Osteoporosis Update

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What is osteoporosis?

Osteoporosis is a condition where there is deterioration of the bone tissue resulting in decreased bone mass and increased bone fragility, and greater risk of fracture. In short, the bones become thinned out and weak, they can break while performing normal daily chore of lifting, moving or turning. More than 25 million (about 1 of out 10) Americans have, or are at a high risk of developing, osteoporosis.

What are the types of osteoporosis?

Primary osteoporosis (95%) is caused by decreased gonadal (hormonal) function and is part of the normal aging process. Secondary osteoporosis, which is seen in 5% of cases, results from nutritional factors, inactivity, chronic diseases, medications (like steroids) and other factors, many of which are listed below.

What are the risk factors?

There are four major headings of risk factors associated with osteoporosis: Personal risk factors: family history, advanced age, white race, female gender, small frame, underweight, and decreased gonadal function; Life style factors include cigarette smoking, low-calcium diet, inadequate nutrition, inadequate physical activities, ovarian hormonal deficiency (from stress, competitive exercise, eating disorders, excessive dieting); Historical factors are: chronic diseases, hyperthyroidism, rheumatoid arthritis, previous bone loss, 5 year menopausal without hormone replacement therapy, dementia, early or premature menopause, primary hyperparathyroidism, vertebral fracture in adulthood, strong family history of osteoporosis, postchemotherapy, subtotal gastrectomy, premenopausal bilateral oophrectomy; Medication factors: anticonvulsant drugs, glucosteroids, cyclosporine, excess thyroxine, cytotoxic chemotherapy, lithium, sedatives/hypnotics, prolonged use of heparin, phenothiazines, tamoxifen (premenopausal).

How prevalent is osteoporosis?

The incidence of osteoporosis goes up with age in both females and males.

Twenty percent (one in five) of women in their 60s, 33.3% in their 70s, and 70% of women in their 80s, have osteoporosis. In their lifetime, 50% of women will suffer fracture due to osteoporosis. One in 6 men in extreme old age will have had a hip fracture. Within the 12 months following a hip fracture, there will be a 15% to 20% decreased in expected survival for both the males and females. Annually, in the United States, there are about 432,000 hospital admissions, 180,000 nursing home admissions and 2.5 million physician visits due to osteoporosis. The societal, individual and family impact of this disease is indeed tremendous.

How do caffeine and soft drinks cause osteoporosis?

Caffeine (in coffee and cola drinks) increases calcium loss in the body, thins the bones, and thus results in greater risk of osteoporosis, not to mention heart irregularities.

How is the diagnosis made?

The diagnosis of osteoporosis is made following evaluation of the medical history coupled with a physical examination. Tests done to diagnose or screen this condition include bone density measurement (bone mineral density tests using the dual energy X-ray absorptiometry---DEXA--- test), and ultrasound. Other tests may be performed (like testosterone level) if a male patient is suspected of not producing enough male hormone, which could cause osteoporosis.

Can plain x-ray detect osteoporosis?

Plain bone x-rays are not done to check for osteoporosis because as much as 30% of bone is lost before plain x-ray could detect it.

When is screening for osteoporosis done?

Screening is done when a persons has a fracture without history of trauma, has a medical condition that thins bones, has risk factors for, or symptoms suggestive of osteoporosis, menopausal women who have risk factors. Some experts recommend a bone density test for all women 65 and over.

How can one prevent osteoporosis?

Today, osteoporosis is no longer accepted in total surrender as an inevitable consequence of the aging process. While bone thinning goes with aging and cannot be totally stopped, some preventive measures can be done to delay or reduce it. Adopting a healthy lifestyle as early as possible in life (during preteen years), like not smoking, drinking no more than one drink of alcoholic beverage a day, eating nutritious low-fat, high-fiber, diet, exercising daily, taking multivitamin and calcium supplement, cutting down, or better yet, abstinence from caffeine (coffee, cola drinks, etc.) can strengthen the bones and delay osteoporosis. And it is never too late to start a healthy lifestyle to retard osteoporosis and prevent other infirmities at any age. Even those with osteoporosis can slow down the process by abandoning self-abuse and living a healthy lifestyle. There are also medications that can minimize the process of bone loss and stimulate new bone growth.

How does exercise help in preventing osteoporosis?

Exercise (weight-bearing regimen like walking, climbing stairs, weight lifting) stimulates new bone growth by working the bones and muscles against gravity, increasing bone mass and density, while toning the muscles also.

What is the treatment of osteoporosis?

Besides living a healthy lifestyle as described above, getting enough calcium and vitamin D is essential. The recommended daily dose of calcium for adults is between 1,000 to 1,200 mg. Women over 65, and those over 51 who are not one estrogen replacement, require 1,500 mg daily. The daily requirement for vitamin D is between 400-800 IU. Daily exposure to sunlight (without sunscreen) for 15 minutes and drinking a glass of milk, or eating yogurt and dairy products can supply this daily need for vitamin D and calcium. Supplements of both are available in the pharmacies.

Are there medications for osteoporosis?

Yes, there are drugs for the prevention and treatment of osteoporosis. Drugs alone cannot prevent osteoporosis, although they can help, provided the healthy lifestyle recommended above is also adopted as a part of the preventive regimen. For the treatment of osteoporosis, hormones (estrogen) are prescribed for women who have gone through menopause, and testosterone for men whose hormone level is low. Hormonal therapy increases bone mass, minimizes bone loss and lessens the risk of fractures. There are other medications used to reduce bone loss and increase bone mass and thickness. Those interested may discuss this in further detail with their physician.

©2003Raoul R. Diez, M.A.O.D.