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From: Art S on 9 Jul 2005 02:54 Frequently Asked Questions (FAQ) for sci.med.diseases.osteoporosis. 10/17/2003 This posting describes the newsgroup Sci.med.diseases.osteoporosis newsgroup as well as other sources about this disease. It should be read by anyone who wishes to post in this newsgroup. Osteoporosis is a disease that can strike most anyone but is rarely diagnosed early. It is treatable. Table Of Contents Part 0: Administrative Issues 0.00 Introduction 0.01 Disclaimer 0.02 Where to get the current version of this FAQ 0.03 Newsgroup Etiquette Part 1: General Information 1.01 What is Osteoporosis? 1.02 How widespread is Osteoporosis? Part 2: Medical Issues 2.01 Am I at risk for developing Osteoporosis 2.02 Do I have Osteoporosis? 2.03 Explain Bone Densitometry and the DXA scan. 2.04 How do I find good medical care for Osteoporosis disease? 2.05 What symptoms are used to diagnose Osteoporosis disease? 2.06 What tests are used to support a clinical diagnosis of Osteoporosis? 2.07 Can Osteoporosis be prevented? 2.08 What treatments are available to combat this disease? 2.09 How long does Osteoporosis last? 2.10 Do falls increase the dangers of Osteoporosis? 2.11 Can Osteoporosis disease cause depression or other psychiatric disorders? 2.12 Can people die from Osteoporosis disease? 2.13 Explain PTH (Parathyroid) and how it affects Osteoporosis. 2.14 Discuss calcium. 2.15 Explain how exercise helps build bone density. 2.16 Osteoporosis friendly Exercises 2.17 Explain the importance of Vitamin D related to calcium and bones. Administrative Issues Part 0.00 Introduction Information in the Osteoporosis disease FAQ, version 1.5, September 15, 2003, was compiled by John Madura and others and was created on behalf of the Osteoporosis disease newsgroup: sci.med.diseases.osteoporosis. Readers may redistribute or quote this document for non-commercial purposes provided that they include: an attribution to sci.med.diseases.osteoporosis; and the website where this FAQ may be retrieved. Please direct all corrections, additions or comments to John at n2rdv(a)Optonline.net This document answers Frequently Asked Questions (FAQ) about Osteoporosis The newsgroup sci.med.diseases.osteoporosis is intended for discussion about many aspects of Osteoporosis, as experienced by patients, their caregivers, friends and family members, doctors and other medical professionals involved with the illness. It is particularly helpful for those who wish to learn about Osteoporosis symptoms, treatment options, and prevention strategies. Anyone with an interest in Osteoporosis disease is free to post, as this newsgroup is designed to foster dialogue between Osteoporosis disease patients from all parts of the world, and provide an open forum for the exchange of international medical, scientific, and lay information. Constructive criticism and on-topic debate, general understanding and support, are encouraged. Posts are to be limited to osteoporosis only. Absolutely NO sales or off-topic posts are permitted. All such posts will be reported. Topics discussed include: * Questions regarding any aspect of Osteoporosis * Disease symptoms, presentations * Current research findings * Current treatments, both conventional and alternative * Coping strategies * Social and political issues regarding Osteoporosis * Insurance and disability issues regarding Osteoporosis Material PROHIBITED includes: * Commercial advertisements * Flames, spam, name-calling, discrimination, and abusive behavior 0.01 Disclaimer The information in this FAQ is developed and provided by patients. It represents an accumulation of knowledge by people who are for the most part NOT medical professionals. As useful as the material presented in this FAQ may be, it must NOT be considered to be medical advice, and must NOT be used as a substitute for medical advice. It is important that anyone who has, or thinks he/she may have Osteoporosis, should consult with a licensed health care practitioner who is familiar with the illness. Your primary physician should be your first contact but past that the medical specialty that is associated with Osteoporosis are the Endocrinologists. 0.02 FAQ Availability This FAQ is posted regularly to the newsgroup: Sci.med.diseases.osteoporosis and is also available at www.jmadura.com/osteofaq.htm 0.03 Etiquette Newsgroups are like self-governing communities; there are no "Newsgroup Cops." Instead, posters regulate themselves. Below are some simple rules of newsgroup etiquette to understand before you venture into a newsgroup. Think of newsgroup etiquette as a set of guidelines that will keep you from making mistakes and make you look and sound like a veteran newsgroup poster. Lurk. Read the newsgroup without posting for a few weeks. This is known as "lurking," and it will give you the flavor of the newsgroup. Read the FAQ. Find and read the newsgroup's FAQ, or list of Frequently Asked Questions and other important and useful information. It can answer questions you didn't even know you had, and it's the quickest way to learn a newsgroup. Stay on-topic. Know what's on-topic and what's off-limits. Every newsgroup is a little different in what it talks about, and how it does the talking. DON'T SHOUT. TYPING IN ALL CAPS IS CONSIDERED SHOUTING. It's easier to read a mix of upper- and lower-case letters. Never, ever post "MAKE MONEY FAST." It doesn't work, it gets people really mad, and no matter what it says, it's probably illegal. Everyone hates commercials. Be very hesitant about posting advertisements or commercial messages. This also gets people really mad. Ignore "trolls." Some people get a thrill from posting "flames" (really obnoxious messages) just to get a rise out of people. Sad, isn't it? Don't "spam." Spam is posting the same message to dozens, even hundreds or thousands of unrelated newsgroups. No matter how important you think your message may be, it's not worth it. Think about it - if everyone posted about every topic, no one would be able to find anything. Be Original. Don't over quote: Copying a long post (more than 20 lines) just to add "I agree" or "me too" is considered bad form. The Golden Rule: Do unto others as you would have them do unto you. Remember, every expert was a newbie once. Write Conservatively, read forgivingly. Communication in a pure text medium, such as a newsgroup, is prone to misunderstanding, often due to the lack of non-verbal cues such as inflections, facial expression and body language. Given this, it is best to be conservative with expressions of anger and sarcasm when writing. When reading, assume good intent; if a message can be taken two ways, assume the friendliest meaning. Keep quoted text to a minimum. When quoting a previous post, edit out the non-relevant parts of the message. Remove salutations and signatures. A good rule of thumb is, there should not be more quoted text than new text. Please, please, please trim replies of irrelevant content and post your reply either immediately after the sentence being replied to or at the bottom of the post. Some of our users are from far away where phone access is quite expensive. 1.01 What is Osteoporosis? Osteoporosis is a skeletal disease characterized by low bone mass, and the deterioration of bone architecture leading to bone fragility and increased risk of fracture. Bone normally rejuvenates itself through a process of bone absorption and formation called bone remodeling. Osteoporosis occurs when bone breakdown, or absorption, occurs at a rate greater than bone formation. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist. Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. The World Health Organization defined osteoporosis as bone mineral density 2.5 or more SD below peak bone mass, osteopenia as bone mass between 1.0 and 2.5 SD below peak, and normal as 1.0 SD below normal peak bone mass or higher. However, the WHO criteria apply only to Caucasian, postmenopausal women, and not men, premenopausal women, or women of ethnicity other than Caucasian. We have yet to classify clinically significant low bone mass in this populations. (see 2.02 below) Osteoporosis has often been called the "silent disease," because it doesn't produce symptoms until a fracture occurs 1.02 Osteoporosis is a very widespread disease that affects women four times more often then men. Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million US women and men aged 50 and over. A women's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. Worldwide the statistics show this to be a major disease. Using the World Health Organization criteria, 30% of Caucasian postmenopausal women in the US have osteoporosis, and 54% have osteopenia. The prevalence of low bone mass increases with age. 2.01 There are many factors that can increase a person's risk of osteoporosis. A few of the risk factors are: Postmenopausal (female) Ethnicity-Caucasian and Asian Family history Petite, small frame Eating disorders Caffeine Smoking Excessive use of alcohol Vitamin D deficiency Inactivity Thyroid disease Chronic steroid use Peak bone mass occurs for both men and women by the early thirties. Genetic factors play the greatest role in determining peak bone mass, but there are clinically significant contributions from nutrition, drug exposures, endocrine health following puberty, and weight-bearing status (ref 4). For example, most teenagers and young adults do not receive the Recommended Daily Allowance (RDA) for calcium of 1200 mg. Smoking and excessive alcohol use contribute to low bone mass. Systemic glucocorticoid use of 7.5 mg daily or greater impairs bone formation. Phenytoin and other anti-seizure medications impair vitamin D metabolism. Oligomenorrhea and amenorrhea cause accelerated bone loss, as do hyperthyroidism or over-replacement of thyroxine supplementation such that the serum TSH is suppressed. Immobility is associated with thinning of the bone from lack of weight-bearing forces 2.02 In order to demonstrate bone loss, a bone scan would need to be performed. The most common type of bone scan is a DEXA test. 2.03 A bone scan (DXA or DEXA) is an x-ray that can show bone loss in the spine and hip area. The test takes about 10-20 minutes. A bone mineral density (BMD) test is a special type of test that is accurate, painless and noninvasive. For every one standard deviation below peak bone mass the risk of vertebral fracture is two times that of normal bone mass, and for the hip, the risk is 2.5 times. Measurement of the bone mass of the lumbar spine and hip are currently used for diagnostic purposes and monitoring of treatment. Peripheral sites such as wrist and heel can be useful screening tools in older individuals; however there is discordance between bone sites in rates of loss with aging. Thus, many newly postmenopausal women will have a normal bone mass of the heel, and yet have clinical significant low bone mass of the spine. The FDA recently approved ultrasound techniques for use as a screening test for low bone mass.(ref 14) Currently, the different manufacturers of bone densitometers all use different reference populations from which the standard deviations from normal are calculated, also called T scores. There are differences in calibration between companies as well, so that an individual patient's bone density reading can differ by as much as 12% from one machine to the next. Thus, to monitor a patient's response to treatment, the same bone densitometer must be used. 2.04 There is no physician specialty dedicated to osteoporosis, nor is there a certification program for health professionals who treat the disease. Therefore, a variety of medical specialists are treating people with osteoporosis, including internists, gynecologists, family physicians, endocrinologists, rheumatologists, physiatrists and orthopedists. Endocrinologists are the specialist most often found treating this disease and for the record, they treat the endocrine system, which comprises the glands and hormones that help control the body's metabolic activity. In addition to osteoporosis, endocrinologists also may treat diabetes, thyroid and pituitary diseases. 