Osteoporosis is a skeletal disorder that is characterized by a loss of bone mass, a deterioration of bone microarchitecture and a decline in bone quality which leads to an increased vulnerability to bone fractures. Osteoporosis has a five fold greater prevalence in women than men. There is also a wide variation in hip and fracture rates in women based on race and ethnicity. In the United States Caucasian women have the highest rate of hip fracture while African- American women have the lowest rate. Mexican-American women fall in-between these two groups. Although Asian women often have bone density measurements lower than Caucasian women, interestingly enough they have fewer vertebral and hip fractures than Caucasians.

Pass the Pearls asks Dr. Rebecca Terry, a gynecologist with Women First of Louisville who also specializes in treating and preventing osteoporosis in women these questions. She is a contributor to our site and serves on the Pass the Pearls editorial board.

What are the symptoms of osteoporosis? How is osteoporosis treated? Osteoporosis has been called the silent epidemic in America. This is because there is no pain associated with it and no outwardly visible signs. Bone mass and quality decrease and a fracture occurs often without any warning symptoms. Before osteoporosis treatment is started secondary causes for osteoporosis besides aging are excluded by blood testing and evaluation of medical problems or any medications that can cause bone loss. There are many treatment options for osteoporosis including the largest category called the bisphosphonate drugs. These include the brand names of Fosamax, Actonel, Boniva, and Reclast along with others. These are given either orally or they can be given via IV infusion. Often times at least a 3-5% increase in bone density is seen after two years of therapy. Another category is a partial estrogen agonist or antagonist. This includes Evista. These drugs mimic the actions of estrogen on bone and improve bone mass. Another drug used more recently on the market is Prolia. It is given as an injection under the skin every six months and helps to prevent the formation of the small cells that actually break down our bones to release calcium. Forteo is a medication that is given as an injection just under the skin daily for two years in patients who have a failure to respond to categories of drugs I have listed. It is also often used in patients who have had skeletal fractures because it tends to act more rapidly to improve bone density. It cannot be used in patients with a history of extensive irradiation to the bone for cancer or other conditions. The final therapeutic intervention most commonly used is estrogen. Estrogen is important as it prevents bone loss from occurring and helps to prevent any further bone loss from occurring and lowers fracture risk.