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Published on 10/23/01

Beef Up Bones, Know Osteoporosis Risks

We learn as children that milk builds strong teeth and bones. But as adults, we need to be aware that things can tear down our bones, too.

Two new, similar studies examined medications that can influence bone mineral density. BMD is a measure of bone strength and bone mineral content. Low BMD puts both men and women at risk for osteoporosis-related fractures.

Healthy BMD depends on many factors, including adequate calcium and vitamin D intake and regular exercise. Bone loss, or low BMD, can be caused by not getting enough calcium and vitamin D, as well as by smoking, inactivity, genetics and certain medications.

Drugs Can Cause Bone Loss

Oral corticosteroids (like prednisone, cortisone or dexamethasone) can cause bone loss if taken regularly. Other medicines, such as antiseizure drugs, very high-dose thyroid drugs or drugs that lower testosterone levels, can also cause bone loss.

One study compared two groups of women who had asthma. One group used inhaled corticosteroids, commonly known as steroids, to control asthma symptoms. The other group didn't use steroids.

All of the women had their BMD measured over three years. Women who used inhaled steroids had more bone loss in their hips and upper thigh bones than women who didn't use steroids.

The women who inhaled more than eight puffs of steroids daily had even more bone loss than those who inhaled only four to eight puffs. The more inhaled steroid used, the greater the bone loss.

While this study makes inhaled steroids sound harmful, people with asthma shouldn't stop using them.

Consult Your Doctor

If you have asthma, work with your doctor to control your asthma symptoms with the lowest steroid doses possible or with nonsteroidal asthma medications. Also, talk to your doctor about BMD testing and how to protect your bones.

The second study looked at preventing or slowing bone loss in men treated for prostate cancer. These patients are often treated with drugs that decrease levels of testosterone (male hormones). Bone loss is a common side effect. This drug-induced bone loss can cause osteoporosis and increase fracture risk in men.

All of the men in the study were treated with a testosterone-lowering drug. Half were also treated with a drug that works to slow bone loss.

Men treated with the testosterone-lowering drug alone lost bone in their spine, hip and thighbones. Men both treated with the bone-saving drug and testosterone-lowering drug had no bone loss.

About 200,000 men will be diagnosed with prostate cancer this year. If you are diagnosed with prostate cancer, discuss treatment options and side effects with your doctor. If you're taking testosterone-lowering drugs, discuss how to slow bone loss and if you need BMD testing.

Calcium, Activity Critical

Both studies bring to light the unseen and harmful effects some drugs can have on bones. It's very important for people taking drugs that can cause bone loss to consume adequate amounts of calcium and vitamin D. Adult men and women need 1,000 milligrams of calcium and 200 international units of vitamin D daily.

Adults over 50 need 1,200 mg calcium and 400 to 600 IU vitamin D daily. This is easily supplied by three or more servings of milk daily. However, you may also need to take calcium and vitamin D supplements to protect bones from the medication side effects.

We all need to get as much physical activity as possible, especially weight-bearing exercises like walking, dancing or gardening, to keep bones strong. It's important to avoid things that weaken bones, like smoking and heavy drinking.

If you have any of these risk factors, ask your doctor if you need medications that prevent bone loss.

To read more on bone loss studies, visit this Web site:

http://content.nejm.org/content/vol345/issue13/index.shtml.