Osteoporosis is widespread and debilitating but can be prevented

Eight million American women have the disease as well as two million men. All ethnic groups are at risk and the disease can strike at any age.

By: Dr. Leroy Hunninghake
   May is National Osteoporosis Prevention Month and the National Osteoporosis Foundation is sponsoring an intense educational campaign to help fight this silent disease.
   The term osteoporosis means "porous bone" and refers to a disease marked by low bone mass and structural deterioration of bone tissue. As bone mass lessens and deterioration occurs, there is an increased risk of hip, spine and wrist fractures.
   The statistics are alarming. Eight million American women have the disease as well as two million men. Another 18 million people in the United States have low bone mass which places them at increased risk. One in two women and one in eight men over age 50 will have an osteoporosis-related fracture in their lifetime. All ethnic groups are at risk and the disease can strike at any age.
   Ten percent of African-American women over age 50 have osteoporosis and another 30 percent have low bone density.
   The disease causes 1.5 million fractures every year with an approximate breakdown as follows: 700,000 vertebral fractures, 300,000 hip fractures, 200,000 wrist fractures and 300,000 fractures at other sites.

   The spine comprises a long series of vertebrae or small connected bones. As the bone mass becomes less dense, it is subject to compression fractures. After these vertebrae heal, they become flattened or compressed, and over time, the spine begins to collapse. This results in pain, a loss of height and stooped posture. Just one compression fracture weakens the whole spine, so prevention is vital and an early diagnosis is critical.
   For those who break a hip, the statistics are even more grim. About two-thirds of the hip-fracture population will need help with ordinary activities, half will never be able to walk independently and between 25 and 39 percent will require care in a long-term facility. Approximately 24 percent of hip-fracture patients die within the first year following a fracture, usually from complications such as blood clots in the lung or pneumonia. For women, the rate of hip fracture is two to three times higher than men, and osteoporosis is to blame for about 90 percent of hip fractures in women over age 65.
   Prevention of osteoporosis begins in childhood, for it is really a childhood disease with adult manifestations. Building strong bones and keeping them strong is the key to prevention. Bone is a living tissue that grows and constantly rebuilds.
   During the first two decades of life, bone mass increases significantly. To reach its peak, the body needs regular physical activity, adequate calcium intake and good nutrition. Risk factors such as smoking, striving for extreme thinness and excessive alcohol intake must be avoided. If the peak bone mass is not reached, the adult bone is at a disadvantage.
   People in their 30s and 40s need to maintain their bone mass by getting adequate amounts of Vitamin D and calcium, engaging in weight-bearing activities and leading a healthy lifestyle.
   For women, bone loss usually begins in their 40s and is most rapid in the first few years following menopause. Men begin to lose bone mass in their 50s and, like women, this can accelerate in the 70s and 80s.
   Increasing the amount of calcium in your diet is one good habit to get into. According to the National Academy of Sciences, optimal calcium intake changes with your age. For example, children between the ages of 9 and 18 require the most at 1,300 mg/day, while adult women and men between 19 and 50 should strive for 1,000 mg/day. Dairy products, broccoli, sesame seeds, oranges, papayas, whole wheat bread and enriched farina cereal are all excellent calcium sources. Also, calcium supplements can help you round out your diet. When it comes to Vitamin D, a daily intake of 400-800 IU is recommended.
   While the causes of osteoporosis are unknown, there are certain risk factors that, when present, can increase your risk. Given that the disease is preventable and treatable, it is essential that you assess your risk and the risk of your family members.
   According to the National Osteoporosis Foundation, the more of the following questions that you answer yes to, the greater your risk for developing osteoporosis:
   • Do you have a small, thin frame and/or are you Caucasian or Asian?
   • Have you or a member of your immediate family broken a bone as an adult?
   • Are you a postmenopausal woman?
   • Have you had an early or surgically induced menopause?
   • Have you been taking excessive thyroid medication or prolonged doses of cortisone-like drugs for asthma, arthritis or cancer?
   • Is your diet low in dairy products and other sources of calcium?
   • Are you physically inactive?
   • Do you smoke cigarettes or drink in excess?
   Diagnosing the disease begins with a look at answers to these questions, a discussion of medical history, and an evaluation of signs and symptoms of possible fractures.
   There are several methods that can be used to test bone density, and DXA is regarded as the "gold standard." This is a painless procedure that takes from one to 15 minutes, depending on what bones are being measured. Your results, called a T-score, are compared with the bone density of healthy young adults in the 20-30 year old range. Your results will fall into one of three categories: normal, low bone mass and osteoporosis. There are additional tests for osteoporosis including biochemical markers, lab tests and bone scans. Following these tests, your physician will discuss how you can maintain or improve the health of your bones.
   A number of medications are available for prevention and treatment of osteoporosis. These include hormone therapy, selective estrogen-receptor modulators, bisphosphonates, calcitonin, Aredia, and hopefully in the near future, parathormone.
   It is a sad truth that most women who suffer from osteoporosis are not being diagnosed and not being treated. To help prevent this disease from ruining your life or the life of a loved one, talk to your doctor, examine your and your family’s diet and exercise patterns, and take the necessary steps to wipe out osteoporosis.
   To help prevent the risk of falling, create a safe home environment, eliminating hazards such as slippery floors, scatter or throw rugs and unlit stairways. Examine outside paths for loose steps and obstacles. Be especially careful in wet or icy weather. Remember that every 20 seconds osteoporosis causes a fracture; let’s change this statistic.
   Dr. Leroy Hunninghake is a board-certified internist and rheumatologist on staff at The Medical Center at Princeton. He will give a free lecture, "Osteoporosis in Men and Women," 7 p.m. Tuesday in the ground floor conference room of The Medical Center at Princeton hospital unit. Call (609) 497-4480 to register. This article was prepared in collaboration with Lorraine Seabrook. Health Matters appears Fridays in the Lifestyle section of The Princeton Packet and is contributed by The Medical Center at Princeton.