Table Of Content77807_FMxx_FINAL.QXP 11/20/09 12:52 PM Page i
100 Questions & Answers
About Osteoporosis and
Osteopenia
Second Edition
Ivy M. Alexander, PhD, APRN,
ANP-BC, FAAN
Yale University School of Nursing
and
Karla A. Knight, RN, MSN
Health Care Writer
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Library of Congress Cataloging-in-Publication Data
Alexander, Ivy M.
100 questions & answers about osteoporosis and osteopenia/Ivy M. Alexander and Karla A.
Knight.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-7637-7780-7 (alk. paper)
1. Osteoporosis—Prevention—Popular works. 2. Osteopenia—Popular works. 3. Bones—
Metabolism—Disorders—Popular works. 4. Osteoporosis—Miscellanea. I. Knight, Karla A.
II. Title. III. Title: 100 questions and answers about osteoporosis and osteopenia.
IV. Title: One hundred questions and answers about osteoporosis and osteopenia.
RC931.O73A42 2010
616.7'16—dc22 2009041695
6048
Printed in the United States of America
13 12 11 10 09 10 9 8 7 6 5 4 3 2 1
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Dedication
To our children:
Lauren,Gillian,Erin,Kyle,and Kelsey.
May you grow up and grow old with healthy bones.
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Contents
Foreword vii
Introduction ix
Part 1:An Overview ofOsteoporosis and Bone Development 1
Questions 1-10describe the physiology of bone development and how osteoporosis
and osteopenia occur, including:
• What is osteoporosis and what does it look like? How does osteopenia differ
from osteoporosis?
• How does osteoporosis occur?
• Are there other vitamins and minerals that contribute to bone development?
• Which bones are affected by osteoporosis?
Part 2:Risk Factors and Testing 17
Questions 11-39 address the risk factors associated with osteoporosis, who should
be tested, and how osteoporosis is diagnosed, including:
• Who gets osteoporosis?
• What are the risk factors for osteoporosis?
• How will I know if I have osteoporosis? Are there any signs or symptoms?
• How will my clinician use my test results to determine whether I have
osteoporosis?
Part 3:Lifestyle Changes and Treatments 75
Questions 40-71address lifestyle changes, exercise, calcium requirements and sup-
plements, prescription medications, and other management strategies for osteoporo-
sis and osteopenia, such as:
• I understand that exercise is important for the treatment of osteoporosis. Why?
• When should I take calcium supplements? Is there any particular time of day
that makes calcium more effective? Should I take it before meals, with meals, or
between meals?
• I know there are other vitamins and minerals that are important to bone devel-
opment. Will I get enough of everything I need if I take a daily vitamin?
• Can I take prescription osteoporosis medications in combination with each
other? Which medications could I use together to get more improvement in
my bones?
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Part 4:Living with Osteoporosis 197
Questions 72-89 discuss the risk of fractures, preventing falls, and other lifestyle
issues related to living with osteoporosis:
• If I fracture a bone, will it change my treatment? Will a broken bone take longer
to heal? Will a broken bone be repaired or casted differently?
• Should I stop exercising if I break a bone?
• It’s hard not to think about my bones being weak. How do I keep osteoporosis
from interfering with my life?
• Are there any medications that I should adjust or stop taking while I’m being
treated for osteoporosis?
Part 5:Prevention and Going Forward 243
Questions 90-100describe some of the steps used to prevent osteoporosis in all age
groups, talking to friends and family about osteoporosis, the future developments
related to treatment, and where to go for more information:
• My daughter’s friend is only 26 and has recently been diagnosed with osteoporo-
sis as a result of being treated for endometriosis. Is osteoporosis reversible at her
age?
• I’m 60 years old. Is it really worth it to start exercising now? Will exercise at my
age help prevent osteoporosis?
• What should I tell my family about osteoporosis? Will it curtail activities with
them?
• Osteoporosis seems to be featured in the news almost daily. What are some of
the future treatments? Are there any new drugs that are being evaluated in clini-
cal trials for the treatment of osteoporosis?
Appendix A 271
This appendix provides drawings of sample exercises with step-by-step instructions.
Appendix B 277
This appendix gives a list of organizations and Web sites that will provide additional
information about osteoporosis and osteopenia.
