Osteoporosis: Prevention, Treatment & Risk Factors

Most people consider it natural that our bones grow weak with age. Indeed, without preventative measures such as a long-term diet with calcium and vitamin D supplements and a weight-bearing exercise program designed to promote and maintain bone strength to offset the increased bone-tissue breakdown that begins in middle age, bones can become porous, brittle, and ultimately subject to spontaneous fractures. This gradual bone loss is called osteoporosis, and for women, it will accelerate after menopause.

How Common is Osteoporosis?

Osteoporosis is responsible for more than 1.5 million fractures annually, mostly of the hip, spine and wrist. Ten million Americans already have osteoporosis and 34 million more have a low bone mass, placing them at increased risk for osteoporosis. Eighty percent of those affected by osteoporosis are women. It is called a silent disease, because it takes many years to develop, and most sufferers do not learn that they have the disease until middle age or later. It commonly afflicts women past menopause. Senile osteoporosis occurs much later in life and affects both men and women.

One out of every two women and one in four men over 50 will have an osteoporosis-related fracture in their lifetime. Five percent of women over 80 will fracture a hip each year, and 20% of these will then die within a year. Forty thousand people will die each year of complications following osteoporosis-associated fractures. The annual medical costs associated with osteoporosis total between 14 and 18 billion dollars.

Osteopenia, a condition in which bone mineral density is lower than normal, and osteoporosis are common problems associated with age and cancer survivorship. Osteopenia may be considered a precursor to osteoporosis. In most cases, breast cancer and prostate cancer survivors have good skeletons before treatment, which then become osteoporotic with hormone deprivation therapy. Such survivors must follow a calcium-rich diet with calcium supplements and vitamin D, and must seek guidance from their health care providers for possible drug treatment.

Who is at Risk for Osteoporosis?

Aside from increasing age, other risk factors include for developing osteoporosis include:

• Being female & postmenopausal
• Being chronically underweight
• Being white or Asian
• A past history of scant or prolonged absence of periods
• Having a family history of osteoporosis
• A poor diet lacking minerals, especially calcium
• Being sedentary
• A lack of weight-bearing exercise
• Smoking, drinking alcohol in excess, taking excess caffeine & certain drugs such as cortisone, thyroid hormone & anti-convulsants

How is Osteoporosis Diagnosed?

Routine X-rays and blood and urine tests are not adequate in uncovering osteoporosis. Loss of height and development of so-called dowager's hump are late developments. It is now possible to discover mineral loss early by the use of Dual Energy X-ray Absorptiometry (DEXA or DXA), which can measure bone mineral content at the wrist, the spine and the hip (the most common sites of fracture) accurately with little discomfort, rapidly, and at reasonable cost with minimal exposure to x-rays. Medicare has approved repeat bone density testing every two years.

Preventing & Treating Osteoporosis

A preventive program started in childhood and continued throughout life will help prevent and/or delay the onset of osteoporosis. By building bone mass early in life, you will be able to withstand bone loss later.

A long-term preventive program to promote bone strength for a lifetime includes both a well-balanced diet with calcium and vitamin D supplements as well as an exercise program emphasizing weight-bearing activities. Twenty to thirty minutes of sun per day, twice a week, stimulates the body to produce sufficient Vitamin D, but for those who use sunblock or live in sunless climates, supplements are necessary.

The diet must contain calcium-rich foods, with vitamin D to help in its absorption. Supplementation with calcium carbonate or calcium citrate may be needed to achieve the recommended daily allowance of 1000-1200 mgs (in twice-daily doses). About 800–1000 IU of Vitamin D daily is usually necessary for maintenance. Weight-bearing exercise such as walking, cycling, dancing, weight lifting and moderate jogging should be a part of your daily life. The combination of adequate calcium and regular exercise will stimulate and maintain bone mineral content. Giving up smoking and heavy alcohol intake is mandatory.

Dairy and Non-dairy Sources of Calcium

Menopause, Estrogen Therapy & Osteoporosis

When premature menopause occurs—especially after an oophorectomy or hysterectomy (removal of the uterus and ovaries)—estrogen therapy is necessary to help prevent osteoporosis. Likewise, estrogen treatment of natural menopause slows the accelerated bone loss in women older than 50. Low-dose estrogen is the most effective physiologic hormone means of prevention and treatment of advancing postmenopausal osteoporosis. Recent evidence shows that long-term estrogen/progesterone therapy increases the risk of heart attacks and strokes, so their use should be limited to one to five years. If you have breast or uterine cancer, talk to your doctor about hormone therapy. If estrogens are contraindicated (e.g., with women older than 75 or with past history of breast or uterine cancer) other drugs, such as nasal calcitonin, and the bisphosphonate drugs: oral Fosamax (Alendronate), Actonel (Risedronate), Boniva (Ibandronate), or the IV bisphosphonates (Zometa or pamidronate) are now used and have shown progressive increases in bone mass, with reduction of fracture rates, similar or greater than estrogens, for periods up to ten years. In patients with severe osteoporosis, the use of injectable parathyroid hormone (Forteo) can restore bone mass.

The most potent bisphosphonates, Zometa and Pamidronate, rarely have caused jaw necrosis, which is usually associated with poor dentition or recent tooth extractions. This problem merits a special dentist preventive examination and treatment attention if needed.

When patients receive certain hormonal therapies for cancer, they may be at higher risk for osteoporosis and need to pay special attention to this problem. (Read about mouth care for cancer patients.)

It is easier to prevent osteoporosis early than to treat the advanced disease when fractures have occurred. Eat a balanced diet, exercise regularly, take daily calcium and Vitamin D supplements, and discuss with your physician the need for hormonal replacement and other measures to increase your bone mass or prevent loss of bone mass. There are also pharmacological measures now available which make it possible both to prevent bone loss once started, and to reverse it once it has progressed to cause fractures. A program for severe compression fractures of the spine by injecting a plastic material into the vertebrae can restore their height and relieve bone pain.

Posted in Prevention Techniques, Risk Factors, Senior Health, Tips for Healthy Living, Treatment Options