Osteoporosis is often considered to be a female condition, but it occurs in men and women. In the United States, approximately 10 million individuals have been diagnosed with osteoporosis and many more have it but have not been diagnosed. Among women 80 years of age an older, the prevalence of osteoporosis is 70%. As the U.S. “baby boomer” population ages, the percentage of adults with osteoporosis is expected to increase. Men in the United States typically get the condition 10 years later than women and experience higher rates of mortality following their first osteoporosis hip fracture. Worldwide, 200 million women are currently estimated to have osteoporosis.
Primary osteoporosis occurs most often in post-menopausal women, while secondary osteoporosis occurs most often in men and pre-menopausal women. Type I primary osteoporosis typically occurs in people between 50 and 70 years old, and type II occurs primarily after age 70. The diagnosis of osteoporosis in children and adolescents is controversial because too little is known about whether the standard adult diagnostic criteria have clinical value for younger age groups. Currently, for a child or adolescent to receive a diagnosis of osteoporosis, the minor would typically need to have a combination of low bone density and one or more fractures that can be attributed to bone fragility.
Because osteoporosis is chronic and gets worse over time, the medical profession has adopted the view that patients should be treated for the rest of their lives. Recently this view has come under reconsideration, with experts calling for a maximum usage of 5 years for bisphosphonates. Alendronate stays in the body for years. Indeed, the "terminal half-life" is 10.5 years, which suggests that the drug may continue to work for years after the patient stops taking it.
People with cystic fibrosis often lose bone density. Many measures are being taken to enhance the quality of life in CF patients these days, and it has been found that alendronate given to young patients can help them weather life in decades to come.
Prevention of osteoporosis can often be achieved by targeting risk factors that a person has the ability to modify. The best-known method of preventing osteoporosis is to consume the recommended daily levels of calcium and Vitamin D during childhood, as these two minerals are vital for bone growth and maintenance. Adolescents up to age 19 are recommended to take 1,300 mg of Calcium per day. Authorities recommend adults under age 50 get 1,000 mg of Calcium daily, and adults age 50 and over get 1,200 mg of daily Calcium. Adolescents and adults up to age 50 require 200 IU of daily Vitamin D, adults between age 50 and 70 require 400 IU of Vitamin D each day, and adults 71 years old and over require 600 IU daily. Achieving the recommended levels of Vitamin D and Calcium may require taking supplements, especially if someone is home-bound, lives in a climate with little sun exposure, or is taking medications that interfere with the body’s ability to absorb calcium.
Other effective methods of preventing the onset of osteoporosis include abstaining from smoking, getting sufficient exercise without over-exerting yourself, and limiting alcohol and caffeine intake. Persons that are already smokers may be able reduce their risk of osteoporosis to the level of never-smokers by quitting smoking. In women with estrogen deficiencies, mostly due to menopause, hormone replacement therapy (HRT) is approved by the FDA for osteoporosis prevention. However, due to the numerous health risks of HRT, taking HRT only for the prevention of osteoporosis is not recommended.
The American College of Physicians released guidelines in 2008, recommending doctors offer medicine to patients with osteoporosis and consider medicine for patients at risk for the disease. The report noted that bisphosphonates are effective for treatment and prevention, but that there is not actionable information on how long people should take them.
Doctors sometimes prescribe 5 mg/day or alendronate for patients they feel are at risk for osteoporosis. Low bone density that does not meet the criteria for osteoporosis is called osteopenia. Sometimes alendronate is used to treat osteopenia; whether this is appropriate or not is of some debate within the medical community.
The synthetic hormone teriparatide, sold under the brand name Forteo, is also given to osteoporosis patients. A recent study compared it to alendronate and found no clinical difference in leg bone strength between patients treated with the two drugs.