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We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
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Osteoporosis is a condition that weakens bone. Healthy bone is very dense and has high concentrations of minerals like calcium and phosphate that keep your bones strong. However, people with osteoporosis, which means "porous bones," have low bone density. Over time, the loss of bone density and essential minerals makes the bones brittle, weak, and more likely to fracture easily.
Osteoporosis and the fractures that result from it are a major public health concern. More than 1.3 million people experience an osteoporosis-related fracture every year in the United States. Early diagnosis and treatment of bone loss can reduce or eliminate the risk of fractures.
It's important to know that:
People with osteoporosis often have no visible symptoms, until they fracture a bone. The condition has a number of symptoms that include:
Loss of height and spinal changes
Osteoporosis is characterized by bone loss and subsequent bone weakness. There are several reasons why you may lose bone:
Your bones grow the most during your teens and your 20s. After age 30, that growth slows down and your body begins to absorb more bone than it produces, making your bones thinner. If your diet did not include enough calcium and vitamin D to support healthy bone growth during your teens and 20s, you are at increased risk of developing osteoporosis later in life.
Bone thinning occurs in both men and women. However, bone loss in women accelerates in the years after menopause because women stop producing estrogen, a hormone that protects against bone loss. This means that women are more likely to develop osteoporosis than men.
Age is the primary risk factor for osteoporosis. Women who are 65 or older and men 70 or older are at risk for osteoporosis. Other factors that increase your risk for developing osteoporosis include:
If you have two or more of these risk factors and are a woman younger than 65 or a man younger than 70, talk to us about early screening and other ways to reduce your risk for developing osteoporosis. A man or woman with risk factors may be screened as early as age 50; we can discuss the screening plan that's best for you.
We recommend that women 65 and older and men 70 and older get screened for osteoporosis. During screening, we evaluate your medical history to assess your risk factors. We may recommend a bone mineral density test to evaluate the thickness of your bones or use a tool called a FRAX calculator that can help in predicting your individual fracture risk.
If you're at a higher risk of developing osteoporosis, we may recommend that you begin screening earlier than 65 or 70 years. If you're uncertain if you are at higher risk, talk with us about whether you need a test.
|1 to -1||Normal|
|-1.1 to -2.4||Osteopenia (low bone density)|
|-2.5 or below||Osteoporosis (severe bone loss)|
*FRAX is a tool developed by the World Health Organization to help people determine their risk of bone fracture in the next 10 years.
We recommend that women come in for an initial screening at 65 years of age and that men begin screening at 70 years of age. Certain men and women should begin screening at a younger age if certain risk factors are present:
If the results of your first BMD scan are normal and:
There are many things you can do to prevent or slow the development of osteoporosis. They include improving your diet, adding more calcium and vitamin D, exercising, minimizing your risk of falling, quitting smoking, and reducing alcohol intake.
Increase your calcium and vitamin D intake
Men and premenopausal women need 1000 mg of elemental calcium and 800 to 1200 units of vitamin D daily. Postmenopausal women need 1200 mg of calcium and 1000 to 2000 units of vitamin D daily. Here are some tips for adding vitamin D and calcium to your diet:
Even with a healthy diet, many people do not get enough calcium. It's a good idea to take an over-the-counter calcium supplement twice a day with meals. If you cannot tolerate milk or dairy products for any reason, supplements are particularly important. Follow these guidelines:
Daily activity helps keep your bones strong and makes them less likely to break if you fall. Weight-bearing exercise (walking, jogging, dancing, or lifting weights) is the best way to build strong bones and muscles.
Smoking reduces bone strength and is a major risk factor for heart disease and cancer. Ask your physician or other health care professional for help quitting.
Caffeine, salt/sodium, and alcohol can all reduce bone strength. Experts recommend that women reduce caffeine and salt intake and drink no more than one alcoholic beverage each day to prevent osteoporosis.
You can protect yourself from injury by preventing falls:
We typically use a class of drugs known as bisphosphonates, such as Fosamax or alendronate, to treat osteoporosis. These medications decrease the breakdown of bone and are used to prevent and treat osteoporosis in postmenopausal women. We will talk with you about which specific medication may be best for your individual situation.
How to take your medication
Common side effects
Rare side effects
Other drugs for treatment of osteoporosis include:
If you cannot tolerate bisphosphonates or can't take them for another medical reason, we will prescribe another class of medicines known as selective estrogen receptor modulators (SERMs). SERMs produce estrogen-like effects on bones and reduce the risk of vertebral fractures. They are less effective than bisphosphonates, but they can still be helpful. Choices include:
Estrogen/progestin therapy (HRT therapy)
Hormone therapy (estrogen alone or estrogen and progesterone) is also very effective at reducing fractures. If a woman is taking hormones to relieve menopausal symptoms, she will also have the benefit of bone protection for as long as she takes the medication.
We no longer recommend HRT therapy to prevent osteoporosis because studies found that in some cases it has been associated with an increased risk of breast cancer, stroke, blood clots, and heart attacks.
A number of alternatives are available to treat osteoporosis. For example, isoflavones, plant estrogens with properties similar to estrogen, have been shown to prevent bone loss in some women and to increase bone density in others. Isoflavones are found in high concentrations in soybeans, chickpeas, and lentils. These effects are more pronounced when taken in combination with calcium and vitamin.
It is important to talk to us before using alternative therapies, as they may affect medicines that we have prescribed for you.
If you are having symptoms that concern you or have questions about osteoporosis screening, your first contact will typically be with your personal physician or Ob/Gyn, who will evaluate your health and symptoms. If specialty care is needed, your personal physician or Ob/Gyn will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.
If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.