Osteoporosis is a disease in which bones become fragile and more likely to fracture. Usually the bone loses density, which measures the amount of calcium and minerals in the bone. Causes, incidence, and risk factors Osteoporosis is the most common type of bone disease. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bone of the spine) during their lifetime. Bone is living tissue. Existing bone is constantly being replaced by new bone. Osteoporosis occurs when the body fails to form enough new bone, when too much existing bone is reabsorbed by the body, or both. Calcium is one of the important minerals needed for bones to form. If you do not get enough calcium and vitamin D, or your body does not absorb enough calcium from your diet, your bones may become brittle and more likely to fracture. Sometimes bone loss occurs without any cause. White women are more likely to have bone loss. Sometimes the tendency to have bone loss and thin bones is passed down through families. A drop in estrogen in women at the time of menopause and a drop in testosterone in men is a leading cause of bone loss. Other causes of bone loss include:

Being confined to a bed

Certain medical conditions

Taking certain medications

Other risk factors include:

Absence of menstrual periods (amenorrhea) for long periods of time •A family history of osteoporosis

Drinking a large amount of alcohol

Low body weight

Smoking Symptoms

There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning that they have the disease. Pain almost anywhere in the spine can be caused by fractures of the bones of the spine. These are called compression fractures. They often occur without an injury. The pain may occur suddenly or slowly over time. There may be a loss of height (as much as 6 inches) over time. A stooped posture or kyphosis (also called a “dowager’s hump”) may develop. Signs and tests Bone mineral density testing (most often with a DEXA scan) measures your bone mineral density. Your health care provider uses this test to:

Diagnose bone loss and osteoporosis

Predict your risk of future bone fractures

See how well osteoporosis medicine is working A spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis. You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Treatment for osteoporosis may involve:

Lifestyle changes, such as diet and exercise

Taking calcium and vitamin

​Using medications Medications are used to strengthen bones when:

Osteoporosis has been diagnosed by a bone density study, whether or not you have a fracture.

A bone fracture has occurred and a bone density test shows that you have thin bones, but not osteoporosis.

Medicines used to treat osteoporosis include:

Bisphosphonates (the main drugs used to prevent and treat osteoporosis in postmenopausal women)

Estrogens, teriparatide, raloxifene, and calcitonin Exercise plays a key role in preserving bone density in older adults.

Some of the exercises recommended to reduce your chance of a fracture include:

Weight-bearing exercises — walking, jogging, playing tennis, dancing

Free weights, weight machines, stretch bands

Balance exercises — tai chi, yoga

Rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures in older adults.

Your body needs calcium and vitamin D to keep your bones strong. Vitamin D helps your body absorb calcium.

Adults under age 50 should have 1,000 mg of caclium and 400 – 800 IU of vitamin D daily.

Women ages 51 to 70 should have 1,200 mg of calcium and 400 – 800 IU of vitamin D a day; men ages 51 to 70 need 1,000 mg of calcium and 400 – 800 IU of vitamin D a day.

Adults over age 70 should get 1,200 mg of calcium and 800 IU of vitamin D daily.

Your doctor may recommend a calcium supplement.

Follow a diet that provides the proper amount of calcium and vitamin D. Stop unhealthy habits:

Quit smoking, if you smoke.

Limit your alcohol intake. Too much alcohol can damage your bones, and put you at risk for falling and breaking a bone. It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good.

Other ways to prevent falling include:

Avoid walking alone on icy days

Leave lights on at night so you can see better when walking around your house

Remove slippery rugs from your house

Use bars in the bathtub, when needed

Wear well-fitting shoes

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop BMD that is very low compared to normal, known as osteoporosis.

What causes osteopenia?

Bones naturally become thinner as people grow older because, beginning in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker and increasing their risk of breaking. All people begin losing bone mass after they reach peak BMD at about 30 years of age. The thicker your bones are at about age 30, the longer it takes to develop osteopenia or osteoporosis.

