Bone brittle
March 1, 2002 | 12:00am
"Blessed is the man unto whom the Lord imputeth no sin: and in whose spirit there is no guile. For while I held my tongue: my bones consumed away through my daily complaining." The Book of Common Prayer, Psalm 32, v. 2
Osteoporosis is, as the Psalmist would say, a picture of "bones consumed away." Osteoporosis is formally defined as "microarchitectural deterioration of bone tissue leading to decreased bone mass and bone fragility." This mouthful really just means that as people get older, particularly menopausal women, their bones begin to lose thickness and become weak and brittle. Unfortunately, most people find out they have osteoporosis the hard way - after getting a fracture.
Are you at risk? Osteoporosis is a worldwide epidemic. It affects 75 million persons in the US, Europe, and Japan. In the United States alone, osteoporosis is the main culprit in 1.3 million fractures a year. Some risk factors include: female gender, white or Asian ancestry, seden-tary lifestyle, lifelong low calcium intake, smoking, excessive use of alcohol and postmenopausal status.
These are the risk factors in primary osteoporosis, the type with no identifiable cause. Secondary osteoporosis occurs due to chronic conditions that accelerate the loss of bone mass. Kidney, liver, and thyroid diseases are often implicated.
Should you see a doctor? Women are often terrified seeing their mothers or aunts in some kind of "permanent stoop." They often wonder, "Will I end up like that too?" That stoop is actually an abnormal curve of the spine resulting from multiple fractures - the dreaded "dowager’s hump." It is a sure sign of osteoporosis and seeing a doctor at this stage is late and unfortunate.
If you are at risk, an out-patient visit to your family medicine doctor, endocrinologist, rheumatologist, rehabilitation medicine specialist, or orthopedic surgeon, will keep you on top of things.
Your doctor might decide on Bone Mineral Density (BMD) Screening. You may suggest a BMD baseline screen. In general, all women over 65 should be screened. Women younger than 65, but with risk factors, may be screened. Since osteoporosis is a net decrease in bone mass, it makes sense to determine if indeed it is being lost. X-rays may help but this qualitative guide will help only if total bone density has decreased by 30 to 50%. The current diagnostic measure of choice is dual energy x-ray absorptiometry or DEXA. This affordable and painless test will put you in any of three groups: normal, osteopenic (beginning bone loss), and osteoporosis. Based on the DEXA reading, the doctor will recommend preventive steps or treatment.
Prevention. Supplemental calcium should range from 1,000 to 1,500 mg a day. What are some calcium rich foods? Milk (skim, low-fat, or whole), plain yogurt, canned sardines, green and leafy vegetables, cheese, and calcium-fortified orange juice. Vitamin D increases the absorption of calcium so this may also be taken.
It may be time to cut back on smoking and alcohol. Regular exercise has also been shown to reduce the risk of osteoporosis and delay the decrease of bone mineral density. Recommended physical activities are jogging and walking, aerobics, racquet and court sports, and dancing. These should be done 30 minutes to one hour at least three times a week. Since osteoporosis is also a hormonal problem, post-menopausal women may also benefit from estrogen replacement. Please do not self-medicate. There is a long list of absolute and relative contraindications to estrogen use, example - history of breast cancer. Doctor-prescribed estrogen is best.
Treatment. The pharma-cologic approach to osteoporosis is divided into using drugs that prevent bone loss (anti-resorptives) and those that help bone to form (bone formation stimulants). An example of a bone-forming stimulant is sodium fluoride. It is always given, however, together with calcium, vitamin D, and estrogen. This combination allows its optimal use. The more common anti-resorptives are estrogen, calcitonin, and the bisphosphonates. The only bisphosphonate currently approved for the treatment of osteoporosis is alendronate sodium (Fosamax). It can also be used for prevention.
Osteoporosis will continue to be a challenge because of an aging population. With measures clearly spelled out however, brittle bones need not be a threat.
