Osteoporosis is a disease that weakens bones to the point where they break easily – most often bones in the hip, backbone (spine), and wrist. Osteoporosis is called the ” silent disease” – you may not notice any changes until a bone breaks. But, your bones have been losing strength for many years.

  Bone is living tissue. To keep bones strong, your body is always breaking down old bone and replacing it with new bone tissue. As people enter their forties and fifties, more bone is broken down than is replaced. A close look at the inside of bone shows something like a honeycomb. Where you have osteoporosis, the places  in this honeycomb grow larger. And the bone that forms this honeycomb gets smaller. The outer shell of your bones also gets thinner. All of this makes your bones weaker.

Who Has Osteoporosis?

  Millions of Americans have osteoporosis. They are mostly women, but more than two million men also have this disease. White and Asian women are most likely to have osteoporosis. Other women at great risk include those who:

*Have a family history of broken bones or osteoporosis

* Have broken a bone while an adult

* Had surgery to remove their ovaries before their periods stopped

* Had early menopause

* Have not gotten enough calcium throughout their lives

* Had extended bed rest

* Used certain medicines for a long time

* Have a small body frame

  The risk of osteoporosis grows as you get older. At the time of menopause, women may lose bone quickly for several years. After that, the loss slows down but continues. In men, the loss of bone mass is slower. But, by age 65 or 70, men and women are losing bone at the same rate.

What Is Osteopenia?

  Millions  more Americans have osteopenia. Whether your doctor calls it osteopenia or just says you have low bone mass, consider it a warning. Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life. That way you will be less likely to break a wrist, hip or vertebrae (bone in your spine) when you are older.

Can My bones Be Tested?

  For some people the first sign of osteoporosis is to realize they are getting shorter or to break a bone easily.  .  . Don’t wait until that happens to see if you have osteoporosis. you can have a bone density test to find out how solid your bones are. Your doctor may suggest a type of bone density test called a DXA test (dual energy x-ray absorptiometry) if you are age 65 or older of  he or she thinks you are at risk for osteoporosis.

  The DXA test gives you important information to help you understand your risk for a fracture or broken bone. It could show that you have normal bone density. Or, it could show that you have low bone mass or even osteoporosis.

How Can I Keep My Bones Strong?

  There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and Vitamin D is important. So is including regular weight-bearing exercise in your lifestyle. These are the best ways to keep your bones strong and healthy.

  Calcium. Getting enough calcium all through yor life helps to build and keep strong bones. People over age 50 need 1200 mg. of calcium every day. Foods that are high in calcium are the best source. For example, eat low-fat dairy foods, canned fish with soft bones such as salmon and dark-green leafy vegetables. Check the labels on foods like orange juice, breads and cereals to find those with calcium added.

  If you think you aren’t getting enough calcium in your diet, check with your doctor first. He or she may tell you to try a calcium supplement. Calcium carbonate and calcium citrate are two common forms. You have to be careful, though. Too much calcium can cause problems for some people On most days, you should not get more than 2500 mg. of total calcium. That includes calcium from all sources – foods, drinks and supplements.

  Vitamin D. Your body uses Vitamin D to absorb calcium. Most people’s bodies are able to make enough Vitamin D if they are out in the sun without sunscreen for 10 to 15 minutes at least twice a week. You can also get Vitamin D from eggs, fatty fish and cereal and milk fortified with Vitamin D. If you think you are not getting enough Vitamin D, check with your doctor. Each day you should have;

* 400 IU (International Units) if you are age 51 to 70

* 600 IU if you are over age 70

  As with calcium, be careful. More than 2000 IU of Vitamin D each day may cause side effects.

  Exercise.Your bones and muscles will be stronger if you are physically active. Weight-bearing exercises, done three to four times a week, are best for preventing osteoporosis. Walking, jogging, playing tennis and dancing are examples of weight-bearing exercises. Try some strengthening and balance exercises, too. They may help you avoid falls, which could cause a broken bone.

