Nov 24, 2008

Osteoporosis: Yet another Complication of Diabetes? (Part 2)

Amy Campbell

Last week, in "Osteoporosis: Yet Another Complication of Diabetes? (Part 1), " we started to look at osteoporosis. As a quick review, osteoporosis is a bone disease whereby you lose too much bone, make too little bone, or both. We also know that, while women are primarily impacted, men can get osteoporosis, too. Everyone needs to be aware of this disease and focus on ways to prevent it. This week we’ll look at diagnosis and medical treatment for osteoporosis.

By the way, the National Osteoporosis Foundation has, on its Web site, a one-page questionnaire that you can take to determine your risk for osteoporosis quickly: www.nof.org/prevention/Risk_Factor_Questionnaire.pdf. When you have a moment, figure out what your risk is. Your health-care provider can also help you with this.

Testing
If you and your health-care provider determine that you're at risk for osteoporosis, the next likely step is to get a bone mineral density (BMD) test. This test is really the only way to determine if you have osteoporosis or have low bone density.

Also known as dual energy X-ray absorptiometry (DEXA or DXA, for short), this test can reveal quite a bit of useful information. For example, besides confirming that a person has osteoporosis, it can determine whether a person's bone density is decreasing, increasing or staying the same; it can pick up low bone density before a bone breaks; and it can even predict the chances of someone breaking a bone in the future. The DEXA test is noninvasive and you don't even have to take your clothes off! It usually takes no more than 15 minutes to have this done.

Your health-care provider will let you know how often you need to have this test repeated (usually every one to two years), and ideally you should try to go to the same facility to have the test repeated. Your provider will also need to write a prescription for this test, and you should check with your health insurance plan about coverage before you have this done. Once you have the test, you'll receive results, called a T-score. Here's what the T-score means:

• +1 to –1 indicates normal bone density
• –1 to –2.5 indicates low bone density (osteopenia)
• –2.5 indicates osteoporosis

Basically, the lower the T-score, the lower the bone density.

Other tests used to gauge bone density include ultrasound, CT scan, and X-ray (to detect a broken bone), but the DEXA test is probably the most common.

Medical Treatment
As with diabetes, it's never good news to find out that you have osteoporosis. However, also as with diabetes, there are more treatment options available today than there were not too many years ago. If your T-score confirms that you have osteoporosis, your health-care provider may use a tool called the absolute fracture risk which can help guide him into figuring out the best type of treatment for you. If medication is the chosen form of treatment, there are several options to choose from:

• Biphosphates. These inhibit or slow bone loss, preserve bone mass, and may increase bone mass. Side effects include nausea, abdominal pain, and esophageal ulcers. These drugs can be taken, in pill form, once a week or once a month. Oral biphosphates include alendronate (brand name Fosamax), risedronate (Actonel), and ibandronate (Boniva). They're also available in IV form. In fact, a drug approved last year, zoledronate (Reclast), is given by IV just once a year. Be aware that biphosphates taken by IV increases your chance of jaw bone problems.
• Selective estrogen receptor modulators (SERMs). These drugs work in a manner similar to estrogen to help both prevent and treat osteoporosis. The most common side effects are hot flashes and blood clots. They're not approved for use in men. Two common SERMs are tamoxifen (Nolvadex) and raloxifene (Evista).
• Calcitonin. Calcitonin is a hormone made in the thyroid gland that may help slow bone loss, prevent spine fractures, and reduce pain. It's usually given as a nasal spray and may be irritating to the nasal passages, but may be given as an injection as well. Brand names include Calcimar and Miacalcin. Calcitonin isn't as effective as other drugs, but may be used if other medications aren't tolerated.
• Teriparitide. This is a synthetic version of parathyroid hormone that actually stimulates new bone growth (unlike the other medications). It's given as an injection once a day, and can be used in postmenopausal women and in men. Side effects are unknown, so the FDA has approved its use for just two years. The brand name is Forteo.

Next week: The role of diet in osteoporosis, plus the diabetes link!

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