2.05 It is hard to diagnose Osteoporosis without a DXA scan but unexplained fractures in an elderly person could be a warning sign. 2.06 There are other tests that the treating physician can perform to help treat osteoporosis. 24 hour urine tests as well as blood tests give indications that are helpful in treating this disease. 2.07 Osteoporosis is largely preventable for most people. Prevention of this disease is very important because, while there are treatments for osteoporosis, there is currently no cure. There are four steps to prevent osteoporosis. No one step alone is enough to prevent osteoporosis but all four may. They are: A balanced diet rich in calcium and vitamin D Weight-bearing exercise A healthy lifestyle with no smoking or excessive alcohol use And bone density testing and medications when appropriate 2.08 Although there is no cure for osteoporosis, currently bisphosphonates (alendronate and risedronate), calcitonin, estrogens, parathyroid hormone and raloxifene are approved by the US Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis. Adequate calcium, vitamin D, appropriate exercise and, in some cases, medication are important for maintaining bone health. Currently, bisphosphonates (alendronate and risedronate), calcitonin, estrogens, parathyroid hormone and raloxifene are approved by the US Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis. The bisphosphonates (alendronate and risedronate), calcitonin, estrogens and raloxifene affect the bone remodeling cycle and are classified as anti-resorptive medications. Bone remodeling consists of two distinct stages: bone resorption and bone formation. During resorption, special cells on the bone's surface dissolve bone tissue and create small cavities. During formation, other cells fill the cavities with new bone tissue. Usually, bone resorption and bone formation are linked so that they occur in close sequence and remain balanced. An imbalance in the bone remodeling cycle causes bone loss that eventually leads to osteoporosis and fracture risk. Anti-resorptive medications slow or stop the bone-resorbing portion of the bone-remodeling cycle but do not slow the bone-forming portion of the cycle. As a result, new formation continues at a greater rate than bone resorption, and bone density may increase over time. Teriparatide, a form of parathyroid hormone, is a newly approved osteoporosis medication. It is the first osteoporosis medication to increase the rate of bone formation in the bone remodeling cycle. For more detailed information on the actions, administration and possible side effects for each of the following medications, please consult the Package Insert, available on-line and at pharmacies. Antiresorptive Medications Bisphosphonates Alendronate Sodium (brand name Fosamax?) Alendronate is approved for both the prevention (5 mg per day or 35 mg once a week) and treatment (10 mg per day or 70 mg once a week) of postmenopausal osteoporosis. Alendronate reduces bone loss, increases bone density and reduces the risk of spine, wrist and hip fractures. Alendronate also is approved for treatment of glucocorticoid-induced osteoporosis in men and women as a result of long-term use of these medications (i.e., prednisone and cortisone) and for the treatment of osteoporosis in men. Risedronate Sodium (brand name Actonel?) Risedronate is approved for the prevention and treatment of postmenopausal osteoporosis. Taken daily (5 mg dose) or weekly (35 mg dose), risedronate slows bone loss; increases bone density and reduces the risk of spine and non-spine fractures. Risedronate also is approved for use by men and women to prevent and/or treat glucocorticoid-induced osteoporosis that results from long-term use of these medications (i.e., prednisone or cortisone). Administration and Side Effects of Bisphosphonates Side effects for alendronate and risedronate are uncommon but may include abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus. Alendronate and risedronate must be taken on an empty stomach, first thing in the morning, with eight ounces of water (no other liquid), at least 30 minutes before eating or drinking. Patients must remain upright during this 30-minute period. Calcitonin (Brand name Miacalcin?) Calcitonin is a naturally occurring hormone involved in calcium regulation and bone metabolism. In women who are more than 5 years beyond menopause, calcitonin slows bone loss; increases spinal bone density, and, according to anecdotal reports, may relieve the pain associated with bone fractures. Calcitonin reduces the risk of spinal fractures but has not been shown to decrease the risk of non-spine fractures. Studies on fracture reduction are on going. Because calcitonin is a protein, it cannot be taken orally as it would be digested before it could work. Calcitonin is available as an injection (50-100 IU daily) or nasal spray (200 IU daily). While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea and a skin rash. Side effects for nasal calcitonin are not common but may include nasal irritation, backache, bloody nose, and headaches. Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT) (Multiple brand names are available.) On January 9th, the Food and Drug Administration (FDA) issued a statement advising women and health care professionals about important new safety changes to labeling of all estrogen and estrogen with progestin products for use by postmenopausal women. NOF is currently in the process of reviewing our materials with regard to this statement. Visit the FDA Web site at for more information about the labeling change. Estrogen replacement therapy (ERT)/Hormone replacement therapy (HRT) is approved for the prevention of osteoporosis. ERT has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spinal fractures in postmenopausal women. ERT is administered most commonly in the form of a pill or skin patch that delivers a low dose of approximately 0.3 mg daily or a standard dose of approximately 0.625 mg daily and is effective even when started after age 70. When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (hormone replacement therapy or HRT) for those women who have an intact uterus. ERT/HRT relieves menopause symptoms and has been shown to have a beneficial effect on bone health. Side effects may include vaginal bleeding, breast tenderness, mood disturbances and gallbladder disease. The Woman's Health Initiative (WHI) study recently confirmed that one type of HRT, Prempro?, reduced the risk of hip and other fractures as well as colon cancer. The WHI also confirmed that this HRT is associated with a modest increase in the risk of breast cancer, strokes, heart attacks and venous blood clots. A study from the National Cancer Institute (NCI) recently reported that long-term use of ERT may be associated with a small increase the risk of ovarian cancer. However, a meta-analysis by the Centers for Disease Control (CDC) did not find an association of either ERT or HRT with ovarian cancer. Raloxifene (Brand name Evista?) Raloxifene, 60 mg a day, is approved for the prevention and treatment of postmenopausal osteoporosis. It is from a class of drugs called Selective Estrogen Receptor Modulators (SERMs) that have been developed to provide the beneficial effects of estrogens without their potential disadvantages. Raloxifene increases bone mass and reduces the risk of spine fractures. Data are not yet available to demonstrate that raloxifene can reduce the risk of hip and other non-spine fractures. Raloxifene appears to decrease the risk of estrogen-dependent breast cancer by 65% over 4 years. While side effects were not common, those reported included hot flashes and deep vein thrombosis, the latter of which is also associated with estrogen therapy. Raloxifene is taken in pill form, once a day with or without meals. Bone Forming Medications Parathyroid Hormone (Brand name Fort?o?) Teriparatide, a form of parathyroid hormone, is approved for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. This medication stimulates new bone formation and significantly increases bone mineral density. In postmenopausal women, fracture reduction was noted in the spine, hip, foot, ribs and wrist. In men, fracture reduction was noted in the spine, but there were insufficient data to evaluate fracture reduction at other sites. Teriparatide is self- administered as a daily injection for up to 24 months. Side effects include nausea, leg cramps and dizziness. As new medications are released, I will try and update this. As with everything else here, suggestions, corrections and additions are very welcome. 2.09 Osteoporosis is often a disease that, once diagnosed, remains with the person for the remainder of their life. There is no known cure at present for this debilitating disease. 2.10 The great majority of all fractures in older women result from falls. Fall risk factors include leg weakness, impaired gait, and balance dysfunction. These can occur from global physical deconditioning as well as specific syndromes such as stroke, osteoarthritis of selective joints, and medical conditions 2.11 Yes! Osteoporosis, as a major disease, can cause depression and other problems. A patient can often be limited in what they can accomplish as well as being forced to curtail their previously normal activities. The added fact that there is no known cure is also of substance in this regard. 2.12 People do not die from Osteoporosis; but they can die of complications related to the disease. The clinical consequence of low bone mass is fracture. Pain and immobility result from fractures of the limbs and spine. Multiple vertebral fractures result in irreversible spinal deformity and chronic pain syndromes. However, hip fractures result in institutionalization and excess mortality. 2.13 PTH - called Parathormone; Parathormone (PTH) intact molecule or Parathyroid hormone is a blood serum level. This test may be performed when PTH abnormality is suspected as a cause of abnormal calcium or phosphorus levels. PTH is a protein hormone secreted by the parathyroid gland which is the most important regulator of body calcium and phosphorus. PTH: increases the calcium and phosphorus release from bone decreases the loss of calcium and increases the loss of phosphorus in the urine increases the activation of 25-hydroxy vitamin D to 1,25-dihydroxy vitamin D in the kidneys Secretion of PTH is regulated by the level of calcium in the blood. Low serum calcium causes increased PTH to be secreted, whereas increased serum calcium inhibits PTH release. Average normal levels are 10-55 pg/ml 2.14 Bones are living structures that need the mineral calcium to help them develop and stay strong. Most of the calcium in our bodies - 99 percent of it - is found in our bones. Without enough calcium, bones can become fragile and break easily with very little stress. Bioavailability refers to how well the digestive system can absorb calcium. This absorption depends on the overall level of calcium in a food and the specific type of food being eaten. Blood calcium is tested to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth. Blood calcium levels do not directly tell how much calcium is in the bones, but rather, how much total calcium or ionized calcium is circulating in the blood. Doctors can get a better picture of your health by comparing your calcium result with the results of other tests. Calcium levels in the blood are regulated and stabilized by a feedback loop that includes: calcium, PTH, vitamin D, phosphorus, and magnesium. Your doctor is looking at the balance among all of these elements. Conditions and diseases that disrupt this feedback loop can cause inappropriate elevations or decreases in calcium and lead to symptoms of hyper- or hypocalcaemia. For example, when parathyroid hormone (PTH) from the parathyroid gland is released, PTH level rises, calcium also rises, and phosphorus drops. In some kidney problems, a high phosphorus level in blood can depress calcium levels. Depending on the levels you have, these two tests can help your doctor discover whether you have a parathyroid problem or another condition. 