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Advice From Your Allergist on Osteoporosis

Osteoporosis is a disease in which bones become fragile. Having less strength, bones can break or fracture more easily. You may not know you have it until you break a bone. The most common break sites are the small bones of the back (vertebrae), wrists, upper arms, pelvis and hips. Once a bone breaks, there is greater chance for more breaks. This results in pain, loss of movement and possible need for surgery.

Who gets osteoporosis?

An estimated 10 million people older than 50 have osteoporosis. Almost 34 million people have low bone mass that puts them at a higher risk for getting the disease. Older people, especially women who have reached menopause, are most at risk. Other factors that increase the risk of osteoporosis are:

  • Family history and race (Caucasians and Asians are at higher risk than African Americans)
  • Inadequate calcium and vitamin D intake
  • Lack of physical activity
  • Cigarette smoking
  • Low body weight
  • Age and female gender
  • Excessive alcohol intake
  • Taking oral cortisone-like medications (glucocorticosteroids) or anti-seizure medications.

Certain menstrual problems causing estrogen deficiency also are associated with an increased risk for osteoporosis.

What are the signs and symptoms?

In the early stages, you may not experience pain or symptoms. But once the bones are weakened, symptoms may include:

  • Back pain, which may be severe if there is fracture or collapsed vertebrae
  • Loss of height over time with stooped posture
  • Fracture of vertebrae, wrist, hip, or other bones.

What does osteoporosis have to do with asthma?

Since asthma is an inflammatory disease of the lung, chronic anti-inflammatory medications are important for most patients with asthma. Cortisone-like medications (corticosteroids) are the most potent anti-inflammatory medications to treat asthma.

Long-term use of oral corticosteroids (for example, prednisone) can be associated with adverse effects, including osteoporosis. In contrast, inhaled corticosteroids are effective in treating asthma and have few adverse effects. Thus, your allergist will always use the lowest effective dose of oral corticosteroid, if it is required, and inhaled rather than oral medication whenever possible.

What can I do to help prevent osteoporosis?

Calcium intake should be adequate. The recommended dietary allowance is:

  • 800 mg/day for 1-10 years of age
  • 1200 mg/day for 11-24 years of age
  • 1000 mg/day for men, premenopausal, and postmenopausal women taking estrogen 1200-1500 mg/day during pregnancy and lactation 1500 mg/day for postmenopausal women not taking estrogen 1500 mg/day for adults at risk of osteoporosis

Total daily intake of calcium should not exceed 2000 mg/day

Calcium is best absorbed if taken with meals in small amounts throughout the day. The most concentrated calcium sources are dairy products which sometimes contain Vitamin D.

Some people lack an enzyme to digest the milk sugar lactose. Therefore, they are lactose intolerant and may not be able to drink milk. Some of these individuals may be able to eat yogurt or hard cheese or acidophilus milk or milk products if the deficient enzyme, lactase, is added to the food.

If calcium consumption is inadequate, supplements are recommended. Attention must be paid to the amount of elemental calcium (the actual amount of calcium present) in these preparations. Taking more than 500 to 600 mg of calcium at one time or ingesting calcium with high fiber foods should be avoided as either reduces absorption. Supplements containing oyster shell, bone meal or dolomite should be avoided as they may contain lead or other toxic materials. Calcium supplementation should be discussed with your physician since excessive amounts may cause kidney stones.

Make sure Vitamin D intake is adequate but not excessive,

Suggested intake is:

  • 400 IU ages 1-18
  • 400-800 IU ages 19-49
  • 800-1000 IU for ages 50 and older

For some individuals your health care provider may recommend a higher dose of Vitamin D. Vitamin D blood levels may be of value in determining the dose of Vitamin D needed. The health risks and benefits of higher doses of Vitamin D need ot be considered on an individual basis. Vitamin D is found in egg yolks, salt-water fish, liver and most importantly Vitamin D fortified milk. Vitamine D is also produced in the skin from ultraviolet rays of sunlight. Caution must be excercise as ultraviolet sunlight may give rise to skin cancer.

Consult with your health care provider to determine your Vitamin D needs.

  • Exercise. Weight-bearing and muscle strengthening exercise is recommended. Examples of weight-bearing exercise are walking, hiking, stair climbing, jogging, dancing, or tennis. Examples of muscle strengthening exercises are weight training and resistive exercises. The goal is to exercise every other day or four times a week. The length of time depends on the intensity of the exercise. For walking 45-60 minutes is recommended. If you have been inactive, consult your physician before beginning to create a program with gradually increasing activity.
  • Avoid cigarette smoking.
  • Avoid excessive alcohol use.
  • If you are a man taking oral corticosteroids (for example, prednisone), a blood testosterone level may need to be measured to be certain the level is not low.
  • Discuss osteoporosis with your physician or health care provider. If you have several risk factors for osteoporosis or you need daily prednisone to control your asthma, your physician may need to determine your bone density. Bone mineral density tests are recommended at age 65, however, the use of corticosteroids and other conditions may necessitate earlier monitoring. Your health care provider will determine the frequency on bone mineral density monitoring.

How Is osteoporosis treated?

Osteoporosis treatment and prevention measures are:

  • Lifestyle changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D;
  • Medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast);
  • Medications that increase bone formation such as teriparatide (Forteo).

For more patient information on the treatment of osteoporosis, see ACAAI’s Medications Prescribed for Osteoporosis.

Where can I find more information about osteoporosis?

For additional information on osteoporosis and its treatment, contact the following organizations:

National Osteoporosis Foundation
1232 22nd Street NW
Washington, DC 20037
(202) 223-2226

NIH Osteoporosis and Related Bone Diseases
2 AMS Circle
Bethesda, MD 20892
(800) 624-BONE
Web: Info/bone/default.asp

"Advice From Your Allergist on Osteoporosis" is derived from Osteoporosis Management in the Steroid-Treated Asthma Patient, a joint venture of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI). This joint project was supported through an educational grant from Merck & Co., Inc.

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