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Guard Your Bones

Osteoporosis is one of the biggest health risks facing older women. The drop in estrogen levels after menopause can lead to bone loss of up to 20% over 5 to 10 years, which is why half of all women over 50 suffer from some degree of osteoporosis. Although there are many treatments, the gold standard is tarnished. Hormone replacement therapy (HRT) has long been prescribed both to relieve the symptoms of menopause and prevent the breakdown of bone that occurs when the body stops producing estrogen. But large studies reported in the past two years have revealed that HRT, though good at bone protection, can increase the risk of breast cancer, heart disease, and Alzheimer's if taken for five years or more.

HRT is still prescribed, but there are alternatives, and medical specialists warn that women at risk of osteoporosis can ill afford to ignore them. In a survey released in April, 1 out of 13 untreated postmenopausal women with osteoporosis who were initially fracture-free were likely to suffer a fracture within a year, even if they were taking vitamin D and calcium, typical over-the-counter treatments. "Choosing a therapy proven to act rapidly is important" for women who are losing bone density, warns Dr. Robert Lindsay of Helen Hayes Hospital in West Haverstraw, N.Y., the lead author of the report.

Bone loss isn't inevitable. Women who exercise regularly in their 20s and 30s and eat a diet rich in calcium can improve their odds of avoiding osteoporosis. Studies have found that even elderly women can strengthen their bones with regular weight-bearing exercise.

For women already at risk, new drugs fall into two categories: those that prevent further deterioration and those that build new bone. Evista is the most popular bone protector. It's sometimes referred to as a designer estrogen because it mimics the hormone's effects. It may also confer other benefits: In a just-released clinical trial that followed 5,200 women with osteoporosis for eight years, Evista cut breast-cancer risk by 66%.


Two other drugs that protect bone, Fosamax and Actonel, are biophosphates. They bind to bone crystals, inhibiting their breakdown. Evista, Fosamax, and Actonel are approved for both prevention and treatment of osteoporosis and have no serious side effects. Evista must be taken daily, while the others come in both daily and once-a-week doses. Another bone protector, Calcitonin, is a nasal spray and is used for treatment only.

Only one drug on the market builds bone density. Forteo, approved in 2002, is a synthetic hormone that stimulates bone production. It's expensive and requires a daily injection, so it is usually prescribed only to patients with severe osteoporosis. Ideally, though, exercise and a healthy diet throughout life will keep such serious bone loss at bay.

By Catherine Arnst

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