  Medicines. Some common medicines can make bones weaker. These include a type of steroid drug called glucocorticoids used for arthritis and asthma, some antiseizure drugs, certain sleeping pills, treatments for endometriosis and some cancer drugs. An overactive thyroid gland or using too much thyroid hormone for an underactive thyroid can also be a problem. If you are taking these medicines, talk to your doctor about what you can do to help protect yor bones.

  Lifestyle. Smoking increases loss of bone mass. For this and many other health reasons, stop smoking. Limit how much alcohol you drink. too much alcohol can put you at risk for falling and breaking a bone.

What Can I Do For My Osteoporosis?

  Treating osteoporosis means stopping the bone loss and rebuilding bone to prevent breaks. Diet and exercise can help make your bones stronger. But, they may not be enough if you have lost a lot of bone density. There are also several medications to  think about. Some will slow your bone loss, and others can help rebuild bone. Talk with your doctor to see if one of these might work for you.

 Bisphosphonates. These medicines slow the breakdown of bone and increase bone density. They can make it less likely that you will break a bone, most of all in your spine, hip or wrist. Side effects may include nausea, heartburn and stomach pain. A few people have muscle, bone or joint pain while using these medicines. These drugs must be taken in a certain way – when you first get up, before you have eaten and with a full glass of water. You should not lie down, eat or drink for at least one-half hour after taking the drug. Even if you follow the directions closely, these drugs can cause serious digestive problems, so be aware of any side effects. These pills are available in once-daily, once-a-week and once-a-month versions. Some bisphosphonates are injected into a vein once every three months or once a year.

  Raloxifene. This drug is used to prevent and treat osteoporosis. It is a SERM (selective estrogen receptor modulator). It prevents bone loss and spine fractures but may cause hot flashes or increase the risk of blood clots in some women.

  Estrogen. Doctors sometimes prescribe this female hormone around the time of menopause to treat symptoms like hot flashes or vaginal dryness. Estrogen also slows bone loss and increases bone mass in your spine and hip, so women can use it to prevent or treat osteoporosis. But, estrogen use is thought to be risky for some women. Talk to your doctor. Ask about the benefits, risks and side effects, as well as other possible treatments for you.

  Calcitonin. This hormone increases bone mass in your spine and can lessen the pain of fractures already there. It comes in two forms – a shot or nasal spray. The shot may cause an allergic reaction and has some side effects like nausea, diarrhea or redness in your face, ears, hands or feet. The only side effect of the nasal spray is a runny nose in some people. Calcitonin is most useful for women who are at least five years past menopause.

  Parathyroid hormone (PTH).Also called teriparatide, this shot is given daily for up to two years to postmenopausal women and to men who are at high risk for broken bones. It improves bone density in the spine and hip. Common side effects include nausea, dizziness and leg cramps.

Can I Avoid Falling?

  When your bones are weak a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery. It might also mean being laid up for a long time, especially in the case of a hip fracture. So, it is important to prevent falls. Some things you can do are;

* Make sure you can see and hear well. use your glasses or a hearing aid if needed.

* Ask your doctor if any of the drugs you are taking can make you dizzy or unsteady on your feet.

* Use a cane or walker if your walking is unsteady.

* Wear rubber-soled and low-heeled shoes.

* Make sure all the rugs and carpeting in your house are firmly attached to the floor, or don’t use them.

* Keep your rooms well-lit and the floor free of clutter.

* Use nightlights.

  You can find more suggestions in the National Institute on Aging’s ”Falls and Fractures” Age  Page, available from the National Institute on Aging Information Center listed in the resource section below.

Do Men have Osteoporosis?

  Osteoporosis is not just a woman’s disease. Not as many men have it as women do, but men need to worry about it as well. This may be because most men start with more bone density than women do and lose it more slowly as they grow older.