Some people who have osteopenia may not have bone loss. They may just naturally have a lower bone density. Osteopenia may also be the result of a wide variety of other conditions, disease processes, or treatments. Women are far more likely to develop osteopenia and osteoporosis than men. This is because women have a lower peak BMD and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause. In both men and women, the following things can contribute to osteopenia:

Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
Chemotherapy, or medicines such as steroids used to treat a number of conditions, including asthma
Exposure to radiation
Having a family history of osteoporosis, being thin, being white or Asian, getting limited physical activity, smoking, regularly drinking cola drinks, and drinking excessive amounts of alcohol also increase the risk of osteopenia and, eventually, osteoporosis.

Osteopenia is treated by taking steps to keep it from progressing to osteoporosis and, for a few people, by taking medicine. Lifestyle changes can help reduce the bone loss that leads to osteopenia and osteoporosis.

What you eat is very important to bone development. Calcium is the most critical mineral for bone mass. Your best sources of calcium are milk and other dairy products, green vegetables, and calcium-enriched products.

Your doctor may also want you to take a calcium supplement, often combined with vitamin D. Vitamin D helps your body absorb calcium and other minerals. It is found in eggs, salmon, sardines, swordfish, and some fish oils. It is added to milk and can be taken in calcium and vitamin supplements. In addition to what you take in from food, your body makes vitamin D in response to sunlight.

Exercise is important for having strong bones, because bone forms in response to stress. Weight-bearing exercises such as walking, hiking, and dancing are all good choices. Adding exercise with light weights or elastic bands can help the bones in the upper body. Talk to your doctor or a physical therapist about starting an exercise program.

In addition to diet and exercise, quitting smoking and avoiding excessive use of alcohol and cola will also reduce your risk of bone loss.

There are medicines for treating bone thinning. But these are more commonly used if you have progressed past osteopenia to the more serious condition of osteoporosis. Medicines that may be used for osteopenia include bisphosphonates, raloxifene, and hormone replacement. For more information on these medicines, see the topic Osteoporosis.

How can osteopenia be prevented?

Whether you will tend to develop osteopenia is, in part, already determined. Things like whether you have any family members who have had osteoporosis or osteopenia, whether you have chronic asthma that requires you to take steroids, and how much calcium and vitamin D you got while you were growing up are beyond your control now. But if you are a young adult or if you are raising children, there are things you can do to help develop strong bones and help slow down osteopenia and prevent osteoporosis.

Your bones don’t reach their greatest density until you are about 30 years old, so for children and people younger than 30, anything that helps increase bone density will have long-term benefits. To maximize bone density, make sure you get plenty of calcium and vitamin D through your diet and by spending a little time in the sun, get weight-bearing exercise on a regular basis, don’t smoke, and avoid cola and excessive alcohol. If you have children, teach them to eat healthy, get regular exercise, and avoid smoking and alcohol. Also, get them to play a little in the sunshine to help their bodies make more vitamin D. Talk with your doctor about how much and what sources of vitamin D are right for your child.

If you’re older than 30, it’s still not too late to make these lifestyle changes. A balanced diet and regular exercise will help slow the loss of bone density, delay osteopenia, and delay or prevent osteoporosis.

Excessive Menstrual Bleeding If your periods are so heavy that they disrupt your normal daily activities, you may have excessive menstrual bleeding. The medical term for periods that are very heavy, prolonged or both is menorrhagia. Symptoms of menorrhagia may also include cramping, pelvic pain, and in severe cases, anemia. Excessive menstrual bleeding is a common condition that occurs for many of reasons. Two of the most common causes are: a hormonal imbalance and uterine growths. Hormone Imbalances Your menstrual cycle is controlled by hormones, including estrogen and progesterone. When these hormones are out of balance, they can cause heavy periods or bleeding between periods. Causes of hormonal imbalances may include:

• Hormonal changes in teens and in women nearing menopause
• Diabetes
• Thyroid Disease
• Obesity
• Stress
• Strenuous exercise
• Anorexia (eating disorder) Types of Uterine Growths
• Fibroids
• benign (non-cancerous) growths in or near the uterus
• Polyps – growths that attach to the inner wall of the uterus and protrude into the uterine cavity
• Adenomyosis
• endometrial tissue normally lining the uterus grows into the muscular walls of the uterus
• Endometriosis tissue that normally lines the inside of your uterus grows outside your uterus
• Endometrial cancer – an uncontrolled growth of cells of the uterine lining
• Hyperplasia – an abnormal proliferation of cells (cell division or growth) that may result in enlargement (growth) of the uterus. This term is sometimes used to refer to a benign tumor or fibroid.

