eNewsletter - May 2010

Who is at Risk for Osteoporosis?

What is osteoporosis (brittle bones)?

Osteoporosis is a debilitating disease that can be prevented and treated. Osteoporosis causes bones to become fragile and, therefore, more likely to break. If not prevented, or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and might cause prolonged or permanent disability — or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.

Millions of Americans are at risk of developing osteoporosis. Although women are four times more likely than are men to develop the disease, men also suffer from osteoporosis.

Who is at risk for osteoporosis?

There are many factors that determine who might develop osteoporosis. The first step in prevention is to determine whether you are at risk. The risk factors include:

1. Age— The older you are, the greater your risk of osteoporosis. Your bones become weaker and less dense as you age.
2. Gender— Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than do men because of the changes involved in menopause.
3. Race — Caucasian and Asian women are more likely to develop osteoporosis. However, African American and Hispanic women are at a significant risk for developing the disease.
4. Bone structure and body weight— Small-boned and thin women are at greater risk.
5. Menopause/menstrual history— Normal or early menopause (brought about naturally or because of surgery) increases your risk of developing osteoporosis. In addition, women who stop menstruating before menopause because of conditions such as anorexia or bulimia, or because of excessive physical exercise, also might lose bone tissue and develop osteoporosis.
6. Lifestyle — By smoking, drinking too much alcohol, consuming an inadequate amount of calcium, or getting little or no weight-bearing exercise, you increase your chances of developing osteoporosis.
7. Medicines and disease— Osteoporosis is associated with certain medicines (such as cortisone-like drugs) and is a recognized complication of a number of medical conditions, including endocrine disorders (having an overactive thyroid gland), rheumatoid arthritis, and immobilization.
8. Family history — Susceptibility to fractures might be, in part, hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass.

Understanding bone and bone health

It is important to understand that bone is not a hard and lifeless structure. It is, in fact, complex, living tissue. Our bones provide structural support for muscles, protect vital organs, and store the calcium essential for bone density and strength.

Because bones are constantly changing, they can heal and might be affected by diet and exercise. Until about age 35, you build and store bone efficiently. Then, as part of the natural aging process, your bones begin to break down faster than new bone can be formed. In women, bone loss accelerates after menopause, when the ovaries stop producing estrogen — the hormone that protects against bone loss.

Assessing your bone health

To determine if you have osteoporosis or might be at risk for the disease, your doctor will ask you a variety of questions about your lifestyle and medical history. Your doctor will want to know if anyone in your family has suffered from osteoporosis or if they have fractured bones.

Based on a comprehensive medical assessment, your doctor might recommend that you have your bone mass measured. A bone mass measurement is the only way to tell if you have osteoporosis. Specialized tests called bone density tests can measure bone density in various sites of the body. If the test is conducted at intervals of a year or more, it can detect osteoporosis before a fracture occurs, predict your chances of having a fracture in the future, determine your rate of bone loss, and/or monitor the effects of treatment.

What if I have osteoporosis?

Although there is no cure for osteoporosis, there are steps you can take to slow its progress. (Keep in mind that these suggestions are made in the context of possibly preventing hip fractures in the elderly.)

Experts recommend 1,500 mg of calcium a day for women. Calcium should be taken with Vitamin D (1,000 IU per day). Although exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. Care should be taken when lifting heavy objects, such as bags of groceries, young children, etc.

If you have osteoporosis, it's important to minimize your chances of breaking a bone. Take steps to prevent falls. As extra insurance against fractures, your health care provider can recommend specific exercises to strengthen and support your back.

Guide to osteoporosis prevention

• All women should receive counseling on their risk factors for osteoporosis. Osteoporosis is a silent risk factor for fractures, just as hypertension (high blood pressure) is for stroke.
• All post-menopausal women who suffer a fracture should be tested for osteoporosis using the bone mineral density method. This test will determine the severity of the disease.
• All post-menopausal women age 65 and older should receive a bone mineral density test regardless of additional risk factors. Women in this group should maintain an adequate intake of dietary calcium (at least 1,500 mg per day, using supplements if necessary) and Vitamin D (1,000 IU per day).
• All people at risk for osteoporosis should perform weight-bearing exercises and muscle-strengthening exercises to reduce the risk of falls and fractures.
• Avoid tobacco, and drink alcohol in moderation.
• All post-menopausal women who suffer vertebral (spine) or hip fractures should be considered as candidates for treatment of osteoporosis.
• Women with no other risk factors whose bone mineral density T-scores are below -2.0 should begin therapy to reduce the risk of fractures. Women whose bone mineral density T-scores are below -1.5 and who have other risk factors should begin therapy to reduce the risk of fractures.
• Menopausal women who are at particularly high risk of developing osteoporosis or who already are losing bone mass, hormone therapy is available in pill or patch form. For those who can’t, or choose not to take hormone therapy, there are other options such as Forteo injections, or a nasal spray Fortical. There are several bisphosphonates on the market, including Fosamax, Actonel, Boniva, and Reclast. They are antiresorptive treatments, meaning they slow or stop the dissolving of bone tissue in the normal bone cycle without slowing the formation of new bone. But not all bisphosphonates are the same and not all reduce the risk of non-spine fractures like hip fractures. At the least, a woman on bisphosphonates will not lose bone faster than she can replace it.
• Postmenopausal women have the option of taking medications such as Evista in treating and/or preventing osteoporosis.

---

Share this article