Prevention

You can help to prevent osteoporosis by:

• Getting enough calcium and vitamin D - Many doctors routinely recommend extra calcium; 500 milligrams to 1,000 milligrams daily in the form of calcium carbonate, as in Tums, and in many other inexpensive forms. You may need even more if your diet is particularly low in calcium or if you are breastfeeding. You may also need to take a daily multivitamin that contains vitamin D.

• Regularly doing weight-bearing exercises

• Not smoking

• Avoiding excess alcohol

If you are a woman who has entered menopause recently, talk to your doctor about being evaluated for osteoporosis. Preventive options for menopause-related osteoporosis include estrogen replacement therapy, raloxifene (Evista), alendronate (Fosamax) or risedronate (Actonel). Because estrogen slows the breakdown of bone, the loss of estrogen during menopause leads to bone loss. Estrogen therapy and raloxifene (which behaves like estrogen on bone) help to counteract this process. Estrogen replacement therapy for preventing or treating osteoporosis has fallen out of favor because of side effects, including an increased risk of heart disease and stroke. Alendronate and risedronate are called bisphosphonates, a family of drugs that slow down the cells that break down bone. In this way, these drugs can help bone to become thicker. A bone density test may make the decision easier if it shows signs of a problem. Because the loss of height caused by osteoporosis-related compression fractures may not cause any other symptoms, it is also a good idea to measure your height every year, especially if you are a woman older than age 40.

Another measure to help prevent osteoporosis is to monitor thyroid medication regularly if you take it, because too much may lead to osteoporosis and other medical problems. If you take prednisone for any reason, work with your doctor to reduce the dose to the lowest possible amount or even to discontinue the medication.

Treatment

Doctors treat osteoporosis by prescribing calcium and vitamin D, by recommending weight-bearing exercises and by modifying other risk factors. In addition, several effective medications are available. For women, estrogen replacement therapy, alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista) and nasal calcitonin (Miacalcin), a spray that inhibits bone breakdown, all treat osteoporosis and are approved by the U.S. Food and Drug Administration (FDA). Long-term estrogen therapy has been associated with many risks, including an increased risk of heart disease, stroke, breast cancer and gallstones. For this reason, many doctors prefer one of the other options as a first choice. Among men, a low level of testosterone is the most common cause of osteoporosis. If testing reveals that testosterone levels are low, other tests will look for the cause so that treatment can be started. Men also can use alendronate and raloxifene.

A form of parathyroid hormone, called teriparatide (Forteo), was approved for treating osteoporosis. Given by a daily injection, it will probably be reserved for the worst cases of osteoporosis, those that failed to respond to other treatments.