Osteoporosis is a disease of brittle bones. Osteoporosis is just what happens to little old ladies who get frail.

Osteoporosis happens only to women.

For the 60 women assembled for a recent meeting of the Women's Midlife Support Group, Lovelace Health System orthopedic surgeon Dr. Keith Harvie is about to bust some myths about a disease that affects 8 million women and 2 million men in the United States and affects all ethnicities.

For starters, osteoporitic bone is not brittle. You can poke an instrument in it, Harvie says, jabbing an imaginary instrument in the air. "It's soft," he says. "It's not brittle at all."

Osteoporosis is a silent disease, health educator Leona Rubin tells the group as she introduces the talk. Rubin, secretary of the local Osteoporosis Foundation and longtime coordinator of these monthly talks at Presbyterian Healthplex, relates that 12 years ago, to demonstrate new bone density scanning equipment, she agreed to be scanned. It was a good thing. It turned out she had osteoporosis.

But this roomful of women is already an educated bunch. Most seem to know about the four-part osteoporosis formula that can prevent or reverse the disease: bonestrengthening medication, weight-bearing exercise, calcium and vitamin D.

They are here for more -- to calibrate the medication just right, to monitor whether their bodies are absorbing calcium and vitamin D, to compare notes on weight-bearing exercise and to quiz Harvie about medication risks. Many other conditions complicate osteoporosis treatment plans, such as thyroid disease, asthma, arthritis, scoliosis and ulcers.

And there's the rub. The formula has to be effective. It depends on how much calcium you take and when you take it, Harvie says. If your body isn't absorbing it -- if your bone turnover rate is too high or your kidneys are kicking the calcium out of your body before it can get to your bones, if other medications cancel out the calcium or osteoporosis medication -- then you aren't preventing a totally preventable disease.

Surgical help

Harvie is here to answer their questions -- and to let them know about a surgery that can relieve the pain of spinal compression fractures, restore height and correct curvature of the spine. The surgery is called kyphoplasty.

It's a minimally invasive surgery -- with two incisions the size of pencil erasers -- that uses a balloon to insert bone cement in a fractured vertebrae. It can head off kyphosis, the curvature of the spine that gives people the hunched-over little old person look. Kyphosis becomes disabling, preventing the person from performing daily activities, and ultimately, it can lead to compression of the heart, lungs and other organs, which can be fatal.

Dr. Michael Lewiecki, president of the local Osteoporosis Foundation and founder of the annual Santa Fe Bone Symposium, agrees about the relatively new surgery. "One good thing about kyphoplasty is it gives immediate pain relief, and they can get active right away," he says in a phone interview.

Spinal compression fractures are by far the most common osteoporosisrelated fracture and have become the focus of research and public education -- at the top of the list of the many unmet needs in the field, Lewiecki says. The national foundation estimates that 700,000 spinal compression fractures occur each year -- twice the number of hip fractures. Many more occur than are diagnosed because they may go unrecognized, both doctors say. With the aging population, the number of people with spinal fractures is expected to reach 2 million in 2025.

Kyphoplasty will not prevent the person from having another spinal compression fracture, but it can relieve pressure on adjacent vertebrae, Harvie says.

To really fix the problem, Harvie repeats, you need: effective medication, weight-bearing exercise, 2,000 units of vitamin D daily and 1,200 milligrams of calcium, split into three daily doses.

Harvie can't say enough about vitamin D, the oftenoverlooked component in the osteo formula. Anyone with osteoporosis or osteopenia should have a vitamin D blood level between 50 to 70. "Normal is 40," he says.

Many people who have osteoporosis or osteopenia are doing one or two of the four-part formula, but not all.

"No matter what you're doing," Harvie says, if you're taking Fosamax or any other bone-building medication, "if you don't take calcium and vitamin D, you don't make bone."

Right combination

Harvie rolls out tip after tip, anticipating the women's questions. If you have trouble absorbing vitamin D, take an oilbased capsule. If you get leg cramps, it's not because of the vitamin D but because of not getting enough calcium. If you're over 65, take calcium citrate. If you're under 65, take calcium carbonate. If you take stomach medications for ulcer or gastroesophageal reflux (such as Zantac or Prilosec), then take calcium citrate. If you take a thyroid medication such as a synthroid, take your calcium four hours after that medication. Don't take magnesium with your calcium. Take your calcium three times a day.

Harvie says patients should not stay on Fosamax or any bisphosphonate for more than six or seven years. That's because, he says, at some point, the medicine shuts down building bone.

At that point, he likes to switch patients to Forteo.

Lewiecki says Forteo is the one medication that can actually make new bone. Forteo is given as a daily injection for two years.

But the fear with Forteo is about studies that suggested a bone cancer risk in laboratory rats.

Both doctors are quick to put the numbers in perspective. More than 1 million humans have been treated with Forteo, Lewiecki says, and there has been only one documented case of bone cancer. In the normal population, the risk of bone cancer is 1 in 250,000. "So you'd expect to have four cases in that 1 million," he says. This might even suggest Forteo has a favorable effect, reducing the risk of bone cancer.

Lewiecki says the risk statistics for jaw problems are similar -- 0.7 cases per 100,000 patient treatment years, he notes.

"You have to compare that to the risk of breaking a bone if you don't take this medication," he says.

About a 2008 study that showed a doubled risk of atrial fibrillations, or irregular heartbeat, in patients taking Fosamax, Lewiecki was dubious, noting the studies were observational, not controlled. At this point the Federal Drug Administration is taking a closer look but recommending Fosamax be prescribed normally.

"If you get a fragility fracture, you need to be tested," says Harvie. "It doesn't get treated unless it gets diagnosed. Be an advocate."

Myths about osteoporosis

MEN DON'T GET OSTEOPOROSIS: About 2 million men in the United States have osteoporosis. Dr. Michael Lewiecki says that when men get osteoporosis, they often have more severe consequences. Their risk of dying after a hip fracture is higher. "Men seem to be sicker when they break their bones."

IT'S A DISEASE OF BRITTLE BONES: People who have osteoporosis have soft bones that are porous.

FOSAMAX WILL SAVE YOU: The now-generic bone-strengthening drug can prevent bone loss or increase bone density, as well as reduce fracture risk, but it will not be fully effective unless you have an adequate intake of calcium and vitamin D.

FOSAMAX BUILDS NEW BONE: Although Fosamax may increase bone density and make bone stronger, it does not change the structure of the bone that was there before the drug was started. Only one drug, Forteo, has been proven to build new bone where bone has been lost.

COFFEE DEPLETES YOUR BONES: You'd have to drink 60 cups a day, Dr. Keith Harvie says. But Lewiecki says it can be a problem if it's displacing good nutrition. One study showed urinary calcium loss, he says, but another study actually showed coffee may help osteoporosis, increasing the amount of calcium absorbed in the intestines.

Definitely curtail red meat and colas, Harvie says. They have a lot of phosphates. If you consume these, you have to take more calcium to compensate.

IF YOU LIVE IN THE SUNNY SOUTHWEST, YOU GET PLENTY OF VITAMIN D: Only if you expose most of your skin for 30 minutes a day and don't wear sunscreen can you get enough vitamin D simply by living in a highsunshine state, Harvie says. To see more of the Albuquerque Journal, or to subscribe to the newspaper, go to http://www.abqjournal.com. Copyright (c) 2009, Albuquerque Journal, N.M. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.