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| Resources: Patient FAQ |
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- Why do I have osteoporosis?
There is no single cause of osteoporosis. Seventy to 80% of an individual’s bone mineral density is
genetically determined. The rest is explained by lifestyle factors.
Our bodies constantly build new bone and remove older bone. In childhood, more bone is built than removed,
and so the bones grow in size. After age 30 or 40, however, the cells that
build new bone do not keep up with those that remove bone. The total amount of
bone then decreases, and osteoporosis may develop as a result.
The average rate of bone loss in men, and in women who have not yet reached menopause, is small. But after
menopause, bone loss in women accelerates to an average of one to two percent a
year. This is because after menopause, the level of the female hormone estrogen in a woman's body sharply
decreases. Estrogen protects the skeleton by helping the body's bone-forming
cells to keep working. After menopause, when the level decreases, some of this
protection is lost. In addition to age and menopause, secondary causes of bone loss are detailed in the
booklet guide on patient on osteoporosis, available in Arabic and English to AUBMC patients at
the Bone Densitometry Unit at AUB.
- When should I get my bone density tested?
Accepted indications for bone mass measurement in post-menopausal woman include:
- Age 65 years
- Presence of vertebral deformity or fragility fracture
- Radiologic evidence of demineralization
- Chronic corticosteroid therapy
- Medical conditions known to cause bone loss
- Monitoring to assess response to therapy.
Additional specific indications depend on the individual clinical profile of patients and
left to the discretion of the caring physician.
- My mother has osteoporosis , I am still premenopausal, should I have a bone density test?
Healthy, normally cycling premenopausal women should not have a Bone Density done. The
recommendations are the same regardless of the test results, that is healthy
lifestyle, exercise, adequate calcium and vitamin D intakes.
According to the Lebanese Guidelines on Osteoporosis Assessment and Treatment, a less
definite indications for BMD testing in pre-menopausal women include:
- Systemic corticosteroids for > 3 months
- Medical conditions known to cause bone loss: hyperprolactenemia, hyperparathyroidism,
hyperthyroidism, anticonvulsant use, Cushing’s disease, renal insufficiency,
chronic liver disease, etc...
The Lebanese Guidelines are posted on the International Osteoporosis Foundation
website at www.iofbonehealth.org/health-professionals/national-regional-guidelines/references.html#ref_9
- What should our children do to protect their bones?
To protect their bones children and adolescents should:
- ensure an adequate calcium intake which meets the relevant dietary recommendations in the country or region concerned
- avoid under nutrition and protein malnutrition
- maintain an adequate supply of vitamin D through
sufficient exposure to the sun or oral supplementation
- increase the level of physical activity
- avoid junk food, carbonated beverages and high salt intake
- avoid smoking
- educate adolescents about the risk of high
alcohol consumption
http://www.osteofound.org/osteoporosis/prevention.html
- How much calcium should I take?
Optimal calcium intake refers to the levels of consumption that are necessary for an individual (a) to
maximize peak adult bone mass, (b) to maintain adult bone mass, and (c) to
minimize bone loss in the later years.
Calcium requirements vary throughout an individual's lifetime, with greater needs during the periods of
rapid growth in childhood and adolescence, during pregnancy and lactation, and
in later adult life (Table 1).
Table 1: Calcium daily requirements through the life cycle:
| Calcium Daily Requirements |
| Amount (mg/d) |
| Children | Ages 1–10 | 800–1200 |
| Adolescents and Young Adults | Ages 11–24 | 1200–1500 |
| Adult Women | Pregnant or lactating | 1200–1500 |
| Ages 25–49 | 1000 |
| Ages 50–64
(postmenopausal taking estrogen) | 1000 |
| Ages 50–64
(postmenopausal not taking estrogen) | 1500 |
| Ages 65+ | 1500 |
| Adult Men | Ages 25–64 | 1000 |
| Ages 65+ | 1500 |
From the National Institutes of Health Consensus Development Panel
Optimal Calcium Intake. NIH Consens Statement 1994 June 6-8; 12(4):1-31
IOF Calcium Calculator:
www.iofbonehealth.org/patients-public/calcium-calculator.html
- What is a good calcium preparation?
