Osteoporosis:
What Do We Need to Know?

Disclaimer: The information in this article is meant to provide you with some basic understanding of osteoporosis. It was not meant as a diagnostic or treatment tool and, as such, should not take the place of any person seeking out proper medical care. If you have any health problems or any questions you should contact your health care provider.

Osteoporosis is crippling disease which starts off SILENTLY. Without proper evaluation, we don't know that we have it until it has already affected us. It is characterized by low bone mass and the microarchitectural deterioration of bone tissue with a consequent increase in susceptibility to fracture. In other words, your bones can deteriorate to the point where they are so thin they can break. A simple, common movement can cause them to break.

While there are many risk factors (listed below) I would like to target MENOPAUSAL WOMEN as they can be at great risk and, now, we can not only diagnose and treat this disease but we can also possibly prevent it. The first 5-10 years after menopause is the time of the greatest and most rapid bone loss in women. It is estimated that at age 50 a woman has a 40% chance of experiencing a fracture, at some point in her life, directly related to decreased bone mass.

BONE FORMATION:
Normal bone remodeling (formation) consists of two activities:
1. Bone resorption: this is when osteoclasts remove old bone tissue (bone loss), thereby, creating a cavity in the bone.
2. Bone formation: This is when osteoblasts form new bone tissue, thereby, filling in the cavity and creating new bone. Normally, this process works together to create strong, healthy bones. Osteoporosis occurs when the rate of bone loss exceeds the rate of bone formation.

It mostly affects women. There is a treatment. The diagnosis is easy and has very minimal risk.

EFFECTS OF OSTEOPOROSIS:
As a direct result of continous bone loss, a person can become shorter, change their body shape (dowager's hump), and sustain multiple fractures. They live with daily pain and fear of fracture. It is a crippling and painful disease which can change the lives of the people it affects.
Osteoporosis can cause loss of self esteem, decreased self image, change of lifestyle, refusal to leave ones home (even fear of getting out of a chair), fear of fracture and a multitude of other psychosocial and physical problems.

LOGISTICS: Each year more than 1.3 million fractures occur in the United States. Most common are spinal fractures (500,00), hip fractures (250,000) and wrist fractures (240,00). Of those who fracture their hips, about 50% will be permanently disabled and 20% will require long term home nursing care. There is a 20% mortality rate within one year after a hip fracture.

It cost the U.S. Health care system more than $10 billion/year. In comparison with other diseases that affect women annually:
513,000 heart attacks
228,000 strokes
182,000 reports of breast cancer
48,600 reports of uterine cancer

RISK FACTORS:
White or Asian Women
Advanced Age
Early Menopause (less than 45 years old; either biologically or surgically)
Inadequate calcium intake
Certain medical diseases (such as hyperthyroidism)
Chronic corticosteroid use (and taking certain other prescribed medications)
Prolonged bedrest
Thin/small build
Low weight/height ratio
Family History
Alcholism
Decreased calcium intake
Smoking
Caffeine

TESTING FOR OSTEOPOROSIS:
Bone mass is evaluated by measuring bone mineral density (BMD). There is a strong correlation between low BMD and fracture risk. This appears to be a stronger corretation than elevated cholesterol and heart disease or hypertension and stroke.

There are, essentially, 4 types of machines used to evaluate the amount of BMD.
1. Dual-energy X-ray absorptiometry (DXA)
2. Single energy X-ray absorptiometry (SXA)
3. Radiographic absorptiometry (RA)
4. Quantitative computed tomography (QCT)

They use a variety of body sites (spine, hip, forearm, phalanges and heels).
They do not reveal the cause of bone loss but, rather, the degree of bone loss.
There are other diseases that can cause bone loss.
The accuracy of each machine varies but the range is 85-99%.
The amount of radiation exposure is minimal and less than a standard chest x-ray.
While, in the past, a basic x-ray has been used to evaluate for bone loss, it is important to realize that there can already be a 30% loss of bone before the x-ray is positive. Ask your health care provider about these diagnostic tools and which would be the best form of testing for you.

DIAGNOSIS:
The diagnosis of bone loss is based on standard deviations from the mean. There are two measures that are evaluated. The T-score and the Z-score. The former compares your bone mass with the mean peak bone mass of a young adult.

It is the T-score that is used to help confirm the diagnosis of osteoporosis. For every standard deviation below the mean (the young adult normal) the risk of fracture increases. The T-score is, therefore, the most clinically relevant value of BMD in relation to the risk of bone fracture.

The Z-score tells us whether your bone mass is typical for your age and sex. It is not used to confirm a diagnosis because a person may have values that compare favorably with age matched controls but may still be at increased risk for fracture.

The reason that a young adult bone mass is used for comparison is because peak bone mass occurs at approximately 30 years of age. This is the time when your bones are the strongest and most developed. After that, at about 40, there begins a slow process of bone loss and at 50 (menopause) there is an extremely rapid loss of bone (which is why menopause is the time of greatest risk). By about 60 years old, while there continues to be bone loss, it slows down.

TREATMENT:
The primary goal of treatment is to prevent fractures. Treatment is also geared towards decreasing pain and increasing functional ability and providing psychosocial support.

The treatment of osteoporosis begins with prevention. The most valuable tools are diet and weight bearing exercise. It is essential that an adequate intake of calcium and Vitamin D begins when you are young. These are found in the foods we eat and in vitamin supplements. Calcium is found in such foods as dairy products, tofu, salmon or sardines with the bones and broccoli. (Ask your health care provider for an extensive resource list).

Below is the current RDA recommendations for daily calcium intake based on age:
Birth-6 months 400mg
6month-1 year 600mg
1-5 years 500mg
6-10 years 800-1200mg
11-24 years
1200-1500mg
25-50 years 1000mg
50 years (with estrogen) 1000mg
without estrogen 1500mg
65+ years 1500mg
pregnant and nursing 1200-12500mg

The current recommendation for Vitamin D intake is 400-800IU depending on the source.

Treatment of osteoporosis once diagnosed:

• Calcium supplements:
  - calcium carbonate
  - calcium citrate
  - calcium gluconate
  
• Horomone Replacement therapy
  
• Biphosphates (recently discovered medications that arrest the process of bone loss).

There are risks and benefits of all treatments. It is important to speak with your health care provider in order to understand your options.

Disclaimer: The information in this article is meant to provide you with some basic understanding of osteoporosis. It was not meant as a diagnostic or treatment tool and, as such, should not take the place of any person seeking out proper medical care. If you have any health problems or any questions you should contact your health care provider.

Resources:
- "An Overview of Bone Mass Measurement Technology" by the Bone Measurement Institute
- Excerpts from various lectures on osteoporosis

Written by Stacey Stich