The Face of Osteoporosis

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Category: Metabolic Bone Disease Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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We have all seen her.  She is everywhere: at the mall, at church and even at the grocery store. She could be your grandmother, mother, sister or neighbor. And as you watch her walk by, slowly and painfully, you worry that maybe someday, you too, will turn into this frail, hunched-back woman.

Osteoporosis is a metabolic bone disease, which causes bone loss, making bones weak and brittle and more prone to fractures. The National Osteoporosis Foundation estimates that 25 million Americans, mostly women, have osteoporosis. Thirteen to eighteen percent of postmenopausal white women have osteoporosis. Today, one out of every two Caucasian women over fifty can expect to suffer some type of osteoporotic fracture, one out of every three can expect to have a vertebral or spinal fracture and one out of every six can anticipate a hip fracture. In the United States alone, more than one million bone fractures, usually of the hip or spine, occur yearly.

BONE REMODELING AND PEAK MASS:

Bones, living growing tissue, are composed of cells called “osteoclasts”, which break down bone creating “microscopic pits” and “osteoblasts” which create new bone that fills in those holes. This process of bone formation and absorption, called “bone remodeling”, perseveres throughout our life.

In growing children and adolescents, more bone is made than is absorbed, resulting in a continual increase of bone density. This continues until around age twenty when peak bone mass is achieved. Genetics have proven to determine eighty percent of one’s peak bone mass, while the other twenty percent is determined by calcium intake, exercise, estrogen, illness and lifestyle factors-such as smoking and alcohol consumption.

Once our peak bone mass is achieved, bone formation and absorption continue at an equal rate. However, if bone absorption increases at a higher rate than bone formation, this will cause a decrease in bone density, possibly resulting in osteoporosis.

BONE STRENGTH AND FRACTURES:

A normal bone is dense and strong and is able to withstand normal daily stresses and strains without fracturing. However, an osteoporotic bone is very porous, meaning thin and weak. Even the simplest daily activity such as climbing stairs or kneeling down can cause a bone to fracture. Bones that bear direct weight such as the spine and hip are more susceptible to injury. Typically, spinal fractures occur when a vertebra collapses, creating curvature of the spine. Unfortunately, these types of fractures mostly go unnoticed except for obvious loss of height.

Most osteoporotic fractures of the hips are a result of a fall. The tragedy of hip fractures from osteoporosis goes far beyond a broken bone and the pain it causes. Half of the individuals who could walk unassisted prior to a hip fracture, cannot do so afterwards. Hip fractures are associated with a ten to twenty percent mortality rate within one year; a twenty-five percent rate of required long-term nursing home care; and 50,000 deaths per year.

ARE YOU AT RISK OF OSTEOPOROSIS?

Every woman should consider herself to be at risk for osteoporosis. Because estrogen plays an important role in keeping bone absorption under control, post-menopausal women are more prone to suffer rapid bone loss as estrogen decreases abruptly. Women in their forties lose about one percent of bone mass from their spine per year. During menopause, this rate increases to three percent or more, while six to ten years after menopause, bone loss seems to slow down to about one percent.

While the average man has thirty percent more peak bone mass than the average woman, he should not be lured into a false sense of security of not falling victim to osteoporosis. As testosterone levels decline with age, men do suffer some bone loss. Granted, the effects are much less dramatic than bone loss due to menopause, still, men have a seventeen percent chance of experiencing an osteoporotic hip fracture in their lifetime.

Some people are at greater risk of osteoporosis than others. Such risk factors include: being Caucasian or Asian, thin or slender, having a family history of osteoporosis, a calcium deficient diet, lack of exercise, alcohol consumption, nicotine abuse, premature menopause, prolonged use of corticosteroids, or an overdose of thyroid hormones. The more risk factors you have, the higher your chances will be.

EARLY DETECTION OF OSTEOPOROSIS:

Because bone loss due to osteoporosis is difficult to detect until a fracture occurs, at which time prevention is too late, early diagnosis is key. The goal of early detection is to quickly identify patients with low bone mass, begin treatment to reverse the process and reduce the possibility of fracture.

Bone mineral density (BMD) determines how strong your bones are and how likely you are to have an osteoporotic fracture. DEXA-bone density testing is today’s most accurate and sensitive test used to measure bone density and offer a precise measurement of change from as little as 1.5 percent. BMD testing is recommended for all women 65 or older regardless of additional risk factors or under the age 65 who have additional risk factors besides menopause. With this test, your physician can actually estimate the risk of future osteoporosis and fractures and plan an individualized course of treatment.

So don’t think of osteoporosis as simply an inevitable part of aging. Even though you can’t change your race, your genes, or the fact that you have arthritis, there are risk factors that you can avoid and treatment get.  It can be prevented, treated and even reversed if proper action is taken early.

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