Osteoporosis is an often crippling, disabling
and potentially life-threatening bone disease that can often be
prevented. Osteoporosis has been called "the silent killer,"
because there are no early warning signs. A bone fracture
is often the first sign of the disease.
Osteoporosis is a wide spread problem. It is a major
public health threat for an estimated 44 million Americans,
or 55 percent of people 50 years of age and older. While osteoporosis
is often thought of as an older person’s disease, or
one where Caucasian or Asian women are at greater risk, it
can strike at any age and it cuts across all ethnic and racial
barriers.
In the U.S. today, 10 million individuals are estimated to
already have osteoporosis and almost 34 million more are estimated
to have low bone mass (osteopenia), placing them at increased
risk for osteoporosis. Of the 10 million who already have
osteoporosis, 8 million are women and 2 million are men.
By the year 2010, it is estimated that over 52 million women
and men age 50+ will be affected and, if current trends continue,
the figure will climb to over 61 million by 2020.
Yet despite these statistics, the disease remains little understood
by the general public (including those at the greatest risk)
and the medical community. Three out of four women, ages 45-75,
have never spoken to their doctor about osteoporosis. Today,
the vast majority of people with the disease remain undiagnosed
and untreated. As a result, osteoporosis takes a huge toll
on its victims.
This disease is responsible for more than 1.5 million fractures
annually, including more than 300,000 hip fractures and approximately
700,000 vertebral fractures, 250,000 wrist fractures and 300,000
fractures at other sites. One in two women and one in four
men over age 50 will have an osteoporosis-related fracture
in her/his remaining lifetime. As many as 300,000 individuals
who suffer an osteoporosis-related fracture die as a result
of complications from the injury.
The irony is that osteoporosis is largely preventable.
The Many Consequences
of Osteoporosis.
If not prevented or if left untreated, osteoporosis can lead
to broken bones. Fractures of the hip and spine are of special
concern because a hip fracture almost always requires hospitalization
and major surgery. It can impair a person’s ability
to walk unassisted and may cause prolonged or permanent disability
— including loss of height, severe back pain and deformity
— and even death. Up to 20% of those suffering hip fractures
will die from injury-related complications within a year.
The Risk Factors
Caucasian, Asian, fair-skinned and/or blond women are at a
higher risk, as are petite or small-boned women. Additional
risk factors include improper diet, low calcium intake and a
history of eating disorders such as anorexia nervosa. Lactose intolerant women may
be at higher risk and should be especially careful to obtain
adequate calcium through other non-dairy sources.
A sedentary lifestyle increases your risk for osteoporosis.
Weight-bearing exercises like walking, jogging, weight lifting,
and low-impact aerobics have been shown to increase bone strength
and size.
Cigarette smoking, alcohol and having a diet low in calcium are some of the factors
that may increase your risk for developing osteoporosis. Therefore,
if you smoke, you should stop. Limit your intake of alcoholic
beverages and drink and get enough calcium in your diet or add a calcium supplement.
How Osteoporosis Occurs
As you age, more bone is broken down than is reformed, causing
loss of density and strength. The rate of bone loss accelerates
in women as they enter menopause. Two important factors affect
the development of osteoporosis: the peak bone mass you attain
by about age 30, and the rate at which you lose bone in later
years. No matter what your age, however, you can also lose
bone mass as the result of certain medical conditions and
medications. They can seriously affect the process of bone
formation and cause or speed the development of osteoporosis.
The following medical conditions may adversely
affect your bone health:
Prolonged use of the following medications may adversely
affect bone health:
Some medications, such as the treatments for osteoporosis
like Fosamax®, Evista® and Actonel®, require adequate intake of calcium and vitamin D for optimum effectiveness
in improving bone health. You may need a calcium and/or vitamin D supplement to reach adequate levels. ASK YOUR DOCTOR FOR ADVICE IF YOU
ARE TAKING ANY OF THESE MEDICATIONS.
Preventing Osteoporosis
Calcium and vitamin D are two of the best life-long defenses against osteoporosis.
