Osteoporosis is a growing problem among women and men because it can be so hard to detect, but New Orleans Living picked the brain of Dr. Alan Bushnell, from Ochsner Health Systems, for some answers to some common questions about this “silent disease.”
How do I know if someone in my family is suffered from osteoporosis? What physical signs or symptoms should I be looking for?
Fractures are the most important symptom. Height loss of more than two inches is suggestive of compression fractures. The person may develop a bending forward or a dowager’s hump.
Are there any medications that put me at higher risk for developing osteoporosis?
Some of the medications that may increase the risk of osteoporosis include glucocorticoids like prednisone and cortisone, seizure medications, powerful antacids like PPIs (protein pump inhibitors), and aromatase inhibitors for breast cancers.
How do I best prevent (or treat) osteoporosis?
Prevention of osteoporosis includes developing adequate bone mass in childhood, avoiding the above medications, correcting premature estrogen or androgen losses. The development of a good skeleton includes good nutrition and exercise in youth.
How do I know if my bone density is low?
Bone mineral density (BMD) can be measured and is recommended for women after menopause with osteoporosis risk factors. In general, thinner older woman are more likely to have low BMD.
How much calcium is right for me? How do I best obtain this calcium?
In general, calcium in the range of 1,000 to 1,500 mgs per day should be sufficient. Calcium needs increase with pregnancy and lactation. Most of the clinical trials used calcium carbonate, which is also the least expensive. If patients have a lack of acid in the stomach, then other calcium products may be useful, but this requires discussion with their physician.
Should I engage in exercise? What kind of exercise is best? How often should I exercise?
Exercise is important for all parts of the body. The most important aspect of exercise is the maintenance of balance. In general, osteoporotic fractures occur with falls, so a major objective of exercise is to prevent falls. Walking helps to maintain the complex balance systems.
Exercise is crucial for impacting bone size when growing. A tennis protégée, playing tennis from age 4 will have a much greater BMD of the dominant arm. However, a 65-year-old starting to play tennis will see little change in the BMD. Immobilization, however, causes bone loss. In summary, a sensible program of activity is good for the heart and the bone. Exercise daily and change the routines.
How do I know if I have fractured a bone in my spine?
Vertebral fractures frequently present with pain. Only one in three vertebral fractures is reported by women in clinical trials. Thoracic and lumbar X-rays may document vertebral fractures. Individuals with height loss of more than two inches may benefit from X-rays in order to see if compression fractures.
Everyone seems to have a general understanding of osteoporosis, but what is osteoporosis, really?
Definition Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected.
Prevalence Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. In the United States, 10 million individuals are estimated to already have the disease, and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.
Of the 10 million Americans estimated to have osteoporosis, 8 million are women and 2 million are men. Significant risk has been reported in people of all ethnic backgrounds. While osteoporosis is often thought of as an older person’s disease, it can strike at any age
Women
Of those affected by osteoporosis, 80% are women. Twenty percent of non-Hispanic white and Asian women aged 50 and older are estimated to have osteoporosis, and 52 percent are estimated to have low bone mass.
Five percent of non-Hispanic black women over age 50 are estimated to have osteoporosis; an estimated additional 35 percent have low bone mass that puts them at risk of developing osteoporosis.
Ten percent of Hispanic women aged 50 and older are estimated to have osteoporosis, and 49 percent are estimated to have low bone mass.
Osteoporosis is under-recognized and undertreated, not only in Caucasian women, but in African American women as well.
Men
Twenty percent of those affected by osteoporosis are men.
Seven percent of non-Hispanic white and Asian men aged 50 and older are estimated to have osteoporosis, and 35 percent are estimated to have low bone mass.
Four percent of non-Hispanic black men aged 50 and older are estimated to have osteoporosis, and 19 percent are estimated to have low bone mass.
Three percent of Hispanic men aged 50 and older are estimated to have osteoporosis, and 23 percent are estimated to have low bone mass.
What about fractures?
One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her or his remaining lifetime. The most typical sites of fractures related to osteoporosis are the hip, spine, wrist and ribs, although the disease can affect any bone in the body.