2.15 Physical Activity and Bones In addition to a calcium-rich diet, physical activity is also very important for building healthy bones. Weight-bearing activity, such as walking or running, is one of the best forms of physical activity for bones because it makes your bones work harder. A weight-bearing physical activity is one in which your feet and legs carry your weight. The impact of this weight on your muscles helps build stronger bones. National surveys have shown that many Americans are not consuming enough calcium. Many women, in fact, consume less than half of the daily recommended amount of calcium. Recommended Calcium Intakes* Ages Amount mg/day Birth - 6 months 210 6 months - 1 year 270 1-3 500 4-8 800 9-13 1300 14-18 1300 19-30 1000 31-50 1000 51-70 1200 70 or older 1200 Pregnant & Lactating 1000 14-18 1300 19-50 1000 In 1996, the U.S. Surgeon General recommended that everyone age two or older participate in at least 30 minutes of moderate physical activity on most, preferably all, days. In 2000, the U.S. Department of Agriculture published its Dietary Guidelines for Americans (DGA), which also suggests that adults get at least 30 minutes of moderate physical activity every day. Make sure you, warm-up before doing any activity to prevent injury. Be sure that you consult a doctor or health care professional before starting any physical activity program. The following tables show the amount of calcium in a variety of foods from several food groups. Calcium amounts may vary. Check nutrition labels on products for exact amounts. Milk Group Calcium (mg) *Milk, regular or low fat, 1 cup 300 Chocolate milk, 1 cup 300 Yogurt, 1 cup 300-415 American cheese, 2 oz 348 Cheddar cheese, 1 1/2 oz 300 Cottage cheese, 1/2 cup 77 Mozzarella cheese, 1 1/2 oz 275 Parmesan cheese, 1/4 cup 338 Ricotta cheese, part skim, 1/2 cup 337 Swiss cheese, 1 1/2 oz 408 Milk shake, 10 fl oz 319-344 Ice cream, 1/2 cup 88 Ice cream, soft-serve, 1/2 cup 113 Frozen yogurt, 1/2 cup 103 Pudding, instant, 1/2 cup 151 Soy milk, calcium-fortified, 1 cup 300 Rice milk, calcium-fortified, 1 cup 300 *Low-fat milk has as much or more calcium than whole milk. Prepared Foods Calcium (mg)(Verify on label.) Bean burrito 57 Cheese enchilada 324 Cheeseburger 182 Lasagna with meat, 2 1/2 "by 2 1/2" 460 Macaroni & cheese, 1/2 cup 180 Pizza, cheese, 1 slice 220 Taco, 1 small 221 Protein Group Calcium (mg) Almonds, chopped, 1 oz 66 White beans, 1/2 cup 113 Salmon, canned with bones, 2 oz 110 Sardines, 2 oz 248 Tofu, calcium-fortified, 1 cup 260 Fruits Calcium (mg) Orange juice, calcium-fortified 300 Orange, 1 medium 50 Prunes, dried, 1/4 cup 22 Raisins, 1/4 cup 22 Vegetables Calcium (mg) Bok choy (Chinese cabbage) 1/2 cup 79 Broccoli, cooked, 1/2 cup 35 Broccoli, raw, 1 cup 35 Carrots, raw, 1 medium 27 Kale, cooked, 1/2 cup 45 Mustard greens, cooked, 1/2 cup 64 Sweet potatoes, mashed, 1/2 cup 44 Turnip greens, cooked, 1/2 cup 98 Grains Calcium (mg) (Verify on label.) Bread, whole wheat, 1 slice 25 Cereal, ready-to-eat, 1 oz 48 Farina, enriched, 1/2 cup 95 Tortilla, corn, 1 medium 60 Waffle, enriched, 4-inch 77 2.16 Exercise I. Various exercise sites 1) Http://www.stumptuous.com/weights.html this is a nice site for the basics and not-to-do's of exercise. 2) Http://www.exrx.net/exercise.html Very comprehensive with Lots of demonstrations 3) http://osu.orst.edu/dept/ncs/newsarch/2000/May00/boneloss.htm 4) http://www.weightliftingdiscussion.com/ 5) http://www.aswonline.com/ 6) http://www.jeanpaul.com/workouts.html 7) http://www.trygve.com/mfw_faq.html Caveats: First, talk to your doctor and make sure that you know what the restrictions are on your exercising 2.17 Vitamin D Vitamin D Vitamin D plays a major role in calcium absorption and bone health. The relationship between calcium absorption and vitamin D is similar to that of a locked door and a key. Vitamin D is the key that unlocks the door and allows calcium to leave the intestine and enter the bloodstream. Vitamin D also works in the kidneys to help resorb calcium that otherwise would be excreted. Vitamin D is manufactured in the skin following direct exposure to sunlight. The amount of vitamin D produced in the skin varies depending on time of day, season, latitude and skin pigmentation. Usually 10-15 minutes exposure of hands, arms and face two to three times a week (depending on one's skin sensitivity) is enough to satisfy the body's vitamin D requirement. Use of sunscreen markedly diminishes the manufacture of vitamin D in the skin, as do window glass, clothing and air pollution. Skin color also affects vitamin D production; the fairer you are, the more you make. As adults age, the ability to make vitamin D through the skin decreases. People who are housebound and experience no sunlight exposure are unable to make vitamin D. Experts recommend a daily intake of between 400 and 800 international units (IU). Do not take more than 800 IU per day unless your doctor prescribes it, since massive doses of vitamin D may be harmful. The U.S. State of Nevada recently addressed this disease openly. http://gov.state.nv.us/PROCLAMATIONS/5-11Osteoporosis.htm is worth reading. There are several very informative websites that I would recommend and many were used in the assembly of this FAQ. National Osteoporosis Foundation: www.nof.org Foundation for Osteoporosis Research and Education: www.FORE.org National Osteoporosis Society: www.nos.org.uk Osteoporosis Learning Project: http://www.jmadura.com/www.betterbones.com/rethinking U.S. National Institute of Health http://www.jmadura.com/www.osteo.org/ International Osteoporosis Foundation http://www.jmadura.com/www.osteofound.org/ University of Washington http://courses.washington.edu/bonephys/ophome.html University of Washington School of Medicine http://uwcme.org/courses/bonephys/index.html Duke University http://www.geri.duke.edu/pepper/osteocurriculum/index.html National Library of Medicine http://www.ncbi.nlm.nih.gov/entrez/query.fcgi National Institute of Health http://www.nlm.nih.gov/medlineplus/ Medline (Web-Md) http://www.medscape.com/ Google message /answer search Http://groups.google.com/advanced_group_search
From: Sammy on 9 Jul 2005 13:07 I don't have a clue where these are. Did you say that the moderator posts them every so often? Why don't we do top posting. That way if we just read a comment, then we just click on the next person, and we can read the reply without having to scroll? Sammy "Art S" <thedabbler02(a)earthlink.net> wrote in message news:%wKze.3$oZ.1(a)newsread2.news.atl.earthlink.net... > > > Frequently Asked Questions (FAQ) for sci.med.diseases.osteoporosis. > > 10/17/2003 > > > > This posting describes the newsgroup Sci.med.diseases.osteoporosis > newsgroup as well as other sources about this disease. It should be > read by anyone who wishes to post in this newsgroup. > > > > Osteoporosis is a disease that can strike most anyone but is > rarely diagnosed early. It is treatable. > > > > Table Of Contents > > Part 0: Administrative Issues > > 0.00 Introduction > 0.01 Disclaimer > 0.02 Where to get the current version of this FAQ > 0.03 Newsgroup Etiquette > > Part 1: General Information > > 1.01 What is Osteoporosis? > 1.02 How widespread is Osteoporosis? > > Part 2: Medical Issues > > 2.01 Am I at risk for developing Osteoporosis > 2.02 Do I have Osteoporosis? > 2.03 Explain Bone Densitometry and the DXA scan. > 2.04 How do I find good medical care for Osteoporosis > disease? > 2.05 What symptoms are used to diagnose Osteoporosis > disease? > 2.06 What tests are used to support a clinical diagnosis > of Osteoporosis? > 2.07 Can Osteoporosis be prevented? > 2.08 What treatments are available to combat this > disease? > 2.09 How long does Osteoporosis last? > 2.10 Do falls increase the dangers of Osteoporosis? > 2.11 Can Osteoporosis disease cause depression or other > psychiatric disorders? > 2.12 Can people die from Osteoporosis disease? > 2.13 Explain PTH (Parathyroid) and how it affects > Osteoporosis. > 2.14 Discuss calcium. > 2.15 Explain how exercise helps build bone density. > 2.16 Osteoporosis friendly Exercises > 2.17 Explain the importance of Vitamin D related to > calcium and bones. > > Administrative Issues > > > Part 0.00 Introduction > > Information in the Osteoporosis disease FAQ, version 1.5, > September 15, 2003, was compiled by John Madura and others > and was created on behalf of the Osteoporosis disease newsgroup: > sci.med.diseases.osteoporosis. Readers may redistribute or quote > this document for non-commercial purposes provided that they > include: an attribution to sci.med.diseases.osteoporosis; and the > website where this FAQ may be retrieved. Please direct all > corrections, additions or comments to John at n2rdv(a)Optonline.net > > This document answers Frequently Asked Questions (FAQ) about > Osteoporosis The newsgroup sci.med.diseases.osteoporosis is > intended for discussion about many aspects of Osteoporosis, as > experienced by patients, their caregivers, friends and family > members, doctors and other medical professionals involved with > the illness. It is particularly helpful for those who wish to > learn about Osteoporosis symptoms, treatment options, and > prevention strategies. > > Anyone with an interest in Osteoporosis disease is free to post, > as this newsgroup is designed to foster dialogue between > Osteoporosis disease patients from all parts of the world, and > provide an open forum for the exchange of international medical, > scientific, and lay information. Constructive criticism and > on-topic debate, general understanding and support, are encouraged. > > > Posts are to be limited to osteoporosis only. > Absolutely NO sales or off-topic posts are permitted. All such > posts will be reported. > > Topics discussed include: > > * Questions regarding any aspect of Osteoporosis > * Disease symptoms, presentations > * Current research findings > * Current treatments, both conventional and alternative > * Coping strategies > * Social and political issues regarding Osteoporosis > * Insurance and disability issues regarding Osteoporosis > > Material PROHIBITED includes: > > > * Commercial advertisements > * Flames, spam, name-calling, discrimination, and abusive > behavior > > 0.01 Disclaimer > > > The information in this FAQ is developed and provided by patients. > It represents an accumulation of knowledge by people who are for > the most part NOT medical professionals. As useful as the material > presented in this FAQ may be, it must NOT be considered to be > medical advice, and must NOT be used as a substitute for medical > advice. It is important that anyone who has, or thinks he/she may > have Osteoporosis, should consult with a licensed health care > practitioner who is familiar with the illness. Your primary > physician should be your first contact but past that the medical > specialty that is associated with Osteoporosis are the > Endocrinologists. > > > > 0.02 FAQ Availability > > > > This FAQ is posted regularly to the newsgroup: > Sci.med.diseases.osteoporosis and is also available at > www.jmadura.com/osteofaq.htm > > > 0.03 Etiquette > > Newsgroups are like self-governing communities; there are no > "Newsgroup Cops." Instead, posters regulate themselves. Below are > some simple rules of newsgroup etiquette to understand before you > venture into a newsgroup. Think of newsgroup etiquette as a set > of guidelines that will keep you from making mistakes and make > you look and sound like a veteran newsgroup poster. > > Lurk. Read the newsgroup without posting for a few weeks. This > is known as "lurking," and it will give you the flavor of the > newsgroup. > > Read the FAQ. Find and read the newsgroup's FAQ, or list of > Frequently Asked Questions and other important and useful > information. It can answer questions you didn't even know you > had, and it's the quickest way to learn a newsgroup. > > Stay on-topic. Know what's on-topic and what's off-limits. Every > newsgroup is a little different in what