not to treat it. Both estrogen alone and combinations of estrogen and progestin reduce women's risk of osteoporosis and bone fracture.

Calcitonin has been shown to prevent fractures of the spine but not of the hip and wrist. It is approved to treat women with osteoporosis, but its approval was based on weaker evidence than more recently approved drugs, and its use is not generally recommended.

The FDA has approved six bisphosphonates to prevent bone loss and fractures in post-menopausal women: alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), and zoleldronic acid (Reclast, Zometra). Some are taken daily, others are formulated for weekly or monthly use. Bisphosphonates seem to have fewer risks than hormones, at least in the first five years.

Selective Estrogen Receptor Modulators:
The FDA has approved raloxifene (Evista) to prevent and treat osteoporosis. The drug has been tested more extensively than biophosphonates and although it reduces the risk of spine fractures, it doesn't seem to reduce hip fracture risk.

Alternatives to drugs exist for making and keeping bones strong. The National Institutes of Health's Consensus Statement on Osteoporosis reviewed the research on osteoporosis prevention and treatment and found strong scientific evidence that calcium and Vitamin D intake are crucial to develop and preserve strong bones. Regular exercise (especially resistance and high-impact activities) contributes to the development of bone mass. Other promising interventions focus on preventing fractures: balance training reduces the risk of falling, which is often responsible for broken bones in older people.

In addition to thinking carefully about their own risk of experiencing a serious fracture, women need to consider safety issues when deciding whether to take osteoporosis drugs.