Osteoporosis

About Osteoporosis

Our bones are made up of living, growing tissue.   They are made mostly of collagen, a protein that provides a soft framework, and calcium, a mineral that adds strength and hardens the framework.  Throughout our lifetime, old bone is removed in a process called resorption, and new bone is added to the skeleton and this process is known as formation.   During the childhood and teenage years, new bone is added faster than old bone is removed, and bones become larger, heavier, and denser.   Bone formation continues at a pace faster than resorption until around age 30.  After that, bone resorption slowly begins to exceed bone formation.

Osteoporosis is a condition that results from decreased bone mass.  This leads to fragile bones which fracture much more easily than a normal, healthy bone.   A fall, blow or lifting action that would not normally bruise or strain the average person can easily break one or more bones in someone with severe osteoporosis.
The term "porosis" comes from the word “porous” which can be loosely defined as “spongy.”  This describes the appearance of bones when they are broken in half and the inside is examined.  Normal bone marrow has small holes within it, but a bone with osteoporosis will have much larger holes, resulting in a more fragile bone.
Osteoporosis and low bone mass affect as many as 44 million individuals in the United States.   It has been estimated to be the cause of 1.3 million bone fractures a year, and is responsible for about 70 percent of all fractures for people 45 and older. 

Women are especially at risk of developing osteoporosis.  As we age and enter menopause, production of a female hormone called estrogen declines.   Since estrogen plays a part in supplying calcium to the bone, this loss is believed to be linked to osteoporosis.   Beginning with menopause, bone loss normally accelerates sharply for about five years, and then continues more slowly after that.  By age 70, approximately half of all women have developed osteoporosis.

Risk Factors of Osteoporosis

There are several risk factors associated with osteoporosis.  Following are some of the most common:

• Age - The risk of osteoporosis increases with increasing age in both men and women.
• Gender - Osteoporosis is estimated to be six to eight times more common in women than in men.  This is partly due to the fact that women have less bone mass to begin with, and partly due to menopause.
• Body Size - Small body frame and underweight women are at greater risk.
• Race – Caucasian women are at higher risk than black women, and caucasian men are at higher risk than black men.
• Family History - A family history of osteoporosis is a risk factor.
• Inadequate Calcium  - Individuals who consistently consumed less than the recommended amount of calcium in any phase of life--childhood, adolescence or adulthood--have an increased risk.  
• Menstrual Status - Women who have an early menopause, hysterectomy, irregular or non-existent menstruation due to low body weight and/or intense long term aerobic exercise are at risk.
• Smoking - An unknown substance in tobacco has been shown to decrease estrogen levels in women.
• Alcoholism or heavy alcohol consumption - Alcohol is believed to have a toxic effect on bone.
• Sedentary Lifestyle - Physical activity fortifies the bones, and not exercising puts you at risk.  In particular, weight bearing exercise where the bones are stressed is the best form of physical activity for bone health.
• Prescription Drugs - Long-term use of certain medications can increase a person’s risk, including corticosteroids/steroids , blood thinners, thyroid hormones, diuretics, anticonvulsants and some antacids.  

Symptoms

Osteoporosis is referred to as a "silent disease", since bone loss occurs without symptoms.  People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a bone to fracture or a vertebra to collapse.  However, there may be a chronic, dull pain particularly in the lower back or neck, which may become sharp later in the course of the disease.

Diagnosis

A procedure commonly known as a bone density scan should be performed at her annual physical exam for all women over 50, and for younger women who have other risk factors.  The most common and accurate bone density scan is the DEXA.   DEXA measures bone density based on how bone absorbs two sets of photons (atomic particles with no electrical charge) generated by an x-ray tube. Measurements are obtained at the wrist, hip and lower spine.   The result of the test is given as a “T-score” which is calculated by comparing your test results with the average bone density of a normal 30-year-old woman.    A negative score means your bones are thinner than an average 30-year-old, while a positive score means they are stronger than the average 30-year-old. 
 

Treatment

Treatment for osteoporosis focuses on slowing down or stopping the mineral loss, increasing bone density, preventing bone fractures, and controlling the pain associated with the disease.   Following are some of the things your healthcare provider might recommend:

• Diet and exercise - Lifestyle modification should in most cases be incorporated into treatment.  Adequate amounts of calcium and Vitamin D, along with regular exercise, can reduce the likelihood of bone fractures associated with osteoporosis.   Studies show that exercises requiring muscle to pull on bones causes the bones to retain, and perhaps even gain, density.
• Estrogen - For newly menopausal women, estrogen replacement is one way to prevent bone loss.
• SERMs - For women who are unable to take estrogen or choose not to, selective estrogen receptor modulators (SERMs) offer an alternative.  The effects of SERMS on bone and cholesterol levels are comparable to those of estrogen replacement.
• Bisphosphonates – These drugs slow down bone loss and in some cases actually increase bone mineral density.   Doctors can measure the effects of these drugs by obtaining DEXAs every year or two and comparing the measurements.  In general, bisphosphonates line the surface of bone, preventing the bone-eating cells from breaking down bone, and slowing down the bone loss.

Prevention of Osteoporosis

The prevention of osteoporosis is a lifetime process.   Most bone mass is developed before the age of 30, so after that, the goal is to retain the bone mass you already have.   The National Osteoporosis Foundation (NOF) provides five simple steps which are important for preventing osteoporosis, when used in combination.   It is never too early or too late to start your osteoporosis prevention program.

Those steps are:

• Maintain adequate calcium and Vitamin D levels
• Get regular weight-bearing exercise (walking, dancing, stair-climbing, etc.)
• Avoid smoking and excessive alcohol intake
• Talk to your doctor about bone health
• Get regular bone density screening and take medications if recommended

Remember

Osteoporosis affects as much as half of all women sometime during their lifetime.  It can usually be stopped and sometimes reversed with the right treatment, so it is important to be tested, especially if you have any risk factors.