  Experts don’t know as much about this disease in men as they do in women. However, many of the things that put men at risk are the same as those for women:

* Family history

* Not enough calcium or Vitamin D

* Too little exercise

* Low levels of testosterone

* Too much alcohol

* Taking certain drugs

* Smoking

  Older men who break a bone easily or are at risk for osteoporosis should talk with their doctors about testing and treatment. Men can sue bisphosphonates or parathyroid hormone to increase bone density. Testosterone supplements may help some men with low levels of testosterone.

For More information

  Here are some helpful resources:

National Institutes of Health Osteoporosis and Related Bone Diseases – National Resource Center 1-800=624-2663 (toll free) 202-466-4315 (TTY) www.niams.nia.gov/Health-Info/Bone

National Library of Medicine Medicine Plus – www.medlineplus.gov

National Osteoporosis Foundation

For more information on health and aging, contact National Institute on aging Information Center – 1-800-222-2225 (toll-free) 1-800-  222-225 (TTY/toll-free) www.nia.nih.gov.

  To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.hih.gov/HealthInformation.

  Visit NIHSenior Health (www.nia.seniorhealth.gov) a senior-friendly websites from the National Institute on aging and the National Library of Medicine. This website has health information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.

(From National Institutes of Health, U.S. Dept. of Health and Human Services)

  Use these checklists to help you stay healthy at 50+ The checklists help answer your questions about what daily steps you can take for good health, whether you need medicines to prevent disease and which screening tests you need and when to get them.

Daily Steps To Good Health

* Be tobacco free. For tips on how to quit, go to www.ahrq.gov and click on ” Quit Smoking” or visit www.smokefree.gov. To talk to someone about how to be tobacco free, call the National Quitline: 1-800-QUITNOW.

* Be physically active. If you are not already physically active, start small and work up to 30 minutes or more of moderate physical activity most days of the week. Walking briskly, mowing the lawn, dancing, swimming and bicycling are just a few examples of moderate physical activity.

* Eat a healthy diet. Focus on fruits, vegetables, whole grains and fat-free or low-fat milk and milk products. Include lean meats, poultry, fish, beans, eggs and nuts. Eat foods low in saturated fats, trans fats, cholesterol, salt and added sugars.

* Stay at a healthy weight. Balance the calories you take in from food and drink with the calories you burn off by your activities. Check with your doctor if you start to gain or lose weight.

* If you drink alcohol, drink only in moderation. Have no more than one drink a day. A standard drink is one 12-ounce bottle of beer or wine cooler, one glass of wine or 1.5 ounces of 80-proof distilled spirits.

Should You Take Preventive Medicines?

* Aspirin. Ask your doctor about taking aspirin to prevent stroke.

* Breast Cancer Drugs. If your mother, sister or daughter has had breast cancer, talk to your doctor about whether you should take medicines to prevent breast cancer.

* Estrogen Use for Menopause (Hormone Replacement Therapy). Do not use estrogen for the prevention of cardiovascular disease or other diseases. If you need relief from the symptoms of menopause, talk with your doctor.

* Immunizations. you need a flu shot every year. You can prevent other serious diseases, such as pneumonia, whooping cough and shingles by being vaccinated. Talk with your doctor or nurse about the vaccines you need and when to get them. You can also find out which immunizations you need by going to http://www2.cdc.gov/nip/adultImmSched/.

Screening tests: What You Need and When

  Health experts from the U.S. Preventive Services Task Force have made these recommendations, based on scientific evidence, about which screening tests you need and when to get them.

* Breast Cancer. have a mammogram every one to two years.

* Colorectal Cancer. Have a test for colorectal cancer. your doctor can help you decide which test is right for you.

* Depression. your emotional health is as important as your physical health. if you have felt ”down,” sad or hopeless over the last two weeks or have felt little interest or pleasure in doing things, you may be depressed. Talk to your doctor about being screened for depression.

* Diabetes. have a blood test for diabetes if you have high blood pressure.

* High Blood Pressure. Have your blood pressure checked at least every two years. High blood pressure is 140/90 or higher.

* High Cholesterol. have your cholesterol checked regularly.

