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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Dennis Lee, MD

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

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Medical Editor:

Catherine Burt Driver, MD

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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In this Article

• What is osteoporosis?
• What are osteoporosis symptoms and signs?
• What are the consequences of osteoporosis?
• Why is osteoporosis an important public health issue?
• What factors determine bone strength?
• What are osteoporosis risk factors and causes?
• How is osteoporosis diagnosed?
• Who should have bone density testing?
• What is the treatment for osteoporosis, and can osteoporosis be prevented?
• Exercise, quitting cigarettes, and curtailing alcohol
• Calcium supplements
• Vitamin D
• Hormone therapy (hormone replacement therapy, menopausal replacement therapy)
• Medications that prevent bone loss and breakdown
• Choosing an osteoporosis medication
• Prevention of osteoporosis caused by long-term corticosteroids
• Monitoring osteoporosis therapy medication
• Prevention of hip fractures in elderly people with osteoporosis
• Osteoporosis At A Glance
• Find a local Internist in your town

Prevention of hip fractures in elderly people with osteoporosis

The FDA has approved hip protector garments for the prevention of hip fractures in elderly people with known osteoporosis. Brand names available include Hipsaver and Safehip. These can be helpful for selected patients who are in the nursing-home environment, although the real extent of protection against hip fractures that is gained with use of hip protectors is controversial.

Additionally, for those elderly people who use canes for walking, etc., it is essential that the rubber tips of the canes are regularly checked for any signs of wear. When this rubber wears through it presents a serious risk of causing the cane (and, therefore, the person) to slip, which can result in serious bodily harm -- including hip fracture.

Controversy

Currently, it is not clear as to how long patients with osteoporosis being treated with bisphosphonates should continue the bisphosphonate treatment. Many doctors are interrupting treatment for a "drug holiday" off of the drug as it may not be necessary after five to seven years. Guidelines for duration of treatment of osteoporosis with bisphosphonates are being developed.

Osteoporosis At A Glance

• Osteoporosis is a condition of increased susceptibility to fracture due to fragile bone.
• Osteoporosis weakens bone and increases risk of bone fracture.
• Bone mass (bone density) decreases after 35 years of age and decreases more rapidly in women after menopause.
• Key risk factors for osteoporosis include genetics, lack of exercise, lack of calcium and vitamin D, personal history of fracture as an adult, cigarette smoking, excessive alcohol consumption, history of rheumatoid arthritis, low body weight, and family history of osteoporosis.
• Patients with osteoporosis have no symptoms until bone fractures occur.
• The diagnosis of osteoporosis can be suggested by X-rays and confirmed by tests to measure bone density.
• Treatments for osteoporosis, in addition to prescription osteoporosis medications, include stopping use of alcohol and cigarettes, and assuring adequate exercise, calcium, and vitamin D.

REFERENCES:

Gehlbach, S.H., R.T. Burge, E. Puleo, J. Klar. Osteoporosis International. 14.1 Jan. 2003: 53-60.

Harris, W.H., and R.P. Heaney. New England Journal of Medicine. 280.6 Feb. 6, 1969: 303-11.

JAMA. 285.6 Feb. 14, 2001: 785-95.

Lindsay, R., S.L. Silverman, C. Cooper, D.A. Hanley, I. Barton, S.B. Broy, A. Licata, L. Benhamou, P. Geusens, K. Flowers, H. Stracke, E. Seeman. JAMA. 285.3 Jan. 17, 2001: 320-3.

Marottoli, R.A., L.F. Berkman, L. Leo-Summers, L.M. Cooney Jr. American Journal of Public Health. 84.11 Nov. 1994: 1807-12.

National Institutes of Health, Department of Health & Human Services, National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Osteoporosis Foundation. Ray, N.F., J.K. Chan, M. Thamer, L.J. Melton. Journal of Bone Mineral Research. 12.1 Jan. 1997: 24-35.

Previous contributing author: Carolyn Janet Crandall, MD, MS, FACP