Question: My mother has been a resident of a local nursing home for the past four years. During this time, she has lost more than eight inches in height due to osteoporosis. She suffers from numerous fractures that keep her in constant pain. We know the facility does its best, but more fractures keep appearing. My sister and I are concerned not only about her, but also about our own odds of being devastated by this disease. Mom’s doctors say there is nothing that can be done to help her.

Answer: A disease that causes bones to become brittle over time, osteoporosis – literally meaning “porous bones” -- can advance without pain until bones fracture, usually in the hips, spine, and wrists. Fractures of the vertebra can cause height loss, severe pain, and deformity. Fractures of the hip generally result in major surgery, hospitalization, and rehabilitation in a nursing facility. Oftentimes, as in your mother’s case, osteoporosis requires longer stays in nursing homes because the patient can’t receive appropriate care at home if she can’t walk without assistance.

Of the millions of Americans at risk, four times as many women as men develop the disease. Increased life expectancies increase the risk of osteoporosis and related fractures, and leading risk factors include 1) age, because bones become less dense; 2) being a woman, as bone loss occurs more rapidly due to menopausal changes; 3) heredity 4) race, as Caucasian and Asian females are more prone to develop the disease; 5) being thin and having small bones; 6) early menopause; 7) smoking, drinking alcohol, ingesting too little calcium, and not getting proper exercise; and 8) taking medications to treat such diseases as arthritis and seizure disorders. Women with bone density levels below the nursing home average appear to be more than twice as likely to experience a fracture as those with higher than average levels.

According to the National Osteoporosis Foundation, osteoporosis causes more than 1.5 million fractures each year, including 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures, and 300,000 fractures at other sites. In 2001, it is estimated that more than $17 billion was spent caring for patients with osteoporosis in hospitals and nursing homes. And about 24% of those over age 50 die within a year after fracturing a hip.

Based on a recent study published in the Journal of the North American Menopause Society, an over-the-counter dietary supplement called Femarelle has been found to preserve bone mineral density (BMD) in women who have reached menopause. According to the study, all women have increased loss of bone mineral density after the normal reduction in estrogen levels. While calcium supplements may help women over 50 maintain a necessary calcium level for healthy bones, they do not build bone density. But according to the study, Femarelle – also available as Tofupil -- has been shown to increase BMD noticeably in the spine and neck.

According to another study, nursing home residents don’t receive satisfactory treatment for osteoporosis. This study found that one of four over the age of 65 were not treated properly, and suggested that nursing home doctors either may not be aware that the residents have the disease or may be hesitant to add yet another drug to the panoply of medications taken by elderly residents. Either way, this study states that therapeutic doses of calcium-vitamin D should be given to nursing home residents, whether they have osteoporosis or not.

Taking the NextStep: For more information about Femarelle, call 1-877-FEMAREL (1-877-336-2735). It can be found in some pharmacies and drug chains. We also suggest that you visit the site of the National Osteoporosis Foundation (http://www.nof.org/), but don’t take any medications or supplements (or give them to Mom) without first clearing it with your/her physician.