The supplement is the one that meets an individual’s needs based on tolerance, convenience, cost and availability.
In choosing a calcium supplement, the following are important considerations:
- Purity:
Look for labels that state "purified or have the USP (United States Pharmacopeia) symbol. Avoid
calcium from unrefined oyster shell, bone meal or dolomite without the USP, as
these historically have contained higher lead levels or other toxic metals.
- Timing/Absorbability:
Calcium, whether from the diet or supplements, is
absorbed best by the body when it is taken several times a day in amounts of
500 mg or less, but taking it all at once is better than not taking it at all.
Calcium carbonate is absorbed best when taken with food. Calcium citrate can be
taken any time. Although some studies suggest that bedtime calcium intake is most favorable, however a beneficial effect is
documented with intake during the day.
- Tolerance:
Certain preparations may cause side effects, such as
gas or constipation, in some individuals. If simple measures such as increased
fluids and fiber intake do not solve the problem, another form of calcium
should be tried. Also, it is important to increase supplement intake gradually;
take 500 mg a day for a week, then add more calcium slowly.
- Calcium Interactions:
It is important to talk with a physician or
pharmacist about possible interactions between prescription or over-the-counter
medications and calcium supplements. For example, calcium supplements also may
reduce the absorption of the antibiotic tetracycline. Calcium also interferes
with iron absorption, so a calcium supplement should not be taken at the same
time as an iron supplement. The exception to this is when the iron supplement
is taken with vitamin C or calcium citrate. Any medication to be taken on an
empty stomach should not be taken with calcium supplements.
- Combination Products:
While vitamin D is necessary for the absorption of
calcium, it is not necessary that it be in the calcium supplement.
This Strategy for Osteoporosis appeared in the Spring 1999 Issue of
NOF's Quarterly Member Newsletter, Osteoporosis Report
www.nof.org/prevention/calcium_supplements.htm
- Does coffee interfere with calcium absorption?
Caffeine, has not been found to affect calcium absorption or excretion significantly.
The amount of caffeine in a cup of coffee can reduce calcium absorption by a few milligrams, but
that loss can be easily offset by adding a tablespoon or two of milk. Much of
the apparently harmful effect of caffeine appears to be due not to the caffeine
itself, but to the fact that caffeine-containing beverages are often
substituted for milk in the diet. For negative dietary factors and practices, see:
www.iofbonehealth.org/health-professionals/about-osteoporosis/prevention/nutrition/negative-dietary-factors-and-practices.html
- The IOF resources regarding nutrition and osteoporosis .
- What is a good exercise for bones and how much of it?
Two types of exercises are important for building and maintaining bone mass and density: weight-bearing
and resistance exercises.
Weight-bearing exercises are those in which your bones and muscles work against gravity. This is any
exercise in which your feet and legs are bearing your weight. Jogging, walking,
stair climbing, dancing and soccer are examples of weight-bearing exercise.
Swimming and bicycling are not weight-bearing, although they have many other
health benefits.
Resistance exercise uses muscular strength to improve muscle mass and strengthen bone. These activities
include weight lifting with free weights or weight machines.
Daily activities and most sports involve a combination of these two types of exercises. Thus, an active
lifestyle filled with varied physical activities strengthens muscles and
improves bone strength.
www.nof.org/prevention/exercise.htm
Exercise including both weight-bearing and resistance 30-40 minutes, 3-4 times/week will have many
benefits, including musculoskeletal as well as cardiovascular.
World Osteoporosis Day 2005. Theme:
'Move it or Lose it': The role of exercise in bone health. www.iofbonehealth.org/about-iof/iof-programs/outreach-education/world-osteoporosis-day/2005-exercise.html
- What builds bone back to normal?
Most therapies such as hormones, bisphosphonates [Alendronate (Fosamax), Risedronate
(Actonel)], SERMS [Raloxifene (Evista)], calcitonin maintain or moderately
increase bone mass by 3-8%. The only anabolic therapy that is FDA approved for osteoporosis is parathyroid
hormone (Forteo), it increases bone mass by up to 15%. For additional information regarding medication check the Food and Drug Administration website. http://www.fda.gov/cder/guidance/1449fnl.pdf
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