* HIV. Talk with your doctor about HIV screening if any of these apply:

  – You have had unprotected sex with multiple partners.

- You exchange sex for money of drugs or have sex partners who do.

- You have past or present sex partners who are HIV-infected, are bisexual or use injection drugs.

- You are being treated for a sexually transmitted disease.

  – You had a blood transfusion between 1978 and 1985

* Obesity. Have your body mass index (BMI) calculated to screen for obesity. BMI is a measure of body fat based on height and weight. You can find your own BMI with the BMI calculator from the National Heart, Lung and Blood Institute at http://www.nhlbisupport.com/bmi/.

* Osteoporosis (Bone Thinning). Have a bone density test at age 65 to screen for osteoporosis. If you are younger than 65, talk to your doctor about whether you should be tested. You may need to have this test again after two or more years.

* Sexually Transmitted Infections. Talk to your doctor about being tested for sexually transmitted infections.

  Every body is different. Always feel free to ask your doctor or nurse abut being checked for any conditions, not just the ones above. If you are worried about diseases such as glaucoma or skin cancer, for example, ask your doctor about them. And always tell your doctor about any changes in your health, including your vision and hearing.  (From U.s. Dept of Health and Human Services Agency for Research and Quality, www.ahrq.gov)

  Modern medicine has made our lives better in many ways. It has helped older adults live longer, healthier lives. But people over 65 have to be careful when taking medications, especially when they’re taking many different drugs.

What Are Medicines? What Are Drugs?

  Some people refer to the pills they take as ”’medicine,” and other people call them ”drugs.” Both words can refer to:

* Medicines you get from a pharmacist with a doctor’s prescription.

* Pills, liquids or creams you buy without a prescription to use every now and then for aches and pains, or

* Vitamins or dietary supplements you take regularly.

  Drugs you get without a doctor’s prescription are called over-the-counter medicines. Because mixing certain medicines can cause problems, be sure to let your doctor know about all the prescription and over-the-counter drugs you are taking. Keep an updated list of medicines you are taking with you at all times.

Generic or Brand name?

  When getting a prescription filled, you may have a choice between either a generic or brand-name drug. Generic and brand-name medicines are alike because they act the same way in the body and they contain the same active ingredients. The generic version works like the brand-name in dosage, safety, strength, performance and use. Generic drugs often cost less.

  If you want a generic drug, ask the pharmacist if that’s a choice. Not all drugs are availabale in the generic form.

At Your Doctor’s Office

 You’ve gone to your doctor because you don’t feel well. The doctor decides a medicine will help and writes a prescription. What should you do next?

* Tell your doctor or nurse about all the medicines you take whenever a new drug is prescribed.

* Remind your doctor or nurse about your allergies and any problems you have had with medicines, such as rashes, indigestion, dizziness or mood changes.

* Find out the right way to take the medicine before you start using it. Ask questions. It might help you to write down the answers. You might want to know:

* What is the name of the medicine and why am I taking it?

* How many times a day should I take it and at what time? If the bottle says take ”4 times a day,” does that mean 4 times in 24 hours or 4 times during the daytime?

* Should I take the medicine before, after or between meals? Is there anything I should avoid eating when taking this medicine?

* What does ”as needed” mean?

* When should I stop taking the medicine?

* If I forget to take my medicine, shat should I do?

* What side effects can I expect? What should I do if I have a problem?

Ask Your Pharmacist

  Your pharmacist is an important part of your health care team. He or she can answer many questions you may have about your medicine. For example, a pharmacist can tell you how and when to take your medicine, whether a drug may interact with or affect another medicine you are taking and any side effects you might have. Also, the pharmacist can answer questions about over-the-counter medications.

  Try to have all your prescriptions filled at the same pharmacy so your records are in one place. The pharmacist will keep track of all your medications and will be able to tell you if a new drug might cause problems. If you’re not able to use just one pharmacy, show the new pharmacist your list of medicines and over-the-counter drugs.