it talks about, and how > it does the talking. > > DON'T SHOUT. TYPING IN ALL CAPS IS CONSIDERED SHOUTING. It's > easier to read a mix of upper- and lower-case letters. > > Never, ever post "MAKE MONEY FAST." It doesn't work, it gets > people really mad, and no matter what it says, it's probably > illegal. > > Everyone hates commercials. Be very hesitant about posting > advertisements or commercial messages. This also gets people > really mad. > > Ignore "trolls." Some people get a thrill from posting "flames" > (really obnoxious messages) just to get a rise out of people. > Sad, isn't it? > > Don't "spam." Spam is posting the same message to dozens, even > hundreds or thousands of unrelated newsgroups. No matter how > important you think your message may be, it's not worth it. Think > about it - if everyone posted about every topic, no one would be > able to find anything. > > Be Original. Don't over quote: Copying a long post (more than 20 > lines) just to add "I agree" or "me too" is considered bad form. > > The Golden Rule: Do unto others as you would have them do unto > you. Remember, every expert was a newbie once. > > Write Conservatively, read forgivingly. Communication in a pure > text medium, such as a newsgroup, is prone to misunderstanding, > often due to the lack of non-verbal cues such as inflections, > facial expression and body language. Given this, it is best to > be conservative with expressions of anger and sarcasm when > writing. When reading, assume good intent; if a message can be > taken two ways, assume the friendliest meaning. > > Keep quoted text to a minimum. When quoting a previous post, > edit out the non-relevant parts of the message. Remove > salutations and signatures. A good rule of thumb is, there > should not be more quoted text than new text. > > Please, please, please trim replies of irrelevant content and > post your reply either immediately after the sentence being > replied to or at the bottom of the post. Some of our users are > from far away where phone access is quite expensive. > > > > > 1.01 What is Osteoporosis? > > Osteoporosis is a skeletal disease characterized by low bone mass, > and the deterioration of bone architecture leading to bone > fragility and increased risk of fracture. Bone normally > rejuvenates itself through a process of bone absorption and > formation called bone remodeling. Osteoporosis occurs when bone > breakdown, or absorption, occurs at a rate greater than bone > formation. If not prevented or if left untreated, osteoporosis can > progress painlessly until a bone breaks. These broken bones, also > known as fractures, occur typically in the hip, spine, and wrist. > Any bone can be affected, but of special concern are fractures of > the hip and spine. A hip fracture almost always requires > hospitalization and major surgery. It can impair a person's > ability to walk unassisted and may cause prolonged or permanent > disability or even death. Spinal or vertebral fractures also have > serious consequences, including loss of height, severe back pain, > and deformity. > > > > The World Health Organization defined osteoporosis as bone mineral > density 2.5 or more SD below peak bone mass, osteopenia as bone > mass between 1.0 and 2.5 SD below peak, and normal as 1.0 SD below > normal peak bone mass or higher. However, the WHO criteria apply > only to Caucasian, postmenopausal women, and not men, premenopausal > women, or women of ethnicity other than Caucasian. We have yet to > classify clinically significant low bone mass in this populations. > (see 2.02 below) > > > > Osteoporosis has often been called the "silent disease," because > it doesn't produce symptoms until a fracture occurs > > > > > 1.02 > > > > Osteoporosis is a very widespread disease that affects women four > times more often then men. Osteoporosis and low bone mass are > currently estimated to be a major public health threat for almost > 44 million US women and men aged 50 and over. A women's risk of > hip fracture is equal to her combined risk of breast, uterine and > ovarian cancer. Worldwide the statistics show this to be a major > disease. Using the World Health Organization criteria, 30% of > Caucasian postmenopausal women in the US have osteoporosis, and > 54% have osteopenia. The prevalence of low bone mass increases > with age. > > > > > > > > 2.01 > > > > There are many factors that can increase a person's risk of > osteoporosis. A few of the risk factors are: > > Postmenopausal (female) > Ethnicity-Caucasian and Asian > Family history > Petite, small frame > Eating disorders > Caffeine > Smoking > Excessive use of alcohol > Vitamin D deficiency > Inactivity > Thyroid disease > Chronic steroid use > > Peak bone mass occurs for both men and women by the early thirties. > Genetic factors play the greatest role in determining peak bone > mass, but there are clinically significant contributions from > nutrition, drug exposures, endocrine health following puberty, and > weight-bearing status (ref 4). For example, most teenagers and > young adults do not receive the Recommended Daily Allowance (RDA) > for calcium of 1200 mg. Smoking and excessive alcohol use > contribute to low bone mass. Systemic glucocorticoid use of 7.5 > mg daily or greater impairs bone formation. Phenytoin and other > anti-seizure medications impair vitamin D metabolism. > Oligomenorrhea and amenorrhea cause accelerated bone loss, as do > hyperthyroidism or over-replacement of thyroxine supplementation > such that the serum TSH is suppressed. Immobility is associated > with thinning of the bone from lack of weight-bearing forces > > > 2.02 > > In order to demonstrate bone loss, a bone scan would need to be > performed. The most common type of bone scan is a DEXA test. > > 2.03 > > > A bone scan (DXA or DEXA) is an x-ray that can show bone loss in > the spine and hip area. The test takes about 10-20 minutes. A > bone mineral density (BMD) test is a special type of test that is > accurate, painless and noninvasive. For every one standard > deviation below peak bone mass the risk of vertebral fracture is > two times that of normal bone mass, and for the hip, the risk is > 2.5 times. Measurement of the bone mass of the lumbar spine and > hip are currently used for diagnostic purposes and monitoring of > treatment. Peripheral sites such as wrist and heel can be useful > screening tools in older individuals; however there is > discordance between bone sites in rates of loss with aging. Thus, > many newly postmenopausal women will have a normal bone mass of > the heel, and yet have clinical significant low bone mass of the > spine. The FDA recently approved ultrasound techniques for use > as a screening test for low bone mass.(ref 14) Currently, the > different manufacturers of bone densitometers all use different > reference populations from which the standard deviations from > normal are calculated, also called T scores. There are > differences in calibration between companies as well, so that > an individual patient's bone density reading can differ by as > much as 12% from one machine to the next. Thus, to monitor a > patient's response to treatment, the same bone densitometer must > be used. > > > > 2.04 > > There is no physician specialty dedicated to osteoporosis, nor > is there a certification program for health professionals who > treat the disease. Therefore, a variety of medical specialists > are treating people with osteoporosis, including internists, > gynecologists, family physicians, endocrinologists, > rheumatologists, physiatrists and orthopedists. Endocrinologists > are the specialist most often found treating this disease and > for the record, they treat the endocrine system, which comprises > the glands and hormones that help control the body's metabolic > activity. In addition to osteoporosis, endocrinologists also may > treat diabetes, thyroid and pituitary diseases. > > 2.05 > > It is hard to diagnose Osteoporosis without a DXA scan but > unexplained fractures in an elderly person could be a warning > sign. > > 2.06 > > There are other tests that the treating physician can perform to > help treat osteoporosis. 24 hour urine tests as well as blood > tests give indications that are helpful in treating this disease. > > > > 2.07 > > Osteoporosis is largely preventable for most people. Prevention > of this disease is very important because, while there are > treatments for osteoporosis, there is currently no cure. There > are four steps to prevent osteoporosis. No one step alone is > enough to prevent osteoporosis but all four may. They are: > > A balanced diet rich in calcium and vitamin D > Weight-bearing exercise > A healthy lifestyle with no smoking or excessive alcohol use > And bone density testing and medications when appropriate > > > 2.08 > > Although there is no cure for osteoporosis, currently > bisphosphonates (alendronate and risedronate), calcitonin, > estrogens, parathyroid hormone and raloxifene are approved by the > US Food and Drug Administration (FDA) for the prevention and/or > treatment of osteoporosis. Adequate calcium, vitamin D, > appropriate exercise and, in some cases, medication are important > for maintaining bone health. Currently, bisphosphonates > (alendronate and risedronate), calcitonin, estrogens, parathyroid > hormone and raloxifene are approved by the US Food and Drug > Administration (FDA) for the prevention and/or treatment of > osteoporosis. > > The bisphosphonates (alendronate and risedronate), calcitonin, > estrogens and raloxifene affect the bone remodeling cycle and are > classified as anti-resorptive medications. Bone remodeling > consists of two distinct stages: bone resorption and bone > formation. During resorption, special cells on the bone's surface > dissolve bone tissue and create small cavities. During formation, > other cells fill the cavities with new bone tissue. Usually, bone > resorption and bone formation are linked so that they occur in > close sequence and remain balanced. An imbalance in the bone > remodeling cycle causes bone loss that eventually leads to > osteoporosis and fracture risk. Anti-resorptive medications slow > or stop the bone-resorbing portion of the bone-remodeling cycle > but do not slow the bone-forming portion of the cycle. As a result, > new formation continues at a greater rate than bone resorption, and > bone density may increase over time. > > Teriparatide, a form of parathyroid hormone, is a newly approved > osteoporosis medication. It is the first osteoporosis medication to > increase the rate of bone formation in the bone remodeling cycle. > > For more detailed information on the actions, administration and > possible side effects for each of the following medications, please > consult the Package Insert, available on-line and at pharmacies. > > Antiresorptive Medications > > Bisphosphonates > Alendronate Sodium (brand name Fosamax?) > > Alendronate is approved for both the prevention (5 mg per day or > 35 mg once a week) and treatment (10 mg per day or 70 mg once a > week) of postmenopausal osteoporosis. Alendronate reduces bone > loss, increases bone density and reduces the risk of spine, wrist > and hip fractures. > > Alendronate also is approved for treatment of glucocorticoid-induced > osteoporosis in men and women as a result of long-term use of these > medications (i.e., prednisone and cortisone) and for the treatment > of osteoporosis in men. > > Risedronate Sodium (brand name Actonel?) > > Risedronate is approved for the prevention and treatment of > postmenopausal osteoporosis. Taken daily (5 mg dose) or weekly > (35 mg dose), risedronate slows bone loss; increases bone density > and reduces the risk of spine and non-spine fractures. > > Risedronate also is approved for use by men and women to prevent > and/or treat glucocorticoid-induced osteoporosis that results from > long-term use of these medications (i.e., prednisone or cortisone). > > Administration and Side Effects of Bisphosphonates > > Side effects for alendronate and risedronate are uncommon but may > include abdominal or musculoskeletal