Treatment Options for Excessive Menstrual Bleeding Excessive menstrual bleeding can be treated with hormone therapy, surgery or a combination of both. Your doctor can diagnose your condition and provide treatment(s) to relieve your symptoms. Hormone Therapy Your doctor may recommend you take hormones such as progesterone or the birth control pill to control and regulate your period. Hormone therapy can limit the swelling of your endometrium (uterine lining that sheds each month during your period) and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery. Surgery Surgical procedures to treat excessive bleeding include endometrial ablation and hysterectomy. Endometrial Ablation Energy is used to destroy the endometrial lining of the uterus with the goal of lightening or stopping your periods. This technique is usually done on an out patient basis at the hospital or in your physicians office. This procedure is not recommended for women who may still want to become pregnant. Hysterectomy The surgical removal of your uterus. Depending upon your condition, your fallopian tubes, ovaries and any visible growths may also be removed. A hysterectomy can be performed using traditional open or laparoscopic surgery. Open surgery involves a large abdominal incision and a four to six week recovery. Laparoscopic surgery is minimally invasive, with only a few small incisions. Your hysterectomy can also be done using the da Vinci Robotic procedure. This procedure requires only a few tiny incisions, less pain and a quicker recovery time.

Essure^® POST-PROCEDURE INSTRUCTIONS

Going Home

• Obtain a completed ID card before you leave. Keep your ID card with you at all times and present it to other doctors involved in your present or future care.
• Schedule your Essure Confirmation Test (see below) for 3 months from now.

When You are Home

• If you are experiencing cramping, follow your doctor’s instructions regarding pain medication.

You may feel faint or nauseous. Follow your doctor’s recommendations regarding activity during the first 24 hours following your procedure.

• Spotting or light bleeding is normal. If bleeding becomes heavy, you suspect you may be pregnant, or you become concerned, please contact your doctor.
• You must use alternative contraception until your physician verifies that the inserts are in the correct location and your fallopian tubes are blocked. You may resume intercourse on .
• Please call your doctor if your period is more than 5 days late or you suspect you may be pregnant.

3-month Essure Confirmation Test

• You will need to schedule the Essure Confirmation Test for 3 months post-procedure. The test is performed to make sure that both of your Essure inserts are in the correct location and that your fallopian tubes are blocked so you can rely on Essure as permanent birth control.

You must use alternative contraception until your 3-month Essure Confirmation Test confirms that your Essure inserts are in the correct location and that your fallopian tubes are blocked. Only at that point can you rely on Essure for birth control.

If you rely on the Essure device for birth control before completing the Essure Confirmation Test, you may get pregnant or have an ectopic pregnancy (pregnancy outside of your uterus, but inside the body). Ectopic pregnancies can be life-threatening; so if you think you might be pregnant, please call your physician.

Indication

Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy.

Important Safety Information

WARNING: You must continue to use another form of birth control until you have your Essure Confirmation Test and your doctor tells you that you can rely on Essure for birth control.

• You can rely on Essure for birth control only after your doctor has reviewed your Essure Confirmation Test results. Your doctor will confirm that the inserts are properly placed and both of your fallopian tubes are blocked. If you rely on Essure for birth control before having your Essure Confirmation Test, you are at risk of getting pregnant.
• Talk to your doctor about which method of birth control you should use for the 3 months after the procedure. Some women can remain on their current birth control. Other women, such as those using an intrauterine device or contraceptive (IUD or IUC), will need to switch to another method.
• It can take longer than three months for the Essure procedure to be effective. In rare cases, it has taken up to 6 months. Make sure to continue using an alternate form of birth control up until your doctor has reviewed your Essure Confirmation Test results and confirmed that you can rely on Essure for birth control.

WARNING: Be sure you are done having children before you undergo the Essure procedure. Essure is a permanent method of birth control. The younger a woman is when she chooses to end her fertility, the more likely she is to regret her choice later.