Danger of Brittle Bones

Exercise and Posture

Physical activity affects bone strength because bone mass increases or decreases in response
to the demands placed on it. Developing and maintaining good exercise habits can significantly
reduce your risk of age-related bone fracture. For example, women who work out regularly
have a bone density that is often 10 percent higher than that of women who do not. Research
also shows that just 3 hours a week of weight-bearing exercise can decrease bone loss by as
much as 75 percent. In addition, exercise increases muscle tone and mass, which serves to
cushion and support bones and makes falls due to unsteadiness less likely.
Weight-bearing exercises, which work the muscles against gravity, are the key to creating
positive stress on your bones. These exercises include jogging, aerobics, dancing, and tennis.
Walking is also an excellent way to strengthen the back, legs, and stomach muscles. Though
swimming and biking provide less positive bone stress, they do help to increase muscle tone.
Strength training exercises with free weights or machines offer almost no beneficial effect on
the bones, but are still well worth pursuing. By increasing steadiness and strength, they can
help prevent the falls that often result in fractures.
Just as exercise has profound effects on the strength of bone, the way you sit and stand every
day affects the way your bones shape themselves. If you slouch, your bones will grow to
conform to that curvature. If you sit and stand with an erect posture, your bones will have a
tendency to grow straight.

Medication Therapy
Until very recently, hormone replacement therapy (for women) and calcitonin shots were the
only prescription treatments available for slowing the progression of osteoporosis. Now,
however, there are several new alternatives that not only slow the progression of osteoporosis,
but may actually reverse bone loss. The advent of these new treatments may ultimately spare
millions of Americans the agony of osteoporosis-related fractures. They give women who
cannot (or fear to) use hormone replacement therapy some viable choices.

Hormone Replacement Therapy

Long-term hormone replacement therapy (HRT) after the onset of menopause improves
calcium absorption and has been shown to prevent osteoporosis in 75 to 80 percent of women.
It is especially effective in women with chemically or surgically induced menopause. HRT is a
combination of the hormones estrogen and progestin. Women who have had hysterectomies
can take estrogen alone, without progestin, since there is no danger that the hormone will
promote uterine cancer.
HRT is usually continued for 8 to 10 years or more after menopause, the time when women
experience bone loss at an accelerated rate. It may also be prescribed for older women to
prevent the progression of osteoporosis. The medical community is still debating the best
dosage and length of time for HRT. One thing is certain, however: Continued hormone
treatment is needed to sustain its preventive effects against bone deterioration. Once the
therapy stops, postmenopausal bone loss resumes. Since osteoporosis-induced fractures are
most likely in women aged 75 to 80, this can translate into decades of preventive hormone
therapy.
HRT is available in pill, injection, implant, cream, and patch forms. In pill form, it's best known
as Premarin, Premphase, and Prempro. The best known patch is Estraderm. Others are Alora,
Climara, Esclim, FemPatch, and Vivelle. In order for any of these products to be fully effective,
a woman's calcium, vitamin D, and magnesium intake need to be at recommended levels.

Along with its beneficial effect on bone, HRT relieves menopausal symptoms and prevents
heart disease. Side effects experienced by some women include vaginal bleeding, breast pain,
nausea, cramping, headaches, fluid retention, vaginal discharge, depression, irritability, weight
gain, and bloating. Uterine cancer, the most serious risk of estrogen therapy, is much less
likely in women who also take progestin such as Provera. Some experts believe that prolonged
hormone replacement therapy may lead to a slightly increased risk of breast cancer. Others
disagree. There is no debate, however, that HRT can double the risk of gallbladder disease.

Raloxifene
This new drugdubbed a "selective estrogen-receptor modulator"offers many of the benefits
of estrogen therapy without its negative effects on the uterus and breasts. Marketed under the
brand name Evista, it reduces bone lose and in fact strengthens the bones. In clinical trials at
doses of 60 milligrams daily for 24 months, it produced a 1 to 2 percent increase in lumbar
spine and hip bone density.
The drug is taken as a single tablet once daily. Some side effects are relatively rarewith the
exception of hot flashes, which strike 1 in 4 women taking the drug. It is not for use by
women who areor could bepregnant. It should also be avoided if you have a history of
blood clot formation, including deep vein thrombosis (a clot in the legs), pulmonary embolism
(a clot in the lungs), and retinal vein thrombosis (a clot in the retina of the eye).

Alendronate
Marketed under the brand name Fosamax, this nonhormonal treatment for osteoporosis after
menopause not only stops bone loss, but actually reverses it. During a 3-year clinical trial
involving almost 1,000 women, the medication was shown to increase bone mineral density in
the spine by 8.2 percent and in the hip by 7.2 percent. It reduced the number of women with
new spinal fractures by nearly half (48 percent) and reduced overall height loss by 35 percent.
Alendronate is taken in pill form, once daily in the morning, with a full glass of plain (not
mineral) water to ensure adequate absorption. It must be taken at least 30 minutes before the
first food, beverage, or medication of the day. You should not lie down for at least 30 minutes
after taking it.
The side effects are generally mild. Most common are abdominal and musculoskeletal pain.
Less frequent are digestive side effects: nausea, heartburn, or irritation or pain of the
esophagus. Alendronate should not be taken by women with severe kidney disease or low
levels of calcium in the blood. It should be used cautiously by those with active stomach
problems.
Risedronate
Sold under the brand name Actonel, this drug is also approved for prevention and treatment of
osteoporosis in postmenopausal women, and of steroid-induced osteoporosis in men and
women. Studies have shown that the drug slows or stops bone loss, increases bone density,
and lowers the risk of spinal and other fractures.

Calcitonin
The naturally occurring hormone calcitonin has been available for many years as a prescription
drug for osteoporosis. Calcitonin inhibits bone resorption and also provides relief from the pain
of vertebral fractures. Until recently the medication was used mainly for people with severe
osteoporosis and multiple fractures, because it required daily or every-other-day injections and
occasionally produced unpleasant side effects such as nausea, vomiting, vertigo, and flushing
of the hands and feet.

Now, however, the FDA has approved a synthetic form of calcitonin (Miacalcin) administered as
a nasal spray. This new formulation has been shown to be highly effective against bone loss
and may induce a significant increase in bone mass in both vertebrae and long bones. In a 2year study, it produced a 3 percent increase in spine density. Treatment schedules of 2 to 3
months on and 2 to 3 months off show the best results. The nasal spray is less likely than the
injection to produce nausea and flushing, though some patients develop a runny nose.