pain, nausea, heartburn, or > irritation of the esophagus. > > Alendronate and risedronate must be taken on an empty stomach, > first thing in the morning, with eight ounces of water (no other > liquid), at least 30 minutes before eating or drinking. Patients > must remain upright during this 30-minute period. > > Calcitonin > (Brand name Miacalcin?) > > Calcitonin is a naturally occurring hormone involved in calcium > regulation and bone metabolism. In women who are more than 5 > years beyond menopause, calcitonin slows bone loss; increases > spinal bone density, and, according to anecdotal reports, may > relieve the pain associated with bone fractures. Calcitonin > reduces the risk of spinal fractures but has not been shown to > decrease the risk of non-spine fractures. Studies on fracture > reduction are on going. Because calcitonin is a protein, it > cannot be taken orally as it would be digested before it could > work. Calcitonin is available as an injection (50-100 IU daily) > or nasal spray (200 IU daily). > > While it does not affect other organs or systems in the body, > injectable calcitonin may cause an allergic reaction and > unpleasant side effects including flushing of the face and hands, > urinary frequency, nausea and a skin rash. Side effects for nasal > calcitonin are not common but may include nasal irritation, > backache, bloody nose, and headaches. > > Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy > (HRT) (Multiple brand names are available.) > > On January 9th, the Food and Drug Administration (FDA) issued a > statement advising women and health care professionals about > important new safety changes to labeling of all estrogen and > estrogen with progestin products for use by postmenopausal women. > NOF is currently in the process of reviewing our materials with > regard to this statement. Visit the FDA Web site at for more > information about the labeling change. > > Estrogen replacement therapy (ERT)/Hormone replacement therapy > (HRT) is approved for the prevention of osteoporosis. ERT has > been shown to reduce bone loss, increase bone density in both > the spine and hip, and reduce the risk of hip and spinal > fractures in postmenopausal women. ERT is administered most > commonly in the form of a pill or skin patch that delivers a > low dose of approximately 0.3 mg daily or a standard dose of > approximately 0.625 mg daily and is effective even when started > after age 70. > > When estrogen is taken alone, it can increase a woman's risk of > developing cancer of the uterine lining (endometrial cancer). > To eliminate this risk, physicians prescribe the hormone > progestin in combination with estrogen (hormone replacement > therapy or HRT) for those women who have an intact uterus. ERT/HRT > relieves menopause symptoms and has been shown to have a beneficial > effect on bone health. Side effects may include vaginal bleeding, > breast tenderness, mood disturbances and gallbladder disease. > > The Woman's Health Initiative (WHI) study recently confirmed that > one type of HRT, Prempro?, reduced the risk of hip and other > fractures as well as colon cancer. The WHI also confirmed that this > HRT is associated with a modest increase in the risk of breast > cancer, strokes, heart attacks and venous blood clots. > > A study from the National Cancer Institute (NCI) recently reported > that long-term use of ERT may be associated with a small increase > the risk of ovarian cancer. However, a meta-analysis by the Centers > for Disease Control (CDC) did not find an association of either > ERT or HRT with ovarian cancer. > > Raloxifene > (Brand name Evista?) > > Raloxifene, 60 mg a day, is approved for the prevention and > treatment of postmenopausal osteoporosis. It is from a class of > drugs called Selective Estrogen Receptor Modulators (SERMs) that > have been developed to provide the beneficial effects of estrogens > without their potential disadvantages. Raloxifene increases bone > mass and reduces the risk of spine fractures. Data are not yet > available to demonstrate that raloxifene can reduce the risk of > hip and other non-spine fractures. > > Raloxifene appears to decrease the risk of estrogen-dependent > breast cancer by 65% over 4 years. > > While side effects were not common, those reported included hot > flashes and deep vein thrombosis, the latter of which is also > associated with estrogen therapy. Raloxifene is taken in pill > form, once a day with or without meals. > > Bone Forming Medications > > Parathyroid Hormone > (Brand name Fort?o?) > > Teriparatide, a form of parathyroid hormone, is approved for the > treatment of osteoporosis in postmenopausal women and men who are > at high risk for a fracture. This medication stimulates new bone > formation and significantly increases bone mineral density. In > postmenopausal women, fracture reduction was noted in the spine, > hip, foot, ribs and wrist. In men, fracture reduction was noted > in the spine, but there were insufficient data to evaluate > fracture reduction at other sites. Teriparatide is self- > administered as a daily injection for up to 24 months. > > Side effects include nausea, leg cramps and dizziness. > > > > As new medications are released, I will try and update this. As > with everything else here, suggestions, corrections and additions > are very welcome. > > > > 2.09 > > Osteoporosis is often a disease that, once diagnosed, remains > with the person for the remainder of their life. There is no > known cure at present for this debilitating disease. > > 2.10 > > The great majority of all fractures in older women result from > falls. Fall risk factors include leg weakness, impaired gait, > and balance dysfunction. These can occur from global physical > deconditioning as well as specific syndromes such as stroke, > osteoarthritis of selective joints, and medical conditions > > 2.11 > > Yes! Osteoporosis, as a major disease, can cause depression > and other problems. A patient can often be limited in what they > can accomplish as well as being forced to curtail their > previously normal activities. The added fact that there is no > known cure is also of substance in this regard. > > > > 2.12 > > People do not die from Osteoporosis; but they can die of > complications related to the disease. The clinical consequence of > low bone mass is fracture. Pain and immobility result from fractures > of the limbs and spine. Multiple vertebral fractures result in > irreversible spinal deformity and chronic pain syndromes. However, > hip fractures result in institutionalization and excess mortality. > > 2.13 > > PTH - called Parathormone; Parathormone (PTH) intact molecule or > Parathyroid hormone is a blood serum level. This test may be > performed when PTH abnormality is suspected as a cause of abnormal > calcium or phosphorus levels. > > PTH is a protein hormone secreted by the parathyroid gland which > is the most important regulator of body calcium and phosphorus. > > PTH: > > increases the calcium and phosphorus release from bone > > decreases the loss of calcium and increases the loss of phosphorus > in the urine > > increases the activation of 25-hydroxy vitamin D to 1,25-dihydroxy > vitamin D in the kidneys > > Secretion of PTH is regulated by the level of calcium in the blood. > Low serum calcium causes increased PTH to be secreted, whereas > increased serum calcium inhibits PTH release. Average normal > levels are 10-55 pg/ml > > > > 2.14 > > Bones are living structures that need the mineral calcium to help > them develop and stay strong. Most of the calcium in our bodies - > 99 percent of it - is found in our bones. Without enough calcium, > bones can become fragile and break easily with very little stress. > > Bioavailability refers to how well the digestive system can absorb > calcium. This absorption depends on the overall level of calcium > in a food and the specific type of food being eaten. > > Blood calcium is tested to screen for, diagnose, and monitor a > range of conditions relating to the bones, heart, nerves, kidneys, > and teeth. Blood calcium levels do not directly tell how much > calcium is in the bones, but rather, how much total calcium or > ionized calcium is circulating in the blood. > > Doctors can get a better picture of your health by comparing your > calcium result with the results of other tests. Calcium levels in > the blood are regulated and stabilized by a feedback loop that > includes: calcium, PTH, vitamin D, phosphorus, and magnesium. Your > doctor is looking at the balance among all of these elements. > Conditions and diseases that disrupt this feedback loop can cause > inappropriate elevations or decreases in calcium and lead to > symptoms of hyper- or hypocalcaemia. For example, when parathyroid > hormone (PTH) from the parathyroid gland is released, PTH level > rises, calcium also rises, and phosphorus drops. In some kidney > problems, a high phosphorus level in blood can depress calcium > levels. Depending on the levels you have, these two tests can help > your doctor discover whether you have a parathyroid problem or > another condition. > > > > 2.15 > > > > > > Physical Activity and Bones > > In addition to a calcium-rich diet, physical activity is also very > important for building healthy bones. Weight-bearing activity, such > as walking or running, is one of the best forms of physical activity > for bones because it makes your bones work harder. A weight-bearing > physical activity is one in which your feet and legs carry your > weight. The impact of this weight on your muscles helps build stronger > bones. > > National surveys have shown that many Americans are not consuming > enough calcium. Many women, in fact, consume less than half of the > daily recommended amount of calcium. > > Recommended Calcium Intakes* > > Ages Amount mg/day > Birth - 6 months 210 > 6 months - 1 year 270 > 1-3 500 > 4-8 800 > 9-13 1300 > 14-18 1300 > 19-30 1000 > 31-50 1000 > 51-70 1200 > 70 or older 1200 > > > > Pregnant & Lactating 1000 > 14-18 1300 > 19-50 1000 > > > > > In 1996, the U.S. Surgeon General recommended that everyone age > two or older participate in at least 30 minutes of moderate > physical activity on most, preferably all, days. In 2000, the > U.S. Department of Agriculture published its Dietary Guidelines > for Americans (DGA), which also suggests that adults get at least > 30 minutes of moderate physical activity every day. Make sure you, > warm-up before doing any activity to prevent injury. Be sure that > you consult a doctor or health care professional before starting > any physical activity program. > > The following tables show the amount of calcium in a variety of > foods from several food groups. Calcium amounts may vary. Check > nutrition labels on products for exact amounts. > > Milk Group > Calcium (mg) > > *Milk, regular or low fat, 1 cup > 300 > > Chocolate milk, 1 cup > 300 > > Yogurt, 1 cup > 300-415 > > American cheese, 2 oz > 348 > > Cheddar cheese, 1 1/2 oz > 300 > > Cottage cheese, 1/2 cup > 77 > > Mozzarella cheese, 1 1/2 oz > 275 > > Parmesan cheese, 1/4 cup > 338 > > Ricotta cheese, part skim, 1/2 cup > 337 > > Swiss cheese, 1 1/2 oz > 408 > > Milk shake, 10 fl oz > 319-344 > > Ice cream, 1/2 cup > 88 > > Ice cream, soft-serve, 1/2 cup > 113 > > Frozen yogurt, 1/2 cup > 103 > > Pudding, instant, 1/2 cup > 151 > > Soy milk, calcium-fortified, 1 cup > 300 > > Rice milk, calcium-fortified, 1 cup > 300 > > *Low-fat milk has as much or more calcium than whole milk. > > > > > Prepared Foods > Calcium (mg)(Verify on label.) > > Bean burrito > 57 > > Cheese enchilada > 324 > > Cheeseburger > 182 > > Lasagna with meat, 2 1/2 "by 2 1/2" > 460 > > Macaroni & cheese, 1/2 cup > 180 > > Pizza, cheese, 1 slice > 220 > > Taco, 1 small > 221 > > > > > Protein Group > Calcium (mg) > > Almonds, chopped, 1 oz > 66 > > White beans, 1/2 cup > 113 > > Salmon, canned with bones, 2 oz > 110 > > Sardines, 2 oz > 248 > > Tofu, calcium-fortified, 1 cup > 260 > > > > > Fruits > Calcium (mg) > > Orange juice, calcium-fortified > 300 > > Orange, 1 medium > 50 > > Prunes, dried, 1/4 cup > 22 > > Raisins, 