Calcium is primarily stored in your bones. It also helps muscles
contract, blood clotting and nerves function. If you don't
get enough calcium, your body must replenish the needed calcium
in your blood and soft tissues by robbing it from your bones
-- slowly, but surely causing your bones to weaken and increasing
the potential for fractures. The best way to get adequate
calcium is to eat lots of calcium-rich food -- from adolescence
through menopause and beyond. However, getting enough calcium
in your diet may be harder than you think and you may need
to add a calcium supplement to your diet.
Throughout your life cycle you have different calcium needs.
Experts recommend the following amounts:
What is the interrelationship between exercise, calcium
and osteoporosis? Calcium is most effective when women
are physically active. Physically active women have a 36 to
42% lower risk of fracturing a hip than the least active women.
Diagnosis of
Osteoporosis
Since osteoporosis can develop undetected for decades until
a fracture occurs, early diagnosis is important. An accurate,
painless and noninvasive bone mineral density test (BMD) one of the best ways to diagnose osteoporosis and help estmiate the risk
for future fractures. A BMD enables the physician to determine
whether medication is necessary to help maintain bone mass,
prevent further bone loss and reduce fracture risk. If medication for osteoporosis treatment is required, adequate calcium and vitamin D intake is also required for optimal effects.
As a result of the 1998 Bone Mass Measurement Act (BMMA) Medicare
will now provide uniform coverage for medically necessary
bone mass measurements.
How is bone density measured? There are
several different machines that measure bone density. Central
machines measure density in the hip, spine and total body.
Peripheral machines measure density in the finger, wrist,
kneecap, shin bone and heel.
With the information obtained from a BMD test, you and your
doctor can decide what prevention or treatment steps are right
for you. BMD tests cannot stand alone; they should always
be a part of a complete medical workup supervised by a knowledgeable
doctor.
What are the T-score and Z-score? The T-score
and Z-score represent the results of the bone mineral density
diagnostic tests used to assess bone density. The T-score
describes how the measured bone density compares to that of
healthy young adults and the Z-score compares how the measured
bone density compares to the average of persons of the same
age as the person being tested. The Z-score can help classify
the type of osteoporosis. This is important because treating
an underlying condition may be necessary to correct the low
bone density.
Treatment
Although there is no cure for osteoporosis, the U.S. Food
and Drug Administration has approved various prescription
medications for the treatment of osteoporosis, including calcitonin,
bisphosphonates (such as alendronate and risendronate) and
selective estrogen-receptor modulators (SERMs), including
raloxifene. Each of these treatments has its unique benefits
and risks.
New prescription treatments currently under investigation
include vitamin D metabolites and other, newer bisphosphonates
and SERMs, and parathyroid hormone (PTH).
Osteoporosis is largely preventable. Lifestyle adjustments
(including diet and exercise) and calcium supplementation
can help optimize bone health.
How do osteoporosis medications work? Osteoporosis
occurs when the process that removes old bone and replaces
it with new bone becomes imbalanced. Bone is depleted (resorbed)
more quickly than it is replaced so bones weaken and may break.
Today, medications that prevent or treat osteoporosis act
on either bone resorption (anti-resorptive) or bone formation
(anabolic).
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Anti-resorptive medications
slow the rate of bone resorption without changing the
rate of bone formation. Bone formation continues as usual,
resulting in a small increase in bone. Anti-resorptive
medications approved by the Food and Drug Administration
for the prevention and/or treatment of osteoporosis include
bisphosphonates (alendronate and risedronate), calcitonin,
estrogen/hormone therapies and selective estrogen receptor
modulators, called SERMs (raloxifene). |
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There is one anabolic medication that acts
on the bone formation part of the cycle. Parathyroid hormone
injections stimulate new bone formation, which strengthens
bone and reduces fracture risk. |
Remember, no matter what medication you may be prescribed,
it is important to get at least 1,200 mg of calcium and 400-800
International Units of vitamin D every day. Regular weight-bearing
exercise also is an essential part of any osteoporosis prevention
or treatment plan. People with osteoporosis should be sure
to review any exercise program with a healthcare provider.
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