Osteoporosis Prevention & Treatment
Interview with Dr. Michael Truong

  • Section 2
  • Exercise, Cigarette Smoking, and Alcohol
  • Estrogen Replacement Therapy
  • Section 3
  • Medications that Prevent Bone Breakdown
  • Fluoride
  • Monitoring Osteoporosis Treatment Success

MedicineNet interviewed Dr. Michael Truong regarding updates in the management of osteoporosis. Dr. Truong finished his medical school training at the University of California, San Francisco medical school. He then studied at the University of California, Davis for his residency training in Internal Medicine, and his Fellowship training in Diabetes, Endocrinology, and Metabolism. He spent two years performing research at ADRI (Aoki Diabetes Research Institute), and teaching at the University of California, Davis Medical School. He is currently director of the osteoporosis center with the Mission Internal Medicine Group, a multispecialty group serving southern Orange County, California.

Introduction

Osteoporosis is a bone disorder featuring progressive loss of bone tissue and bone mass leading to weakening of bone. Normal bone tissue is made of protein (called collagen) and calcium salts. The osteoporosis process depletes both the calcium salts and the protein from the bone. The weakened bone is more prone to breakage (fracture), either by cracking or collapsing (compression). In patients with osteoporosis, bone fractures can occur from minor falls or injuries that normally would not cause a bone fracture. Bones that commonly break in patients with osteoporosis include the spine, hips and the wrists.

Even though osteoporosis can affect both men and women, it is most common among postmenopausal women. The female hormone, estrogen, is important for the preservation of bone mass. Inadequate estrogen during menopause causes accelerated bone loss. Without effective prevention, a woman can lose 20%-30% of her bone mass during the first 10 years of menopause. The osteoporosis process can operate silently for decades. These women may not be aware of their weakened bones until suffering a painful fracture.

Over 20 million people have osteoporosis in the United States, and approximately 1.3 million people each year will suffer a bone fracture as a result of osteoporosis. In 1993, the United States incurred an estimated loss of 10 billion dollars due to loss of productivity and health care costs related to osteoporosis.

The goal of osteoporosis treatment is to prevent bone fractures by 1) stopping bone loss, and 2) by increasing bone mass and strength.

The prevention and treatment of osteoporosis involves programs which include a nutritious diet, cessation of cigarette smoking, curtailing of alcohol consumption, regular exercise, adequate intake of calcium and vitamin D, estrogen replacement or raloxifene (Evista) treatment in postmenopausal women, and medications (such as aledronate, etidronate, or calcitonin) that decrease breakdown (resorption) of bone. Medications that decrease bone breakdown or resorption are also called antiresorptive agents

DIET, CALCIUM, AND VITAMIN D

MedicineNet: How important is diet in the prevention and treatment of osteoporosis?

Dr. Truong: Balanced nutrition, adequate calcium and vitamin D intake, regular exercise, and cessation of cigarettes are important measures to maintain healthy bones for everybody. This is true for children, men, premenopausal and postmenopausal women, and the elderly, regardless of presence or absence of osteoporosis.

Conversely, malnutrition, such as found in patients with anorexia nervosa, contributes to osteoporosis.

MedicineNet: Why is adequate calcium intake important in osteoporosis prevention and treatment?

Dr. Truong: Calcium is an essential nutrient necessary for the proper functioning of the heart, muscles, nerves, and other body functions, as well as maintaining strong bones. Adequate calcium intake is important for everyone, regardless whether she/he already has osteoporosis.

Each day, the body loses calcium in the urine, feces, and sweat. These losses have to be replaced by calcium in the diet. If calcium in the diet is not sufficient to cover these losses, the body takes calcium from the bones. Over time, insufficient calcium in the diet leads to negative calcium balance and bone loss (osteoporosis). Adequate calcium intake can help prevent osteoporosis and increase bone mass and strength.

MedicineNet:  How much calcium intake is necessary to prevent and treat osteoporosis?