1/4 cup > 22 > > > > > Vegetables > Calcium (mg) > > Bok choy (Chinese cabbage) 1/2 cup > 79 > > Broccoli, cooked, 1/2 cup > 35 > > Broccoli, raw, 1 cup > 35 > > Carrots, raw, 1 medium > 27 > > Kale, cooked, 1/2 cup > 45 > > Mustard greens, cooked, 1/2 cup > 64 > > Sweet potatoes, mashed, 1/2 cup > 44 > > Turnip greens, cooked, 1/2 cup > 98 > > > > > Grains > Calcium (mg) (Verify on label.) > > Bread, whole wheat, 1 slice > 25 > > Cereal, ready-to-eat, 1 oz > 48 > > Farina, enriched, 1/2 cup > 95 > > Tortilla, corn, 1 medium > 60 > > Waffle, enriched, 4-inch > 77 > > > > > 2.16 Exercise > > > > I. Various exercise sites > > 1) Http://www.stumptuous.com/weights.html this is a nice site for > the basics and not-to-do's of exercise. > > 2) Http://www.exrx.net/exercise.html Very comprehensive with Lots > of demonstrations > > 3) http://osu.orst.edu/dept/ncs/newsarch/2000/May00/boneloss.htm > > 4) http://www.weightliftingdiscussion.com/ > > 5) http://www.aswonline.com/ > > 6) http://www.jeanpaul.com/workouts.html > > 7) http://www.trygve.com/mfw_faq.html > > > > > > Caveats: > > > > First, talk to your doctor and make sure that you know > > what the restrictions are on your exercising > > 2.17 Vitamin D > > Vitamin D > > Vitamin D plays a major role in calcium absorption and bone > health. The relationship between calcium absorption and vitamin > D is similar to that of a locked door and a key. Vitamin D is > the key that unlocks the door and allows calcium to leave the > intestine and enter the bloodstream. Vitamin D also works in the > kidneys to help resorb calcium that otherwise would be excreted. > > Vitamin D is manufactured in the skin following direct exposure > to sunlight. The amount of vitamin D produced in the skin varies > depending on time of day, season, latitude and skin pigmentation. > Usually 10-15 minutes exposure of hands, arms and face two to > three times a week (depending on one's skin sensitivity) is > enough to satisfy the body's vitamin D requirement. Use of > sunscreen markedly diminishes the manufacture of vitamin D in the skin, as > do window glass, clothing and air pollution. > Skin color also affects vitamin D production; the fairer you are, > the more you make. > > As adults age, the ability to make vitamin D through the skin > decreases. People who are housebound and experience no sunlight > exposure are unable to make vitamin D. > > Experts recommend a daily intake of between 400 and 800 > international units (IU). Do not take more than 800 IU per day > unless your doctor prescribes it, since massive doses of vitamin > D may be harmful. > > > > The U.S. State of Nevada recently addressed this disease openly. > http://gov.state.nv.us/PROCLAMATIONS/5-11Osteoporosis.htm is worth > reading. > > > > There are several very informative websites that I would recommend and > many were used in the assembly of this FAQ. > > National Osteoporosis Foundation: www.nof.org > Foundation for Osteoporosis Research and Education: www.FORE.org > National Osteoporosis Society: www.nos.org.uk > Osteoporosis Learning Project: > http://www.jmadura.com/www.betterbones.com/rethinking > U.S. National Institute of Health http://www.jmadura.com/www.osteo.org/ > International Osteoporosis Foundation > http://www.jmadura.com/www.osteofound.org/ > University of Washington > http://courses.washington.edu/bonephys/ophome.html > University of Washington School of Medicine > http://uwcme.org/courses/bonephys/index.html > Duke University http://www.geri.duke.edu/pepper/osteocurriculum/index.html > National Library of Medicine http://www.ncbi.nlm.nih.gov/entrez/query.fcgi > National Institute of Health http://www.nlm.nih.gov/medlineplus/ > Medline (Web-Md) http://www.medscape.com/ > Google message /answer search > Http://groups.google.com/advanced_group_search > > > > > >
From: Art S on 9 Jul 2005 14:52 "Sammy" <rstevrock(a)cox.net> wrote in message news:VuTze.113321$yV4.52722(a)okepread03... >I don't have a clue where these are. Did you say that the moderator posts them every so often? > Unfortunately, he doesn't. Once I have an updated FAQ, I will attempt to post it periodically. > Why don't we do top posting. That way if we just read a comment, then we just click on the next > person, and we can read the reply without having to scroll? A couple reasons: 1) not all ISP's get all posts. If your ISP doesn't get someone's posts and you are trying to follow a conversation that they are in, you will be continually scrolling down and up trying to follow the conversation. 2) some people (myself included) look at quite a few news groups. That makes it harder for them to see post and know immediately what it is in response to. If posts are snipped and responses after the sentence(s) that prompted them, it is easier for someone to refresh their memory and then continue reading the response. 3) most people that top-post don't bother to snip now unnecessary verbage. That makes it take longer for other people to download the post. In my case, when I moved to where I am now, I was stuck using a dial-up line that never went above 34 kbs. Cable isn't available. DSL wasn't available. I typically started messages downloading and then walked away for 10 minutes. In addition, in some foreign countries (at least the last I heard), people couldn't get "unlimited local calling" - they needed to pay for every minute of the connection. As the joke goes: > A: Because it messes up the order in which people normally read text. > Q: Why is top-posting such a bad thing? > A: Top-posting. > Q: What is the most annoying thing on usenet and in e-mail? Art
From: Sammy on 9 Jul 2005 17:15 "Art S" <thedabbler02(a)earthlink.net> wrote in message news:k1Vze.20169$eM6.11779(a)newsread3.news.atl.earthlink.net... > > "Sammy" <rstevrock(a)cox.net> wrote in message > news:VuTze.113321$yV4.52722(a)okepread03... >>I don't have a clue where these are. Did you say that the moderator posts >>them every so often? >> > > Unfortunately, he doesn't. Once I have an updated FAQ, I will attempt > to post it periodically. > >> Why don't we do top posting. That way if we just read a comment, then we >> just click on the next person, and we can read the reply without having >> to scroll? > > A couple reasons: > 1) not all ISP's get all posts. If your ISP doesn't get someone's posts > and > you are trying to follow a conversation that they are in, you will be > continually scrolling down and up trying to follow the conversation. > 2) some people (myself included) look at quite a few news groups. That > makes it harder for them to see post and know immediately what it is > in response to. If posts are snipped and responses after the > sentence(s) > that prompted them, it is easier for someone to refresh their memory > and then continue reading the response. > 3) most people that top-post don't bother to snip now unnecessary > verbage. > That makes it take longer for other people to download the post. In > my > case, when I moved to where I am now, I was stuck using a dial-up > line > that never went above 34 kbs. Cable isn't available. DSL wasn't > available. > I typically started messages downloading and then walked away for 10 > minutes. In addition, in some foreign countries (at least the last I > heard), > people couldn't get "unlimited local calling" - they needed to pay > for every > minute of the connection. > > As the joke goes: > >> A: Because it messes up the order in which people normally read text. >> Q: Why is top-posting such a bad thing? >> A: Top-posting. >> Q: What is the most annoying thing on usenet and in e-mail? > > Art > OK Sammy
From: jon on 9 Jul 2005 19:26 Hello Folks, I have had a rough year so far but will be back to help this group again. THe FAQ was on my website for many years but during my most recent hospital stay, my subscription expired so i will have to get a new website and - then update and repost the FAQ. AS always i am open to any and all suggestions. Sincerely John M On Sat, 09 Jul 2005 06:54:51 GMT, "Art S" <thedabbler02(a)earthlink.net> wrote: > > >Frequently Asked Questions (FAQ) for sci.med.diseases.osteoporosis. > >10/17/2003 > > > >This posting describes the newsgroup Sci.med.diseases.osteoporosis >newsgroup as well as other sources about this disease. It should be >read by anyone who wishes to post in this newsgroup. > > > >Osteoporosis is a disease that can strike most anyone but is >rarely diagnosed early. It is treatable. > > > >Table Of Contents > > Part 0: Administrative Issues > > 0.00 Introduction > 0.01 Disclaimer > 0.02 Where to get the current version of this FAQ > 0.03 Newsgroup Etiquette > > Part 1: General Information > > 1.01 What is Osteoporosis? > 1.02 How widespread is Osteoporosis? > > Part 2: Medical Issues > > 2.01 Am I at risk for developing Osteoporosis > 2.02 Do I have Osteoporosis? > 2.03 Explain Bone Densitometry and the DXA scan. > 2.04 How do I find good medical care for Osteoporosis > disease? > 2.05 What symptoms are used to diagnose Osteoporosis > disease? > 2.06 What tests are used to support a clinical diagnosis > of Osteoporosis? > 2.07 Can Osteoporosis be prevented? > 2.08 What treatments are available to combat this > disease? > 2.09 How long does Osteoporosis last? > 2.10 Do falls increase the dangers of Osteoporosis? > 2.11 Can Osteoporosis disease cause depression or other > psychiatric disorders? > 2.12 Can people die from Osteoporosis disease? > 2.13 Explain PTH (Parathyroid) and how it affects > Osteoporosis. > 2.14 Discuss calcium. > 2.15 Explain how exercise helps build bone density. > 2.16 Osteoporosis friendly Exercises > 2.17 Explain the importance of Vitamin D related to > calcium and bones. > >Administrative Issues > > >Part 0.00 Introduction > >Information in the Osteoporosis disease FAQ, version 1.5, >September 15, 2003, was compiled by John Madura and others >and was created on behalf of the Osteoporosis disease newsgroup: >sci.med.diseases.osteoporosis. Readers may redistribute or quote >this document for non-commercial purposes provided that they >include: an attribution to sci.med.diseases.osteoporosis; and the >website where this FAQ may be retrieved. Please direct all >corrections, additions or comments to John at n2rdv(a)Optonline.net > >This document answers Frequently Asked Questions (FAQ) about >Osteoporosis The newsgroup sci.med.diseases.osteoporosis is >intended for discussion about many aspects of Osteoporosis, as >experienced by patients, their caregivers, friends and family >members, doctors and other medical professionals involved with >the illness. It is particularly helpful for those who wish to >learn about Osteoporosis symptoms, treatment options, and >prevention strategies. > >Anyone with an interest in Osteoporosis disease is free to post, >as this newsgroup is designed to foster dialogue between >Osteoporosis disease patients from all parts of the world, and >provide an open forum for the exchange of international medical, >scientific, and lay information. Constructive criticism and >on-topic debate, general understanding and support, are encouraged. > > >Posts are to be limited to osteoporosis only. >Absolutely NO sales or off-topic posts are permitted. All such >posts will be reported. > >Topics discussed include: > > * Questions regarding any aspect of Osteoporosis > * Disease symptoms, presentations > * Current research findings > * Current treatments, both conventional and alternative > * Coping strategies > * Social and political issues regarding Osteoporosis > * Insurance and disability issues regarding Osteoporosis > > Material PROHIBITED includes: > > > * Commercial advertisements > * Flames, spam, name-calling, discrimination, and abusive > behavior > >0.01 Disclaimer > > >The information in this FAQ is developed and provided by patients. >It represents an accumulation of knowledge by people who are for >the most part NOT medical professionals. As useful as the material >presented in this FAQ may be, it must NOT be considered to be >medical advice, and must NOT be used as a substitute for medical >advice. It is important that anyone who has, or thinks he/she may >have Osteoporosis, should consult with a licensed health care >practitioner who is familiar with the illness. Your primary >physician should be your first contact but past that the medical >specialty that is associated with Osteoporosis are the >Endocrinologists. > > > >0.02 FAQ Availability > > > >This FAQ is posted regularly to the newsgroup: >Sci.med.diseases.osteoporosis and is also available at >www.jmadura.com/osteofaq.htm > > >0.03 Etiquette > >Newsgroups are like self-governing communities; there are no >"Newsgroup Cops." Instead, posters regulate themselves. Below are >some simple rules of newsgroup etiquette to understand before you >venture into a newsgroup. Think of newsgroup etiquette as a set >of guidelines that will keep you from making mistakes and make >you look and sound like a veteran newsgroup poster. > >Lurk. Read the newsgroup without posting for a few weeks. This >is known as "lurking," and it will give you the flavor of the >newsgroup. > >Read the FAQ. Find and read the newsgroup's FAQ, or list of >Frequently Asked Questions and other important and useful >information. It can answer questions you didn't even know you >had, and it's the quickest way to learn a newsgroup. > >Stay on-topic. Know what's on-topic and what's off-limits. Every >newsgroup is a little different in what it talks about, and how >it does the talking. > >DON'T SHOUT. TYPING IN ALL CAPS IS CONSIDERED SHOUTING. It's >easier to read a mix of upper- and lower-case letters. > >Never, ever post "MAKE MONEY FAST." It doesn't work, it gets >people really mad, and no matter what it says, it's probably >illegal. > >Everyone hates commercials. Be very hesitant about posting >advertisements or commercial messages. This also gets people >really mad. > >Ignore "trolls." Some people get a thrill from posting "flames" >(really obnoxious messages) just to get a rise out of people. >Sad, isn't it? > >Don't "spam." Spam is posting the same message to dozens, even >hundreds or thousands of unrelated newsgroups. No matter how >important you think your message may be, it's not worth it. Think >about it - if everyone posted about every topic, no one would be >able to find anything. > >Be Original. Don't over quote: Copying a long post (more than 20 >lines) just to add "I agree" or "me too" is considered bad form. > >The Golden Rule: Do unto others as you would have them do unto >you. Remember, every expert was a newbie once. > >Write Conservatively, read forgivingly. Communication in a pure >text medium, such as a newsgroup, is prone to misunderstanding, >often due to the lack of non-verbal cues such as inflections, >facial expression and body language. Given this, it is best to >be conservative with expressions of anger and sarcasm when >writing. When reading, assume good intent; if a message can be >taken two ways, assume the friendliest meaning. > >Keep quoted text to a minimum. When quoting a previous post, >edit out the non-relevant parts of the message. Remove >salutations and signatures. A good rule of thumb is, there >should not be more quoted text than new text. > >Please, please, please trim replies of irrelevant content and >post your reply either immediately after the sentence being >replied to or at the bottom of the post. Some of our users are >from far away where phone access is quite expensive. > > > > >1.01 What is Osteoporosis? > >Osteoporosis is a skeletal disease characterized by low bone mass, >and the deterioration of bone architecture leading to bone >fragility and increased risk of fracture. Bone normally >rejuvenates itself through a process of bone absorption and >formation called bone remodeling. Osteoporosis occurs when bone >breakdown, or absorption, occurs at a rate greater than bone >formation. If not prevented or if left untreated, osteoporosis can >progress painlessly until a bone breaks. These broken bones, also >known as fractures, occur typically in the hip, spine, and wrist. >Any bone can be affected, but of special concern are fractures of >the hip and spine. A hip fracture almost always requires >hospitalization and major surgery. It can impair a person's >ability to walk unassisted and may cause prolonged or permanent >disability or even death. Spinal or vertebral fractures also have >serious consequences, including loss of height, severe back pain, >and deformity. > > > >The World Health Organization defined osteoporosis as bone mineral >density 2.5 or more SD below peak bone mass, osteopenia as bone >mass between 1.0 and 2.5 SD below peak, and normal as 1.0 SD below >normal peak bone mass or higher. However, the WHO criteria apply >only to Caucasian, postmenopausal women, and not men, premenopausal >women, or women of ethnicity other than Caucasian. We have yet to >classify clinically significant low bone mass in this populations. >(see 2.02 below) > > > >Osteoporosis has often been called the "silent disease," because >it doesn't produce symptoms until a fracture occurs > > > > >1.02 > > > >Osteoporosis is a very widespread disease that affects women four >times more often then men. Osteoporosis and low bone mass are >currently estimated to be a major public health threat for almost >44 million US women and men aged 50 and over. A women's risk of >hip fracture is equal to her combined risk of breast, uterine and >ovarian cancer. Worldwide the statistics show this to be a major >disease. Using the World Health Organization criteria, 30% of >Caucasian postmenopausal women in the US have osteoporosis, and >54% have osteopenia. The prevalence of low bone mass increases >with age. > > > > > > > >2.01 > > > >There are many factors that can increase a person's risk of >osteoporosis. A few of the risk factors are: > >Postmenopausal (female) >Ethnicity-Caucasian and Asian >Family history >Petite, small frame >Eating disorders >Caffeine >Smoking >Excessive use of alcohol >Vitamin D deficiency >Inactivity >Thyroid disease >Chronic steroid use > >Peak bone mass occurs for both men and women by the early thirties. >Genetic factors play the greatest role in determining peak bone >mass, but there are clinically significant contributions from >nutrition, drug exposures, endocrine health following puberty, and >weight-bearing status (ref 4). For example, most teenagers and >young adults do not receive the Recommended Daily Allowance (RDA) >for calcium of 1200 mg. Smoking and excessive alcohol use >contribute to low bone mass. Systemic glucocorticoid use of 7.5 >mg daily or greater impairs bone formation. Phenytoin and other >anti-seizure medications impair vitamin D metabolism. >Oligomenorrhea and amenorrhea cause accelerated bone loss, as do >hyperthyroidism or over-replacement of thyroxine supplementation >such that the serum TSH is suppressed. Immobility is associated >with thinning of the bone from lack of weight-bearing forces > > >2.02 > >In order to demonstrate bone loss, a bone scan would need to be >performed. The most common type of bone scan is a DEXA test. > >2.03 > > >A bone scan (DXA or DEXA) is an x-ray that can show bone loss in >the spine and hip area. The test takes about 10-20 minutes. A >bone mineral density (BMD) test is a special type of test that is >accurate, painless and noninvasive. For every one standard >deviation below peak bone mass the risk of vertebral fracture is >two times that of normal bone mass, and for the hip, the risk is >2.5 times. Measurement of the bone mass of the lumbar spine and >hip are currently used for diagnostic purposes and monitoring of >treatment. Peripheral sites such as wrist and heel can be useful >screening tools in older individuals; however there is >discordance between bone sites in rates of loss with aging. Thus, >many newly postmenopausal women will have a normal bone mass of >the heel, and yet have clinical significant low bone mass of the >spine. The FDA recently approved ultrasound techniques for use >as a screening test for low bone mass.(ref 14) Currently, the >different manufacturers of bone densitometers all use different >reference populations from which the standard deviations from >normal are calculated, also called T scores. There are >differences in calibration between companies as well, so that >an individual patient's bone density reading can differ by as >much as 12% from one machine to the next. Thus, to monitor a >patient's response to treatment, the same bone densitometer must >be used. > > > >2.04 > >There is no physician specialty dedicated to osteoporosis, nor >is there a certification program for health professionals who >treat the disease. Therefore, a variety of medical specialists >are treating people with osteoporosis, including internists, >gynecologists, family physicians, endocrinologists, >rheumatologists, physiatrists and orthopedists. Endocrinologists >are the specialist most often found treating this disease and >for the record, they treat the endocrine system, which comprises >the glands and hormones that help control the body's metabolic >activity. In addition to osteoporosis, endocrinologists also may >treat diabetes, thyroid and pituitary diseases. > >2.05 > >It is hard to diagnose Osteoporosis without a DXA scan but >unexplained fractures in an elderly person could be a warning >sign. > >2.06 > >There are other tests that the treating physician can perform to >help treat osteoporosis. 24 hour urine tests as well as blood >tests give indications that are helpful in treating this disease. > > > >2.07 > >Osteoporosis is largely preventable for most people. Prevention >of this disease is very important because, while there are >treatments for osteoporosis, there is currently no cure. There >are four steps to prevent osteoporosis. No one step alone is >enough to prevent osteoporosis but all four may. They are: > >A balanced diet rich in calcium and vitamin D >Weight-bearing exercise >A healthy lifestyle with no smoking or excessive alcohol use >And bone density testing and medications when appropriate > > >2.08 > >Although there is no cure for osteoporosis, currently >bisphosphonates (alendronate and risedronate), calcitonin, >estrogens, parathyroid hormone and raloxifene are approved by the >US Food and Drug Administration (FDA) for the prevention and/or >treatment of osteoporosis. Adequate calcium, vitamin D, >appropriate exercise and, in some cases, medication are important >for maintaining bone health. Currently, bisphosphonates >(alendronate and risedronate), calcitonin, estrogens, parathyroid >hormone and raloxifene are approved by the US Food and Drug >Administration (FDA) for the prevention and/or treatment of >osteoporosis. > >The bisphosphonates (alendronate and risedronate), calcitonin, >estrogens and raloxifene affect the bone remodeling cycle and are >classified as anti-resorptive medications. Bone remodeling >consists of two distinct stages: bone resorption and bone >formation. During resorption, special cells on the bone's surface >dissolve bone tissue and create small cavities. During formation, >other cells fill the cavities with new bone tissue. Usually, bone >resorption and bone formation are linked so that they occur in >close sequence and remain balanced. An imbalance in the bone >remodeling cycle causes bone loss that eventually leads to >osteoporosis and fracture risk. Anti-resorptive medications slow >or stop the bone-resorbing portion of the bone-remodeling cycle >but do not slow the bone-forming portion of the cycle. As a result, >new formation continues at a greater rate than bone resorption, and >bone density may increase over time. > >Teriparatide, a form of parathyroid hormone, is a newly approved >osteoporosis medication. It is the first osteoporosis medication to >increase the rate of bone formation in the bone remodeling cycle. > >For more detailed information on the actions, administration and >possible side effects for each of the following medications, please >consult the Package Insert, available on-line and at pharmacies. > >Antiresorptive Medications > >Bisphosphonates >Alendronate Sodium (brand name Fosamax?) > >Alendronate is approved for both the prevention (5 mg per day or >35 mg once a