What is osteoporosis?
The word “osteoporosis” means porous bones. The more porous the bone, the weaker it is, and the greater the chance that it will fracture sometime when you least expect it. The inside of the bone resembles a sponge with large holes – the result of loss of protein and minerals, especially calcium. Normal bones have holes, too, but they are small and cause no trouble. People pass through two stages of bone health: the first 20 years are marked by bone formation, but after that bone destruction takes over. How rapidly this progresses depends on several factors: the strength of the bone in childhood, the food you’ve eaten all your life and the influence of exercise, or lack of it. Once the disease is well advanced, a wave goodbye or a sudden turn of the body may be enough to break a bone.
Your doctor cannot easily check the structure of your bones (unless he happens to have a broken one on hand) but through the use of special x-ray techniques called “densitometry.” This will produce precise and accurate measurements of the amount of bone present (if not the quality), called “bone mineral density,” or BMD.
Is it a common disease?
We are all at risk, men and women, but at present about 28 million Americans suffer from osteoporosis, and the disease is responsible for 1.5 million bone fractures per year.
What are the risk factors?
You are at risk if you are:
o A post-menopausal woman
o Older, and white
o A smoker
o Estrogen deficient
o Low weight and body mass index (BMI)
o From a family with a history of osteoporosis
o “Inclined” to falls or fractures
o A coffee drinker or consume alcohol
What causes it?
Let’s review normal bone formation. In fetuses and infants, bone mass forms rapidly, but slows through childhood until ages 11-13. As the child enters adolescence a period of rapid bone growth occurs, when much new bone is formed. By the time the child turns 18 or 19, they have achieved most of their adult bone mass.
Hormones play a large part in this process. Everyone complains about the “raging hormones” of teens – as though they were doing it deliberately! – but in fact the hormones estrogen or testosterone, along with a few others, are present so this massive bone growth can take place.
Bone growth is also influenced by environmental/lifestyle choices. Good nutrition and regular exercise are arguably the most important of these factors, with smoking following a close third. A debilitating illness in the teen years, or an accident which causes the child to be bedridden for a significant period of time can prevent complete bone growth.
Around 28 years of age, we will find our bone formation has stopped at its peak. Through a process called “remodeling” the body maintains its peak bone mass by breaking down old bone and replacing it with new. This is a 24/7/365 process, performed by cells within the bone called “osteoclasts.” These large cells live in the bone core; they constantly work to remove microscopic bits of bone. After they have removed the bone, cells called “osteoblasts” come along and fill in the holes. This process, called “resorption,” isn’t perfect, as the osteoblasts do not always get the job done – they just aren’t as efficient as the osteoclasts. It is this unfortunate situation that accounts for the loss of bone mass as a person ages. Whatever causes remodeling to speed up in the body will cause more porous, fragile bones.
What are the symptoms?
You will probably not know you have osteoporosis until you break a bone. The elderly say “I fell and broke my hip,” but my doctor tells me this is backward. What happens is that their hip breaks, and they fall.
According to the National Osteoporosis Foundation (NOF), fractures are very common and also costly:
“One in two women and one in four men over age 50 will have an osteoporosis-related fracture in their remaining life span. The estimated national direct costs (hospitals and nursing homes) for osteoporotic and related fractures was $17 billion in 2001 ($47 million each day), and the cost is rising.
Some people have spine fractures that lead to a curve in their upper back, sometimes called a dowager’s hump. You may learn from a doctor’s visit that you are not as tall as you used to be. You may have back pain, stooped posture, and spine deformities because of osteoporotic fractures. If you have lost more than 1 Ã?Â½ inches from your height as a young adult, you may wish to speak with your doctor about testing for osteoporosis.”
The severity of the problem becomes more obvious when we consider that “The 300,000 Americans who have hip fractures each year face a higher risk of death or serious disability,” according to NOF. They say 25% of victims of hip fracture die within the first year.” Also:
Ã¢Â?Â¢ “20% more deaths occur among people with hip fractures compared with those of the same age without factures;
Ã¢Â?Â¢ “25% of those with hip fractures need nursing home care or long-term care; and
Ã¢Â?Â¢ “20% of those with hip fractures never regain the function they had before their fracture. At six months after a hip fracture, only 15% of hip fracture patients can walk across a room unaided.”
NOF recommends that if you are over 50 and have suffered a fracture, you may want to consider a bone density test, called a “DXA scan (dual x-ray absorptiometry scan). This “safe, simple and non-invasive test” takes only a few minutes. All women who have gone through menopause should be tested, also women who have lost height or have been taking hormone replacement therapy for an extended period of time – even those who are merely concerned, should be tested.
Can osteoporosis be treated?
Yes, it can. Exercise is important, and so is the right amount of calcium consumed in the diet. Vitamin D helps the body absorb the calcium, as does estrogen. But this regime will not be effective for everyone; some will require medication, hormonal or non-hormonal.
Estrogen is effective in reducing the rate of bone loss, and thus fracture risk, in the hip and spine. It also has application to menopausal symptoms such as vaginal dryness or hot flashes. Those who are at risk for breast or uterine cancer should discuss the use of estrogen therapy with their doctors. For women who are at a significant risk for osteoporosis, estrogen therapy may prove more beneficial than harmful. However, estrogen use is believed to increase the risk of deep vein thrombosis (blood clots) in the sedentary. These are matters you will want to discuss with your doctor.
The best kind of treatment for osteoporosis is prevention. Keep your diet free of fats and animal products. Replace them with calcium-rich foods such as dairy products, sardines, dark-green leafy vegetables, salmon, and almonds; whole grains and fresh fruit. Supplements are also a good idea, especially calcium, vitamin D and magnesium. Continue your weight bearing exercise for best results.
Alternative treatments consist largely of herbal supplements (calcium containing plants) such as alfalfa, horsetail, marsh mallow, yellow dock. Chinese medicine suggests dong quai, Asian ginseng. Plant estrogens from soybeans or progesterone from wild yams are believed by some to be capable of slowing bone loss.