What is osteoporosis?

Osteoporosis means "porous bone". With this disease a person develops low bone density and the bone gets thinner. It can become so thin it looks like lace. If you have this disease, you have a higher risk of fracturing or breaking your bones. These fractures occur most often in the spine, wrist or hip.

The most common type of osteoporosis occurs when women reach menopause and their female hormone (estrogen) levels drop. This causes the bone density to drop and the bones get thinner.

Osteoporosis can occur from a variety of causes including using steroid, antiseizure, or thyroid medicines for a long time.

As a woman with a disability, you may have a higher risk for osteoporosis. Some reasons include immobility, lack of weight-bearing exercise, and use of medicines such as steroids or antiseizure drugs.

You can have a bone mineral density test that will measure the density of your bones and tell you and your doctor or nurse if you are at risk for osteoporosis. As a woman, your bone density is highest when you are in your 30s and slowly drops from that point on. This level drops more quickly when estrogen levels fall with menopause. There are several ways to test for low bone density. The tests are safe and do not hurt. They measure the density of bones in your spine, hip and wrist. These are the bones that you are most likely to break if you have the disease.

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What is osteopenia?

Osteopenia means the bone density is low but not low enough to be called osteoporosis.

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Prevention:

There are three main ways you can prevent osteoporosis: exercise, diet and hormone therapy. It also helps if you do not smoke and avoid heavy use of alcohol. 

Exercise

Exercise can help to prevent you from getting osteoporosis. Weight-bearing exercises are best. These include jogging, walking, hiking, aerobics, and climbing stairs for 20 minutes a day. As a woman with a physical disability, you may not be able to do these exercises. If you are able to bear weight and do some of these activities, they will help to improve your overall bone health. You also need to get enough calcium and vitamin D in your diet. 

Note: It is important to talk to your doctor or nurse before you start any exercise program.

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Diet

You need calcium to keep your bones strong. Your body also needs calcium for blood clotting, nerve transmission, and muscle contractions, including your heartbeat.

You should get 1000-1500 mg of calcium per day in your diet (this is the amount of calcium your body needs to prevent osteoporosis). Many women in the United States do not get this amount. If you do not get enough calcium in your diet, you may want to take a supplement. Your body also needs vitamin D and magnesium to absorb the calcium. Too much vitamin D can be harmful. Remember to talk to your doctor or nurse first before taking any of these supplements.

Calcium supplements

If your need to take calcium consider the following:

·         Your body can only absorb about 500 mg of calcium at one time. It is best if you take your daily amount spread out over the course of the day.

·         When you take calcium, read the label to see how much ELEMENTAL calcium the product contains. This is the amount your body can actually use.

For example, calcium carbonate has 40% elemental calcium. So if a product has 1250 mg of calcium carbonate, it would only give you 500 mg of elemental calcium.

This table lists how much elemental calcium is in common calcium products.

COMMON CALCIUM SUPPLEMENTS

Source: Boning Up on Osteoporosis, National Osteoporosis Foundation, 1998

Eating a calcium rich diet

·         Eat foods that have a lot of calcium, such as milk, yogurt and cheese.

·         Avoid eating too much fat and protein since they can keep your body from absorbing calcium.

·         Be sure you get enough vitamin D. Your body can make vitamin D if you spend 20 minutes each day in the sun. If you can't get in the sun, or if your symptoms get worse when you get warm, you can drink milk with vitamin D in it. You can also take a daily supplement. You should get 400 IU of vitamin D each day.

·         Don't let dieting keep you from getting your calcium; drink fat free or low-fat milk.

·         Stay away from carbonated soft drinks. These drinks have phosphates that can cause calcium loss from your bones.

·         Make sure you get enough magnesium in your diet which helps your body absorb calcium. You can also take a vitamin supplement. You need 400 mg of magnesium per day.

·         Avoid getting too much caffeine (coffee, tea, colas) since it can cause your body to lose calcium.