week) and treatment (10 mg per day or 70 mg once a >week) of postmenopausal osteoporosis. Alendronate reduces bone >loss, increases bone density and reduces the risk of spine, wrist >and hip fractures. > >Alendronate also is approved for treatment of glucocorticoid-induced >osteoporosis in men and women as a result of long-term use of these >medications (i.e., prednisone and cortisone) and for the treatment >of osteoporosis in men. > >Risedronate Sodium (brand name Actonel?) > >Risedronate is approved for the prevention and treatment of >postmenopausal osteoporosis. Taken daily (5 mg dose) or weekly >(35 mg dose), risedronate slows bone loss; increases bone density >and reduces the risk of spine and non-spine fractures. > >Risedronate also is approved for use by men and women to prevent >and/or treat glucocorticoid-induced osteoporosis that results from >long-term use of these medications (i.e., prednisone or cortisone). > >Administration and Side Effects of Bisphosphonates > >Side effects for alendronate and risedronate are uncommon but may >include abdominal or musculoskeletal pain, nausea, heartburn, or >irritation of the esophagus. > >Alendronate and risedronate must be taken on an empty stomach, >first thing in the morning, with eight ounces of water (no other >liquid), at least 30 minutes before eating or drinking. Patients >must remain upright during this 30-minute period. > >Calcitonin >(Brand name Miacalcin?) > >Calcitonin is a naturally occurring hormone involved in calcium >regulation and bone metabolism. In women who are more than 5 >years beyond menopause, calcitonin slows bone loss; increases >spinal bone density, and, according to anecdotal reports, may >relieve the pain associated with bone fractures. Calcitonin >reduces the risk of spinal fractures but has not been shown to >decrease the risk of non-spine fractures. Studies on fracture >reduction are on going. Because calcitonin is a protein, it >cannot be taken orally as it would be digested before it could >work. Calcitonin is available as an injection (50-100 IU daily) >or nasal spray (200 IU daily). > >While it does not affect other organs or systems in the body, >injectable calcitonin may cause an allergic reaction and >unpleasant side effects including flushing of the face and hands, >urinary frequency, nausea and a skin rash. Side effects for nasal >calcitonin are not common but may include nasal irritation, >backache, bloody nose, and headaches. > >Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy >(HRT) (Multiple brand names are available.) > >On January 9th, the Food and Drug Administration (FDA) issued a >statement advising women and health care professionals about >important new safety changes to labeling of all estrogen and >estrogen with progestin products for use by postmenopausal women. >NOF is currently in the process of reviewing our materials with >regard to this statement. Visit the FDA Web site at for more >information about the labeling change. > >Estrogen replacement therapy (ERT)/Hormone replacement therapy >(HRT) is approved for the prevention of osteoporosis. ERT has >been shown to reduce bone loss, increase bone density in both >the spine and hip, and reduce the risk of hip and spinal >fractures in postmenopausal women. ERT is administered most >commonly in the form of a pill or skin patch that delivers a >low dose of approximately 0.3 mg daily or a standard dose of >approximately 0.625 mg daily and is effective even when started >after age 70. > >When estrogen is taken alone, it can increase a woman's risk of >developing cancer of the uterine lining (endometrial cancer). >To eliminate this risk, physicians prescribe the hormone >progestin in combination with estrogen (hormone replacement >therapy or HRT) for those women who have an intact uterus. ERT/HRT >relieves menopause symptoms and has been shown to have a beneficial >effect on bone health. Side effects may include vaginal bleeding, > breast tenderness, mood disturbances and gallbladder disease. > >The Woman's Health Initiative (WHI) study recently confirmed that >one type of HRT, Prempro?, reduced the risk of hip and other >fractures as well as colon cancer. The WHI also confirmed that this >HRT is associated with a modest increase in the risk of breast >cancer, strokes, heart attacks and venous blood clots. > >A study from the National Cancer Institute (NCI) recently reported >that long-term use of ERT may be associated with a small increase >the risk of ovarian cancer. However, a meta-analysis by the Centers >for Disease Control (CDC) did not find an association of either >ERT or HRT with ovarian cancer. > >Raloxifene >(Brand name Evista?) > >Raloxifene, 60 mg a day, is approved for the prevention and >treatment of postmenopausal osteoporosis. It is from a class of >drugs called Selective Estrogen Receptor Modulators (SERMs) that >have been developed to provide the beneficial effects of estrogens >without their potential disadvantages. Raloxifene increases bone >mass and reduces the risk of spine fractures. Data are not yet >available to demonstrate that raloxifene can reduce the risk of >hip and other non-spine fractures. > >Raloxifene appears to decrease the risk of estrogen-dependent >breast cancer by 65% over 4 years. > >While side effects were not common, those reported included hot >flashes and deep vein thrombosis, the latter of which is also >associated with estrogen therapy. Raloxifene is taken in pill >form, once a day with or without meals. > >Bone Forming Medications > >Parathyroid Hormone >(Brand name Fort?o?) > >Teriparatide, a form of parathyroid hormone, is approved for the >treatment of osteoporosis in postmenopausal women and men who are >at high risk for a fracture. This medication stimulates new bone >formation and significantly increases bone mineral density. In >postmenopausal women, fracture reduction was noted in the spine, >hip, foot, ribs and wrist. In men, fracture reduction was noted >in the spine, but there were insufficient data to evaluate >fracture reduction at other sites. Teriparatide is self- >administered as a daily injection for up to 24 months. > >Side effects include nausea, leg cramps and dizziness. > > > >As new medications are released, I will try and update this. As >with everything else here, suggestions, corrections and additions >are very welcome. > > > >2.09 > >Osteoporosis is often a disease that, once diagnosed, remains >with the person for the remainder of their life. There is no >known cure at present for this debilitating disease. > >2.10 > >The great majority of all fractures in older women result from >falls. Fall risk factors include leg weakness, impaired gait, >and balance dysfunction. These can occur from global physical >deconditioning as well as specific syndromes such as stroke, >osteoarthritis of selective joints, and medical conditions > >2.11 > >Yes! Osteoporosis, as a major disease, can cause depression >and other problems. A patient can often be limited in what they >can accomplish as well as being forced to curtail their >previously normal activities. The added fact that there is no >known cure is also of substance in this regard. > > > >2.12 > > People do not die from Osteoporosis; but they can die of >complications related to the disease. The clinical consequence of >low bone mass is fracture. Pain and immobility result from fractures >of the limbs and spine. Multiple vertebral fractures result in >irreversible spinal deformity and chronic pain syndromes. However, >hip fractures result in institutionalization and excess mortality. > >2.13 > > PTH - called Parathormone; Parathormone (PTH) intact molecule or >Parathyroid hormone is a blood serum level. This test may be >performed when PTH abnormality is suspected as a cause of abnormal >calcium or phosphorus levels. > >PTH is a protein hormone secreted by the parathyroid gland which >is the most important regulator of body calcium and phosphorus. > >PTH: > >increases the calcium and phosphorus release from bone > >decreases the loss of calcium and increases the loss of phosphorus >in the urine > >increases the activation of 25-hydroxy vitamin D to 1,25-dihydroxy >vitamin D in the kidneys > >Secretion of PTH is regulated by the level of calcium in the blood. >Low serum calcium causes increased PTH to be secreted, whereas >increased serum calcium inhibits PTH release. Average normal >levels are 10-55 pg/ml > > > >2.14 > > Bones are living structures that need the mineral calcium to help >them develop and stay strong. Most of the calcium in our bodies - >99 percent of it - is found in our bones. Without enough calcium, >bones can become fragile and break easily with very little stress. > >Bioavailability refers to how well the digestive system can absorb >calcium. This absorption depends on the overall level of calcium >in a food and the specific type of food being eaten. > >Blood calcium is tested to screen for, diagnose, and monitor a >range of conditions relating to the bones, heart, nerves, kidneys, >and teeth. Blood calcium levels do not directly tell how much >calcium is in the bones, but rather, how much total calcium or >ionized calcium is circulating in the blood. > >Doctors can get a better picture of your health by comparing your >calcium result with the results of other tests. Calcium levels in >the blood are regulated and stabilized by a feedback loop that >includes: calcium, PTH, vitamin D, phosphorus, and magnesium. Your >doctor is looking at the balance among all of these elements. >Conditions and diseases that disrupt this feedback loop can cause >inappropriate elevations or decreases in calcium and lead to >symptoms of hyper- or hypocalcaemia. For example, when parathyroid >hormone (PTH) from the parathyroid gland is released, PTH level >rises, calcium also rises, and phosphorus drops. In some kidney >problems, a high phosphorus level in blood can depress calcium >levels. Depending on the levels you have, these two tests can help >your doctor discover whether you have a parathyroid problem or >another condition. > > > >2.15 > > > > > >Physical Activity and Bones > >In addition to a calcium-rich diet, physical activity is also very >important for building healthy bones. Weight-bearing activity, such >as walking or running, is one of the best forms of physical activity >for bones because it makes your bones work harder. A weight-bearing >physical activity is one in which your feet and legs carry your >weight. The impact of this weight on your muscles helps build stronger >bones. > >National surveys have shown that many Americans are not consuming >enough calcium. Many women, in fact, consume less than half of the >daily recommended amount of calcium. > >Recommended Calcium Intakes* > >Ages Amount mg/day >Birth - 6 months 210 >6 months - 1 year 270 >1-3 500 >4-8 800 >9-13 1300 >14-18 1300 >19-30 1000 >31-50 1000 >51-70 1200 >70 or older 1200 > > > >Pregnant & Lactating 1000 >14-18 1300 >19-50 1000 > > > > >In 1996, the U.S. Surgeon General recommended that everyone age >two or older participate in at least 30 minutes of moderate >physical activity on most, preferably all, days. In 2000, the >U.S. Department of Agriculture published its Dietary Guidelines >for Americans (DGA), which also suggests that adults get at least >30 minutes of moderate physical activity every day. Make sure you, >warm-up before doing any activity to prevent injury. Be sure that >you consult a doctor or health care professional before starting >any physical activity program. > >The following tables show the amount of calcium in a variety of >foods from several food groups. Calcium amounts may vary. Check >nutrition labels on products for exact amounts. > >Milk Group > Calcium (mg) > >*Milk, regular or low fat, 1 cup > 300 > >Chocolate milk, 1 cup > 300 > >Yogurt, 1 cup > 300-415 > >American cheese, 2 oz > 348 > >Cheddar cheese, 1 1/2 oz > 300 > >Cottage cheese, 1/2 cup > 77 > >Mozzarella cheese, 1 1/2 oz > 275 > >Parmesan cheese, 1/4 cup > 338 > >Ricotta cheese, part skim, 1/2 cup > 337 > >Swiss cheese, 1 1/2 oz > 408 > >Milk shake, 10 fl oz > 319-344 > >Ice cream, |