Introduction
Bone is a living tissue. It contains cells that make, mold and take back up (resorb) bone. As we get older, bone is resorbed faster than it is formed. As a result, from about the age of 35, we start to lose a certain amount of bone material overall. If you have a lot of bone loss then you have ‘thinning’ of the bones (osteoporosis) and the loss of bone density over time. This causes the bones to become brittle and break easily. If you have a milder degree of bone loss, this is known as osteopenia.
Osteoporosis affects men and women of all races, but white and Asian women — especially older women who are past menopause (when estrogen levels fall) — have the highest risk of developing this condition. Women who have either undergone early menopause or have had their ovaries surgically removed before age 45, are also more likely to develop osteoporosis. Other risk factors for women are small body frame and having periods that stop for six months to a year or more before the onset of menopause due to over-exercising or over-dieting.
Other risk factors include:
- getting older
- being small and thin
- having a family history of osteoporosis
- taking certain medicines such as glucocorticoids and some anticonvulsants
- having osteopenia (low bone density)
- consuming a diet low in calcium and vitamin D
- smoking cigarettes
- having an inactive or sedentary lifestyle
- consuming excessive amounts of alcohol
Osteoporosis is often called a silent disease because bone loss occurs without symptoms and people may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).
Osteoporosis is diagnosed with a bone density test. Bone mineral density (BMD) can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked, usually in the hip, wrist and spine.
BMD tests can:
- detect low bone density before a fracture occurs
- confirm a diagnosis of osteoporosis if you already have one or more fractures
- predict your chances of fracturing in the future
- determine your rate of bone loss, and monitor the effects of treatment if the test is conducted at intervals of a year or more
Several medications are readily available for the prevention and/or treatment of osteoporosis. For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. These drugs reduce bone loss.
Common bisphosphonates include:
- alendronate (Fosamax)
- risedronate (Actonel, Atelvia)
- ibandronate (Boniva)
- zoledronic acid (Reclast)
How can compounds help?
Patients who need an alternative treatment to medications readily available on the market can benefit from customized hormone replacement therapy.
Estrogen, especially when started soon after menopause, can help maintain bone density and decrease the risk of fractures. Testosterone therapy may also be utilized to slow bone loss. Calcium and vitamin D, as well as other minerals, are important for bone health. Your body needs adequate supplies of vitamin D in order to take up (absorb) the calcium that you eat or drink in your diet.
Ask your compounding pharmacist and other health care professionals for more information about customizing your hormone replacement therapy and nutritional supplementation with compounded vitamins and minerals to optimize your bone health.