Other sources of calcium  

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Hormone therapy (HT)

Hormone therapy (HT), or hormone replacement therapy (HRT) used to be a common way to prevent osteoporosis. It was approved by the Food and Drug Administration (FDA) for that use. However, recent studies suggest that the risks of this therapy may be greater than the benefits. While these studies have found that taking hormones (estrogen) does decrease the risk for bone fracture, they may increase women’s risk for heart disease and breast cancer.

Women who have gone through menopause, especially an early menopause, or have had their ovaries removed by surgery may take hormones to relieve menopausal symptoms.
Taking estrogen alone raises the risk for uterine cancer. If estrogen is taken along with another hormone called progesterone, this risk is reduced. There is also a risk of thrombosis or blood clots. This can be very important for the woman who uses a wheelchair all the time. It is important that you talk to your doctor or nurse about whether taking hormones is right for you. 

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Treatment

The following medicines have been approved to treat osteoporosis. If you have been diagnosed with osteopenia or osteoporosis, talk to your doctor or nurse about these treatments. Other products are being tested.
 
Bisphosphonates
Alendronate (Fosamax) and Risedronate (Actonel) are two medications in this category that work well to maintain and build bone.

Raloxifene (Evista)
Raloxifene (Evista) is a medication that works like estrogen to help bone health. It does not increase the risk for breast or uterine cancer.

Calcitonin
Calcitonin nasal spray can be used in women who are past menopause for more than 5 years.

Hormone therapy (HT)
Taking hormones (estrogen) has been shown to increase bone density and reduce the risk for fracture by 50 to 60%. But new studies point out other risks with this therapy. Only you and your doctor or nurse can decide if hormones are right for you.

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Fall Prevention

Fall prevention is also a very important way for you to stay healthy and protect your bones. Here are some things to remember:

• Hold on to handrails in the bathroom, on stairs and ramps
• Remove all loose rugs from your home
• Add more light to dark areas
• Wear sturdy non-slip shoes
• Make sure your wheelchair or scooter is locked when you transfer
• Use a sturdy step or long-handed tongs or reacher to get objects you need; never use something unsteady to reach for an item overhead.

For more information about Fall Prevention, click here   

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Facts about osteoporosis

Osteoporosis is the number one cause of hip fracture. If you break your hip, it could increase your disability.

Of those people who fracture their hip, only one-third will return to the level of function that they had before the injury. One-third of these people will have to go to a nursing home. Even worse, one in five of these people will die from problems that resulted from the fracture.

10 million Americans have osteoporosis.

Of that 10 million, 80% are women.

Almost 22 million women have osteopenia or low bone mass. That means that nearly 30 million women have either osteopenia or osteoporosis.

1 out of 2 women in the U.S. will get osteoporosis at some time in her life.

Osteoporosis causes 1.5 million fractures each year. The bones most often broken are the hip, spine and wrist.

As a woman, your risk for breaking your hip because of osteoporosis is equal to your combined risk of getting breast, uterine and ovarian cancer. In other words, your risk for breaking your hip at some point in your life is as high as your risk of getting all three of these cancers.

Source: National Osteoporosis Foundation

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Risk Assessment

Are you at risk?

1. Are you white/Caucasian?

2. Have you gone through menopause? In other words, have you not had periods for at least one year?

3. Did you go through menopause early, before age 51? Or did you have a hysterectomy before that age?

4. Do you have a small, thin frame?

5. Have you recently broken a bone?

6. Does anyone in your family have osteoporosis?

7. Is your diet low in calcium? (Dairy products give you the most calcium.)

8. Do you lack regular exercise?

9. Do you smoke or did you smoke in the past?

10. Do you drink more than 2-3 ounces of alcohol per day?

11. Do you drink more than 2-3 drinks per day with caffeine?

12. Do you take thyroid medicine?

13. Do you take or have you taken steroids?

14. Do you take antiseizure medicine?

The more times you answer 'yes', the greater your risk for getting osteoporosis.