Bibliography 286
Glossary 305
Index 315
vi
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Foreword
What is osteoporosis? The simple answer is that it is the most
prevalent bone disease in America and affects over 44 million peo-
ple.Ten million Americans have osteoporosis; 34 million have low
bone mass, which puts them at serious risk of osteoporosis. How-
ever, answers from many sources seem to perpetuate a series of
myths about this disease. These myths include the following:
osteoporosis is a normal consequence of aging; ONLY older white
women develop osteoporosis; osteoporosis medication causes upset
stomachs or that it always causes problems with the jaw (ONJ, or
osteonecrosis of the jaw); taking calcium and vitamin D is enough
to prevent osteoporosis;and exercise causes fractures in people with
osteoporosis. Because these myths are so widely believed, people
miss opportunities to prevent or treat bone loss.
How can we combat these damaging myths? First,research can
show us what is true about osteoporosis.We now know that osteo-
porosis is—without a doubt—a disease, and not a part of normal
aging. We also know that while many people who have osteoporo-
sis are White, postmenopausal women, people of all races, both
genders, and all adult ages can and do develop fragile bones.
Recently published research also shows that the right kind of exer-
cise builds bone,strengthens muscles,and prevents falls.
Second, we need to teach people the truth about bone loss.
Despite the mention of osteoporosis in television shows and com-
mercials, magazines, and newspapers, the American public remains
woefully ignorant about it. Osteoporosis is a disease that starts in
childhood and has consequences in later life. Kids today don’t get
enough calcium or exercise and are not achieving peak bone mass.
Adolescent women who avoid calories and over-exercise for weight
control stop their menses—again,a strong risk factor for inadequate
bone development. Premenopausal women say, “I don’t need to
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worry about that until menopause.” Postmenopausal women say, “I
can worry about that when I’m older.” And older women and men
who have low bone density,multiple fractures,and chronic pain say,
“Why didn’t someone tell me about this when it would have made a
difference?”
The mission for many of us is to educate both the people who
suffer from the debilitating consequences and those who are at risk
of this disease. How can we teach them? We read, then listen, then
read some more. This book, 100 Questions & Answers About Osteo-
porosis and Osteopenia,Second Edition,is an excellent first step toward
learning about osteoporosis. Read it cover to cover or look up the
particular questions that interest you.Either way,this is a wonderful
resource for all families.
Ivy Alexander and Karla Knight have written a treasure:a book
that answers questions clearly, concisely, and accurately. They pro-
vide medication information, lists of risk factors, lifestyle issues
that influence bone health as well as suggestions on how best to live
with osteoporosis.They rely on the recent Surgeon General’s Report
on Bone Health and Osteoporosis (2004),recent research,and national
organizations as sources for the most timely information on pre-
vention and treatment of this bone disease.The message is clear:It is
never too early or too late to prevent or treat osteoporosis. Anyone
who reads 100 Questions & Answers About Osteoporosis and Osteopenia,
Second Edition, will know better than to believe the myths and old
wives’tales that surround osteoporosis!
Deborah T.Gold,PhD
Associate Professor ofMedical Sociology,
Departments ofPsychiatry & Behavioral Sciences,
Sociology,and Psychology:Social & Health Sciences
Duke University Medical Center
viii
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Introduction
Osteoporosis is the most common bone disease. When I was asked
to co-author a second Jones and Bartlett book with Karla Knight,the
first edition of this book focusing on osteoporosis,I was delighted to
have the opportunity.I am again delighted to have the opportunity to
work with Karla and update the information in this second edition.
Many men and women still do not know about osteoporosis, the
potentially devastating effects following osteoporosis-related fractures,
and the many effective prevention and treatment options.
Osteoporosis is often considered a woman’s disease, because of
the dramatic increase in bone loss following menopause.But osteo-
porosis and osteopenia also affect men,young adults,and individu-
als with certain chronic illnesses or who take certain medications.
The Surgeon General published a report on osteoporosis and
osteopenia in 2004, highlighting the numbers of people affected by
boneloss,the risks for bone loss,and the many options for prevent-
ing and treating bone loss. Yet so many remain unaware of these
important facts.
My interest in osteopenia and osteoporosis stems from my clin-
ical work, my research, and my own family history. I practice in
internal medicine with a specialty in midlife women’s health and
have seen patients struggle with the after-effects of osteoporosis-
related fractures. Through my research I have learned that many
men and women are unaware of the risks of bone loss and the pre-
vention strategies that can minimize bone loss.On a more personal
level, my grandmother suffered with osteoporosis and experienced
several broken bones during her older years,causing her significant
pain and suffering. These facts continue to feed my interest in
identifying and educating others about methods to prevent and
manage osteoporosis. It is disturbing that so many of us are
unaware of the needed vitamins and minerals to promote bone