Fact/Factoid. According to the AMA Book of Skin and Hair Care, male pattern baldness becomes noticeable in 12% of 25 year old men, 37% of 35 year old men, 45% of 45 year old men, and 65% of 65 year old men.
Osteoporosis is, as the Psalmist would say, a picture of "bones consumed away." Osteoporosis is formally defined as "microarchitectural deterioration of bone tissue leading to decreased bone mass and bone fragility." This mouthful really just means that as people get older, particularly menopausal women, their bones begin to lose thickness and become weak and brittle. Unfortunately, most people find out they have osteoporosis the hard way - after getting a fracture.
Are you at risk? Osteoporosis is a worldwide epidemic. It affects 75 million persons in the US, Europe, and Japan. In the United States alone, osteoporosis is the main culprit in 1.3 million fractures a year. Some risk factors include: female gender, white or Asian ancestry, seden-tary lifestyle, lifelong low calcium intake, smoking, excessive use of alcohol and postmenopausal status.
These are the risk factors in primary osteoporosis, the type with no identifiable cause. Secondary osteoporosis occurs due to chronic conditions that accelerate the loss of bone mass. Kidney, liver, and thyroid diseases are often implicated.
Should you see a doctor? Women are often terrified seeing their mothers or aunts in some kind of "permanent stoop." They often wonder, "Will I end up like that too?" That stoop is actually an abnormal curve of the spine resulting from multiple fractures - the dreaded "dowager’s hump." It is a sure sign of osteoporosis and seeing a doctor at this stage is late and unfortunate.
If you are at risk, an out-patient visit to your family medicine doctor, endocrinologist, rheumatologist, rehabilitation medicine specialist, or orthopedic surgeon, will keep you on top of things.
Your doctor might decide on Bone Mineral Density (BMD) Screening. You may suggest a BMD baseline screen. In general, all women over 65 should be screened. Women younger than 65, but with risk factors, may be screened. Since osteoporosis is a net decrease in bone mass, it makes sense to determine if indeed it is being lost. X-rays may help but this qualitative guide will help only if total bone density has decreased by 30 to 50%. The current diagnostic measure of choice is dual energy x-ray absorptiometry or DEXA. This affordable and painless test will put you in any of three groups: normal, osteopenic (beginning bone loss), and osteoporosis. Based on the DEXA reading, the doctor will recommend preventive steps or treatment.
Prevention. Supplemental calcium should range from 1,000 to 1,500 mg a day. What are some calcium rich foods? Milk (skim, low-fat, or whole), plain yogurt, canned sardines, green and leafy vegetables, cheese, and calcium-fortified orange juice. Vitamin D increases the absorption of calcium so this may also be taken.
It may be time to cut back on smoking and alcohol. Regular exercise has also been shown to reduce the risk of osteoporosis and delay the decrease of bone mineral density. Recommended physical activities are jogging and walking, aerobics, racquet and court sports, and dancing. These should be done 30 minutes to one hour at least three times a week. Since osteoporosis is also a hormonal problem, post-menopausal women may also benefit from estrogen replacement. Please do not self-medicate. There is a long list of absolute and relative contraindications to estrogen use, example - history of breast cancer. Doctor-prescribed estrogen is best.
Treatment. The pharma-cologic approach to osteoporosis is divided into using drugs that prevent bone loss (anti-resorptives) and those that help bone to form (bone formation stimulants). An example of a bone-forming stimulant is sodium fluoride. It is always given, however, together with calcium, vitamin D, and estrogen. This combination allows its optimal use. The more common anti-resorptives are estrogen, calcitonin, and the bisphosphonates. The only bisphosphonate currently approved for the treatment of osteoporosis is alendronate sodium (Fosamax). It can also be used for prevention.
Osteoporosis will continue to be a challenge because of an aging population. With measures clearly spelled out however, brittle bones need not be a threat.
Fact/Factoid. According to the AMA Book of Skin and Hair Care, male pattern baldness becomes noticeable in 12% of 25 year old men, 37% of 35 year old men, 45% of 45 year old men, and 65% of 65 year old men.
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