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Osteoporosis Risk Factors: Fact vs. Fiction

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Fiction: If you have osteoporosis, it's too late to do anything about it.

"After being diagnosed with osteoporosis, some people think they should just go home and give up. That's a terrible mistake," says Heaney. "We can do a lot to slow the disease and lower the risk of fracture. Getting a diagnosis is a good thing compared with having the disorder and not knowing it, because now you can take steps."

There are a variety of osteoporosis drugs available. Most cannot build new bone -- instead, they slow the rate of bone loss. These drugs include bisphosphonates, hormone replacement therapy, and selective estrogen receptor modulators (SERMs). Your doctor can help you decide which drug is right for you, but it's important to know that these treatments can reduce your risk of spinal fractures by up to 65%, and your risk of fractures elsewhere in the body by up to 53%.

People with osteoporosis don't have to sit at home and stare out the window. Regular weight-bearing exercise has been shown to reduce the risk of fracture, both because it strengthens the bones and because it can help you stay strong and agile and avoid falls. Talk with your doctor about exercise that you can safely do when you have osteoporosis.

Fiction: If you only have osteopenia, not osteoporosis, you don't have to worry about fractures.

"Osteopenia is a complicated thing," says Ethel Siris, MD, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center and president of the National Osteoporosis Foundation. "In younger postmenopausal women, it does increase fracture risk down the road, but it's not as huge a risk. But in an older person, in their mid-60s or 70s, osteopenia may be a very significant risk factor for a fracture. I know women who say 'My girlfriend has osteoporosis and I only have osteopenia, so I'm better off.' That may or may not be true."

In fact, the majority of fractures occur in people with osteopenia -- although the risk of fracture with osteoporosis is higher, there are so many more people with osteopenia that they have more fractures overall. If your doctor tells you you have osteopenia, treat it as a warning sign -- a chance to practice good bone health by eating a calcium-rich diet (and taking supplements if you need to) and getting regular weight-bearing and resistance exercise.

Fiction: If you've been on an osteoporosis drug but your bone density hasn't gone up, it means the drug must not be working!

Most osteoporosis drugs don't "build bone" -- they slow the rate of bone loss. So if you go in for a bone scan after taking medication for osteoporosis for a couple of years, and your T-score (the measure of your bone density) hasn't changed, that doesn't mean the drug isn't working. "As long as your T-score is stable and hasn't dropped, that implies that the drug is working," says Siris. "What these drugs do is they make the bone stronger and do it fairly quickly, within a year. Even without a dramatic change in bone density, there's a decline in the risk of fractures."

In fact, even a decline in bone density in your first scan after taking medication doesn't necessarily mean you're getting no benefit from the drug you're taking. One study found that women who lost the most bone during the first year of treatment experienced the most improvements in the years afterward.

WebMD Medical Reference

Reviewed by Jeffrey S. Beitler, MD on January 31, 2012
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