Osteoporosis: Prevention is the Key
Dateline: 08/20/98For while I held my tongue: my bones consumed away through my daily complaining.
While it may not be a fact that complaining escalates the thinning of your bones, you can be sure that whiling away your days sitting on the couch certainly will. Inactivity contributes to the development of osteoporosis, while activity helps to prevent it. What is osteoporosis? Can it affect you? What else can you do to prevent osteoporosis? Read on and follow the links to get answers to these questions and more!
What Is Osteoporosis?
Osteoporosis is a metabolic disease of bone remodeling where bone resorption takes place faster than bone replacement, resulting in a thinning and weakening of bones. Osteoporosis is diagnosed when other causes of bone deterioration--osteomalacia, hyperparathyroidism, multiple myeloma, and metastatic cancer--have been excluded.
Normal bone undergoes constant remodeling throughout life. Under the control of various hormones (mainly calcitonin and parathyroid hormone), bone gets reabsorbed and reconstructed repeatedly. Up to age 35 years, reconstruction exceeds resorption, so that bone mass is increased. After peaking at between age 30 and 35, bone mass stabilizes for twenty years or so, before resorption starts to outstrip reconstruction, resulting in a gradual loss of bone mass.
Reduced bone mass significantly increases the frequency of bone fractures, the main manifestation of osteoporosis. Osteoporosis causes about 1.5 million fractures annually in the USA in people over age 45. By the time you reach age 90, your chance of suffering a hip fracture may be as high as 32%, if you are a woman, and 17%, if you are a man. The annual cost of care for the consequences of osteoporosis exceeds $3.8 billion in the USA, $400 million in Canada, untold millions elsewhere around the world.
Who Gets Osteoporosis?
Virtually everyone is susceptible to osteoporosis. Women are about twice as likely as men to suffer from osteoporosis, and people of white or Asian descent are more likely to be affected than people of African descent. One Osteoporosis Fact Sheet suggests this list of risk factors for women:
- advanced age (but we knew that)
- early menopause (natural or surgical)
- family history of osteoporosis
- physical inactivity
- thin build
- low calcium or vitamin D intake
- cigarette smoking
- certain medications
- excessive alcohol or caffeine consumption
- previous fractures
- not giving birth
Men also suffer from osteoporosis. Osteoporosis in Men suggests that men over age 50 "have a higher risk of suffering an osteo-related fracture than developing clinical prostrate cancer." This site's list of risk factors for men parallels that for women, adding only low testosterone levels as an important risk in men.
The importance of recognizing risk factors lies in their value in preventing osteoporosis. Take another look at the list to identify those risk factors you can minimize or eliminate. You won't find many.
How to Diagnose and Treat Osteoporosis
Unfortunately, osteoporosis is most often first diagnosed when the elderly person presents to her physician or emergency room with a bone fracture. There are, however, a few ways of assessing bone mass.
Regular x-rays do not provide much help. Your bone mass must be reduced by 30% before significant changes appear in x-rays.
The most common method of assessing bone mass or bone mineral density (BMD) is probably dual energy x-ray absorptiometry (often abbreviated DXA, DEXA, pDEXA, and RA). According to FORE (the Foundation for Osteoporosis Research and Education), there are several indications for testing. Some of them include:
- susceptible women who cannot use hormone replacement therapy
- women with multiple risk factors
- men with multiple risk factors
- patients undergoing therapy who need response monitored
Once osteoporosis has been diagnosed, several treatment options may be presented by your doctor. The JAMA Patient Page mentions the following treatment options: estrogen or hormone replacement therapy; alendronate (Fosamax); calcitonin A; and raloxifene (Evista). For more information on these treatments, contact your physician and visit
Pharmacists Caring for Osteoporosis.
How To Prevent Osteoporosis
Once bone mass is lost, very few treatments can effectively restore it to near normal. The best way to address osteoporosis, then, is prevention. And prevention lies in modifying your own risk factors. The mainstays of prevention include exercise, calcium supplementation, and vitamin D replacement.
Exercise must be weight-bearing exercise that you do frequently, increasing in intensity, and habitually. Walking briskly, engaging in strength training, climbing stairs, hiking, and dancing work best. Swimming and bicycling are less effective. As always, consult your physician before initiating any exercise program.
Ask your physician how much calcium supplementation is right for you. Postmenopausal women should probably be taking 1500 mg daily, especially if not receiving hormone replacement therapy. Others should probably take 800 mg to 1000 mg daily. This calcium will probably come from a high quality supplement, because it is unlikely you will take that much calcium in your regular diet. Just to give you an idea, here are some equivalents. To get 1000 mg of calcium, you would need to consume one of the following:
- 790 mL (just over three cups) of whole, 1%, 2%, or skim milk
- 185 grams (about 6 ounces) of mozzarella cheese
- two cans of pink salmon with bones
- 52 small sardines
You should also ask your doctor about vitamin D supplementation, especially if you don't get out in the sunlight much (at least 20 to 30 minutes daily). Recommendations range from 400 IU to 800 IU daily, depending upon your particular risk factors. Vitamin D goes hand in hand with calcium. For many elderly, both supplements are advised.
Finally, you should stop smoking cigarettes and you should limit your alcohol intake.
Three great resources on the Internet provide a wealth of information on osteoporosis.
- National Osteoporosis Foundation (NOF) offers information on osteoporosis and support for osteoporosis sufferers and their families.
- Osteoporosis and Related Diseases National Resource Center provides current information on osteoporosis and other bone diseases, such as Paget's Disease, osteogenesis imperfecta, and hyperparathyroidism.
- Foundation for Osteoporosis Research and Education (FORE) is dedicated to preventing osteoporosis through research and education of the public and medical community.
Remember, knowledge and prevention are the critical variables in osteoporosis. Know as much as you can about your risk factors, and then do something to reduce them. Don't wait until you've fractured your hip to start thinking about osteoporosis. Think about this: the mortality rate in the year after hip fracture approaches 20 percent!
Previous
Features