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Mark Tantorski, DO, Orthopedics
The Chester County Hospital and Health System
Published: May 6, 2013
Osteoporosis or low bone density is a silent epidemic. It is estimated that more than 200 million people worldwide have osteoporosis and about 44 million in the United States, numbers that are expected to rise significantly as the population ages. The term "osteopenia" is also used to describe low bone density.
Unfortunately individuals cannot feel their bones getting weaker, and the first sign of osteoporosis is often a broken bone (fracture). Bone breaks secondary to osteoporosis are termed fragility fractures and often occur from minor trauma, such as a fall from standing height that would not ordinarily cause a broken bone in someone with normal bone density. There are more than two million fragility fractures in the U.S. each year, more than all heart attacks, strokes and breast cancer combined. Estimates show that half of all women and a quarter of all men will suffer a fragility fracture in their lifetimes, most commonly in the spine, wrist and hip.
Here are two more sobering facts about osteoporosis and fragility fractures:
1. Costs exceed $19 billion dollars per year in the U.S.
2. Four out of five individuals with osteoporosis plus a fracture do not receive the appropriate treatment for the underlying bone disease, resulting in an 86% higher risk for a subsequent fracture.
Our bodies achieve their maximum bone density by about age 25, depending on a variety of factors including genetics, health during growth, nutrition, hormonal input and physical activity. Bone remodeling (cycles of breaking down and rebuilding) is a normal process, with calcium and vitamin D playing important roles. When removal of older bone is balanced by new bone replacement, there is no net loss; but bone loss begins to occur when there is greater removal than replacement. There are a number of factors that can lead to osteoporosis, some of which we can control and others we can't. Gender (women have a much higher likelihood than men), advancing age, body size, ethnicity and family history can all contribute the development of this disease. Other factors, including lifestyle, medication use, alcohol use, smoking, as well as calcium and vitamin D intake can also affect your bone density and increase your risk for fragility fractures.
So how do we minimize and treat osteoporosis, as well as prevent fragility fractures? Individuals can take a number of steps to help maintain stronger bones. Weight-bearing exercises and a healthy diet of fruits and vegetables, as well as smoking cessation and limiting alcohol intake can be helpful. Individuals should have adequate calcium and vitamin D intake, but even with the best diets supplementation is often recommended. Medications profiles should also be examined because some can adversely affect bone density.
Numerous medical specialties address and manage issues related to osteoporosis and bone density, so primary care physicians, orthopedists, endocrinologists, gynecologists and rheumatologists are all potentially good resources. They can also order specific tests to help determine bone density, such as an imaging procedure known as a DEXA scan, which is generally recommended for women over 65 and men over 70 (women under 65 may also be candidates based on certain risk factors such as smoking, use of certain medication and family history). The DEXA scan can help determine the appropriate treatment as well as assess fracture risk. In addition to education for nutrition, exercise and fall prevention, there are also several types of medical treatments physicians can prescribe for low bone density. However, the best medicine is first understanding that osteoporosis exists, then with your physician's help learning how to prevent it and, if necessary, treat it appropriately.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 5/6/2013