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As we age, our bones become light and hollow like the bones of birds because they lose some of their protein and calcium.

Osteoporosis is the natural aging of bones, which begins after menopause in women and after testosterone declines in aging men.  Bones should be dense and strong enough to carry our weights and resist breaking if we should fall.  When they become light and hollow, they start to break at the slightest trauma or even without trauma.  Broken hips and spinal vertebrae are the bane of age; they ruin the quality of life and shorten its duration.

Osteoporosis should be suspected when our bodies become light and frail with age and especially when an older person breaks a bone for any reason.  Heavy bodies resist osteoporosis because bones that carry heavy weights tend to retain their high density.  This is one of the few benefits of being overweight.  Other causes of osteoporosis are smoking, heavy alcohol intake, sedentary life styles, epilepsy medications, serotonin antidepressants, long-term cortisone treatments, low calcium intake, low vitamin D levels, colitis, malabsorption syndromes, Celiac disease, low weight, poor nutrition, etc.

Osteoporosis should not be routinely tested for in fit menstruating women, fit women on hormone replacement therapy, fit sexually potent older men, fit but overweight older men and women.  In these populations, the yield of bone density tests is quite low. 

The screening tests that measure bone density are widely available and reliable.  They are useful in diagnosing osteoporosis and the pre-osteoporosis stage known as osteopenia.  They should not be done on everybody as one does cholesterol tests.  Rather, they are best reserved for those who fit the osteoporosis profile such as women five years after menopause, men who decline sexually after 65, chronically ill or frail or underweight older persons, and persons on medications that promote osteoporosis.  Such persons, if they are found to have osteoporosis, will need to be treated with preventive osteoporosis medications.  The aim of treatment is to prevent future fractures.  However, if they are found to have the pre-osteoporosis stage of osteopenia, they are best treated with high calcium and vitamin D tablets and life style changes that increase weight bearing exercises.        

The osteoporosis medications are not benign and should be used with caution.  The Bisphosphonates such as Fosamax, Actonel, and Boniva can burn the esophagus and have to be taken on an empty stomach with strict instructions not to eat or drink or take other medicines or lie down for 30-60 minutes after intake.  They may also cause breakdown of the jawbones after dental procedures or if dental health is poor.  Other side effects are body aches, upset stomachs, and chest pains. 

The hormones (estrogen and progesterone for women and testosterone for men) also prevent osteoporosis but are seldom used for that purpose.  They are primarily indicated for the treatment of hormone-deficiency symptoms but the prevention of osteoporosis is one of their beneficial side effects.  There is, however, a female hormone like agent called Evista, which is primarily used for the prevention of osteoporosis.  Unfortunately, all these hormones can increase blood clots, strokes, heart attacks, etc. and should only be used when the benefits clearly outweigh the harms.         

All men and women over 30 should take enough calcium and enough vitamin D.  Enough calcium means 1200 to 2000 mg daily.  The usual calcium tablets contain 500 to 600 mg and most people need to take two to four tablets daily.  Calcium is constipating and is best taken with meals.  Many calcium tablets also contain Magnesium, which prevents constipation.

The dose of vitamin D3 should be at least 2000 units daily.  The available vitamin D3 tablets are 1000 or 2000 units and should supplement the calcium tablets because without vitamin D, the calcium is not absorbed nor made available to bones.  Taking more vitamin D is not harmful, especially for those who do not spend much time in the sun.  Many calcium tablets also contain vitamin D but they don’t contain enough and should not be used as the main source of vitamin D.  They should always be taken with 2000 units of vitamin D3 daily.        

Osteoporosis is, for most people, a preventable disease.  The antidotes for this bone-aging syndrome is taking about 2000 mg of calcium and 2000 units of vitamin D daily beginning at or before the age of 30.  A healthy life style with no smoking, low alcohol intake, frequent weight-bearing exercises, and good nutrition is as important as the calcium and vitamin D supplements.

Testing older, chronically ill, and frail men and women for osteoporosis may save them from the horrible consequences of bone fractures.  Since osteoporosis is an asymptomatic disease, the first symptom may indeed be a broken hip or arm or spine and when it happens, the disease may well be too far advanced to treat or reverse.

 2009 - ISSUE 86