What’s the Latest?
December 2007

Osteoporosis
by Lisa Frantz, PA-C

Osteoporosis is a skeletal disease affecting both men and women. The disease is characterized by low bone mass, increasing bone fragility and vulnerability to fracture. Over 200 million people worldwide and 10 million Americans suffer from this disease. According to the World Health Organization, 30% of women over the age of 65 have osteoporosis. Though all races are affected, Caucasians are at higher risk for osteoporosis than Hispanics and African-Americans.

Bone is a living tissue that is constantly being remodeled and reconstructed. The cells involved in this process are osteoclasts (which resorb bone) and osteoblasts (which build bone). The balance between these cell types determines whether bone is made, maintained or lost. Hormones, genetics and environmental factors are also involved in this process. Peak bone mass is usually reached by the age of 25 and gradually declines with age.

Important risk factors for developing osteoporosis are insufficient bone mass at the time of skeletal maturity and rapid bone loss after menopause. Other risk factors include family history of osteoporosis, female gender, advancing age, smoking, heavy alcohol use and some medications (such as corticosteroids). Assessment of these risk factors may be used as a screening tool to determine if you are at risk for fragility fractures due to osteoporosis.

Prevention of osteoporosis begins in childhood by developing healthy eating habits and regular exercise. Nutrition with adequate protein, calcium and Vitamin D is important for bone development and preservation. Calcium is found in dairy products, spinach and broccoli as well as fortified foods like orange juice, tofu and frozen yogurt. Calcium and Vitamin D supplements are also appropriate to reach the recommended daily intake. The recommended daily calcium intake for adult premenopausal women is 1200 mg/day and 1500 mg/day for postmenopausal women.

Exercise also builds and maintains bone strength. Weight bearing exercise such as walking, running and lifting weights is more beneficial to bone health than cycling or swimming (though the latter exercises are excellent for overall health). Risk of falls may be decreased by maintaining good posture and balance.

The gold standard for diagnosis of osteoporosis is bone mass or bone mineral density (BMD) determination by dual-energy X-ray absorptiometry (DEXA). This non-invasive, painless test may be used to obtain your BMD. If your bone mass is within 1 standard deviation (SD) of the average bone mass for your gender and age, then your BMD is considered to be normal. However, if your BMD is 1 SD below the mean or average value, then you have osteopenia (mild to moderate bone deficiency). Those who have BMD 2.5 SD below average are considered to have osteoporosis. DEXA is recommended for women over 65, postmenopausal women under 65 with at least one risk factor, postmenopausal women with a fracture or women on hormone therapy for prolonged period of time.

Medications (such as Fosamax) are available for treatment of osteoporosis. These are aimed at preventing further bone loss in order to decrease risk of fracture. The medications work to slow the rate of bone resorption and help rebuild the skeleton.

If you think you need DEXA screening or treatment for osteoporosis, please discuss this with us or with your family physician.

Want more information online?  Go to the American Academy of Orthopaedic Surgeons website at www.orthoinfo.aaos.org for information on many topics related to osteoporosis.  Another online resource is the International Osteoporosis Foundation website www.iofbonehealth.org. 

References

1. Lane JM, Nydick M. Osteoporosis: Current Modes of Prevention and Treatment. J Am Acad of Ortho Surg; Vol 7, No 1: 19-31; Jan/Feb 99.

2. Schulman JE, Williams S, Khera O, Sahba T, Michelson J, Fine K. Effective Osteoporosis Education in the Outpatient Orthopaedic Setting. J Bone Joint Surg, 89-A(2): 301-306; Feb 07.