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By William F. Brazerol, M.D., Obstetrician/Gynecologist
The Chester County Hospital
Published: December 15, 2008
One almost inevitable consequence of growing older is bone loss known as Osteopenia-the low bone mass that can progress to Osteoporosis with reduced bone strength and increased risk of fracture. This occurs most commonly in postmenopausal women who have bone loss related to estrogen deficiency. However, other risks including cigarette smoking, sedentary lifestyle, thyroid disorders, chronic use of steroids (i.e. prednisone), low body weight, premature menopause, Caucasian and Asian ethnicity, excessive alcohol consumption and disorders of calcium metabolism, also play a factor. It is not uncommon for the initial presenting symptom to be a fracture often caused by a low impact or trauma. Loss of height and back pain can also be an initial presentation. Hip fractures occur in 15% of women and 5% of men with Osteoporosis by age 80. Osteoporosis is a major public health problem that is both under-diagnosed and under-treated.
Osteopenia and Osteoporosis are usually diagnosed by measuring bone mineral density (BMD) in the hip and spine via Dual Energy X-ray Absorptiometry (DEXA). Women over 65 and men over 70 years should be screened regardless of risk factors. Other individuals to be considered for testing include these: younger postmenopausal women; men age 50 - 70 with risk factors; adults who have fractures after age 50; adults with a condition or who are taking medication associated with low bone mass or bone loss; and postmenopausal women discontinuing estrogen therapy. DEXA scan results are reported as T-scores (BMD as compared to young adults), and Z-scores (BMD compared to similar age and sex). T-scores above -1.0 are usually considered normal; scores between -1.0 and -2.5 reflect Osteopenia, while those below -2.5 would be classified as Osteoporosis.
The World Health Organization has recently released an algorithm on a 10-year fracture risk called FRAX. This computer model helps determine if a person is at risk for an osteoporotic fracture. By incorporating all risk factors in a quantitative risk assessment, it makes it possible to identify who will benefit from treatment. This tool is accessible to you with knowledge of your DEXA results and a quick survey at www.shef.ac.uk/frax.
Prevention is the key, as peak bone mass occurs early in life and declines as we age. Lifestyle choices-not smoking, limiting alcohol consumption, consuming adequate calcium and vitamin D throughout adulthood, as well as regular weight-bearing exercise-are important. Management goals for optimizing bone health are to achieve strong bones during the growth period in adolescence and young adulthood, to minimize bone loss later in life, and to reduce the risk factors associated with fracture.
Treatment of Osteopenia and Osteoporosis can vary for individuals, but usually focus on several aspects: adequate supplementation with calcium (1500mg/day) and vitamin D (at least 800 units/day); weight-bearing exercise for 30 minutes three-times per week; and various medications. Medications can include: 1.Bisphosphonates (i.e. Fosamax, Actonel, Boniva, Reclast) that inhibit breakdown and removal of bone; 2. SERMS (i.e., selective estrogen-receptor modulators such as Evista) that produce estrogen-like effects in bone, and decrease breast cancer risk in high-risk women; 4. Hormone Replacement Therapy; 5. Genistein, a natural plant-based isoflavone found in soybeans that has been shown to increase bone density; and 6. Calcitonin, a hormone that inhibits bone breakdown.
Prevention, early detection by screening and prompt treatment are familiar approaches to a number of different health conditions; for Osteopenia and Osteoporosis they could mean standing tall and walking strong into the best years of your life.
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: 7/27/2009