Osteoporosis is responsible for more than 1.5 million fractures annually, including over 300,000 hip fractures, approximately 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites.
The rate of hip fractures is two to three times higher in women than in men; however, the one-year mortality following a hip fracture is nearly twice as high for men as for women. A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.
In 2001, about 315,000 Americans age 45 and over were admitted to hospitals with hip fractures. Osteoporosis was the underlying cause of most of these injuries.
Not just hip fractures, but vertebral fractures are also linked with an increased risk of death.
WHAT YOU NEED TO KNOW
Cost The estimated national direct care expenditure (including hospitals, nursing homes, and outpatient services) for osteoporotic fractures is $18 billion per year in 2002, and costs are rising.
Symptoms Osteoporosis is often called a “silent disease” because 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 fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.
Risk factors
There are many factors that determine who will develop osteoporosis. The first step in prevention is to determine whether you are at risk, since not everyone is. Following is a list of risk factors:
- Age The older you are, the greater your risk of osteoporosis. Your bones become weaker and less dense as you age.
- Gender Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.
- Family History and Personal History of Fractures as an Adult Susceptibility to fracture may be, in part, hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass. A personal history of a fracture as an adult also increases your fracture risk.
- Race Caucasian and Asian women are more likely to develop osteoporosis. However, African American and Hispanic women are at significant risk for developing the disease.
- Bone Structure and Body Weight Small-boned and thin women (under 127 pounds) are at greater risk.
- Menopause/Menstrual History Normal or early menopause (brought about naturally or because of surgery) increases your risk of developing osteoporosis. In addition, women who stop menstruating before menopause because of conditions such as anorexia or bulimia, or because of excessive physical exercise, may also lose bone tissue and develop osteoporosis.
- Lifestyle Current cigarette smoking, drinking too much alcohol, consuming an inadequate amount of calcium or getting little or no weight-bearing exercise, increases your chances of developing osteoporosis.
- Medications/Chronic Diseases A significant and often overlooked risk factor in the development of osteoporosis is the use of certain medications to treat chronic medical conditions. Medications to treat disorders such as rheumatoid arthritis, endocrine disorders (that is, an underactive thyroid), seizure disorders and gastrointestinal diseases may have side effects that can damage bone and lead to osteoporosis. It is important to discuss the use of certain medications with your physician.
A few other risk factors include
- Current low bone mass
- Presence of certain chronic medical conditions
- Anorexia nervosa
- Low testosterone levels in men
- Vitamin D deficiency
Detection
Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A BMD test can do four important things:
- Detect osteoporosis before a fracture occurs
- Predict chances of fracturing in the future
- Determine rate of bone loss and/or monitor the effects of treatment if a DXA BMD test is conducted at intervals of one year or more Medicare reimburses for BMD testing every two years.
An increase in BMD testing and osteoporosis treatment was associated with a decrease in hip fracture incidence.
Bone density is an important determinant of fracture risk even in nursing home patients.
There has been a five-fold increase in office visits for osteoporosis (from 1.3 million to 6.3 million) in the past 10 years.
It is important to take action now to find out your risk for developing osteoporosis. Your doctor can help you determine whether you should have a BMD test. Your doctor may order a BMD test for:
• all postmenopausal women under age 65 who have one or more additional risk factor for osteoporosis (in addition to being postmenopausal and female)
• all women age 65 and older regardless of additional risk factors
• postmenopausal women who present with fractures (to confirm diagnosis and determine disease severity).
• women who are considering therapy for osteoporosis if BMD testing would facilitate the decision.
Prevention
By about age 20, the average woman has acquired 98 percent of her skeletal mass. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. There are five steps, which together can optimize bone health and help prevent osteoporosis. They are:
- A balanced diet rich in calcium and vitamin D
- Weight-bearing and resistance-training exercises
- A healthy lifestyle with no smoking or excessive alcohol intake
- Talking to one’s health care professional about bone health
- Bone density testing and medication when appropriate
A study of disease management in a rural healthcare population demonstrated that a preventive program was able to reduce hip fractures and save money.