  When you have a prescription filled:

* Make sure you can read and understand the name of the medicine and the directions on the container and on the color-coded warning stickers on the bottle. If the label is hard to read, ask your pharmacist to use larger type.

* Check that you can open the container; if not, ask the pharmacist to put your medicines in bottles that are easier to open.

* Tell the pharmacist if you have trouble swallowing pills. There may be liquid medicine available. do not chew, break or crush tablets without first finding out if the drug will still work.

* Ask about special instructions on where to store a medicine. For example, should it be kept in the refrigerator or in a dry place?

* Read the label on your medicine before leaving the pharmacy. It should have your name on it and the directions prescribed by your doctor. If it doesn’t, don’t take it.

Now It’s Your Turn 

  Your doctor has prescribed a medication, the pharmacist has filled the prescription and now it’s up to you to take the medicine safely. Here are some tips that can help:

*  Make a list of all the medicines you take. Show it to all your health care providers including physical therapists and dentists. Keep one copy in your medicine cabinet and one in your wallet or pocketbook. The list should include the name of each medicine, doctor who prescribed it, reason it was prescribed, amount you take and time(s) you take it.

* Read and save all written information that comes with the medicine.

* Take your medicine in the exact amount and at the time your doctor prescribes.

* Call your doctor right away if you have any problems with your medicine or if you are worried that the medicine might be doing more harm than good. Your doctor may be able to change your medicine to a different one that will work better for you.

* Use a memory aid to take your medicines on time. Some people use meals or bedtime as reminders to take their medicine. Other people use charts, calendars and weekly pill boxes to remind them. Use a system that works for you.

* Do not skip doses of medication or take half doses to save money. Talk with your doctor or pharmacist if you can’t afford the prescribed medicine. There may be less costly choices or special programs to help with the cost of certain drugs.

* Avoid mixing alcohol and medicine. Some medicines may not work correctly or may make you sick if taken with alcohol.

* Take your medicine until it’s finished or until your doctor says it’s okay to stop.

* Don’t take medicines prescribed for another person or give yours to someone else.

* Don’t take medicine in the dark. To avoid making a mistake, turn your light on before reaching for your pills.

* Check the expiration dates on your medicine bottles and throw away outdated medicines.

* Don’t leave your medicine on a kitchen table or counter where a young child may get into it. Make sure you store all medicines and supplements out of sight and out of reach of children.

  Remember medicines that are strong enough to cure you can also be strong enough to hurt you if they aren’t used the right way.

  Medicare prescription drug coverage is available to people with Medicare. for information call 1-800-633-4227 or visit www.medicare.gov. 

For More Information

  Here are some helpful federal and nonfederal resources:

Centers for Medicare and Medicid Services (CMS) 1-877-267-2323 (toll-free), www.cms.hhs.gov.

Partnership for Prescription Assistance – 1-888-477-2669 (toll-free), www.pparx.org. 

National Institute on Aging Information Center – 1-800-222-2225 (tolll-free) 1-800-222-4225 (TTY/toll-free), www.nia.hih.gov.

(From NIH)

  Recommendations for cancer prevention from AICR are as follows:

  1. Be as lean as possible without becoming underweight

  2. Be physically active for at least 30 minutes every day.

  3. Avoid sugary drinks. Limit consumption of energy-dense foods, particularly processed foods high in added sugar, low in fiber or high in fat.

  4. Eat more of  a variety of vegetables, fruits, whole grains and legumes such as beans.

  5. Limit consumption or red meats such as beef, pork and lamb and avoid processed meats.

  6. If consumed at all, limit alcoholic drinks to two for men and one for women a day.

  7. Limit consumption of salty foods and foods processed with salt (sodium).

  8. Don’t use supplements to protect against cancer.

Special population recommendations

  9. It is best for mothers to breast-feed exclusively for up to six months and then add other liquids and foods.

  10. After treatment, cancer survivors should follow the recommendations for cancer prevention.

  And always remember – do not smoke or chew tobacco.