Consumer Focus

Osteoporosis - The Silent Thief

Osteoporosis is the most common of the bone diseases that affect Americans. It is characterized by low bone mass resulting in weakening of the skeleton and an increased susceptibility to fractures. The condition is called "silent" because you can't feel or see your bones becoming weaker. Bone loss occurs slowly over time, and is not realized until a simple activity or fall results in a fracture. Osteoporosis is a major health risk for 28 million Americans. In the U.S. today, 10 million individuals already have the disease and 18 million more have low bone mass, placing them at increased risk for the disease.

• 80% of those affected by osteoporosis are women.
• 8 million women and 2 million men have osteoporosis.
• Significant risk has been reported in people of all ethnic backgrounds (but Caucasians and those of Asian descent are at higher risk).
• Of those diagnosed with osteoporosis, one out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime.
• Osteoporosis is responsible for more than 1.5 million fractures annually.

• Stooped posture or rounded shoulders.
• Hump forming at the upper back.
• Back pain or tiredness (often caused by an unknown vertebral fracture).
• Fracture or broken bones (typically of the hip, wrist, ankle and spine).

Screening

Bone mineral density (BMD) predicts hip and other types of fractures. The diagnosis of osteoporosis begins with a thorough medical history, an x-ray (if a fracture is suspected) and bone density testing. Specialized tests called bone density tests can measure bone density in various sites of the body. Your bones are scanned with either x-rays or ultrasound waves. The amount of radiation exposure is very low and the procedure is painless. The lower your BMD is, the greater your risk of fracture. Additional tests (such as bone scans, urine and blood tests) also exist. Ask your physician about screening options.

* The decision to have a bone density test is based on your risk factors and should be done if the results will help you to decide about treatment.

Other Resources

This is just brief overview. For more information on osteoporosis and related issues check out these resources on the World Wide Web:

• Boning Up on Osteoporosis
• Dietary Guidelines for Americans 2000
• Food Guide Pyramid
• Q&A About Hip Replacement
• Taking Charge of Menopause
• To Be or Not to Be: On Hormone Replacement Therapy

• Publications available for ordering from the Health Page

• Publications on health available to read

Web Sites*:

• Administration on Aging
• National Institute of Arthritis, Musculoskeletal and Skin Diseases
• National Institute on Aging
• National Library of Medicine
• NIH Osteoporosis and Related Bone Diseases National Resource Center
• American Academy of Orthopaedic Surgeons
• American Medical Association
• National Osteoporosis Foundation

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Risk Factors

Women are more likely to develop osteoporosis than men because they have lighter, thinner bones and lose bone mass rapidly. However, other factors are believed to contribute to an individual's likelihood of developing the disease. Some of these risk factors may include the following:

• Family history of osteoporosis.
• Over 50 years old.
• Low hormone levels
  In women - as a result of decreased estrogen production or premature menopause.
  In men - as a result of decreased testosterone production.
• Diet low in calcium.
• Eating disorders (such as anorexia nervosa or bulimia).
• Excessive use of alcohol.
• Cigarette smoking.
• An inactive lifestyle. Exercise builds bone strength and helps prevent bone loss. Physical activity is essential for keeping muscles toned, joints flexible, and bones strong.
• Thin and/or small frame.
• Use of certain medications (corticosteroids and anticonvulsants).
• Inflammatory disorders (rheumatoid arthritis, asthma, lupus).
• Chronic kidney, liver, lung and gastrointestinal disorders.
• Breast or prostate cancer.

* Women can lose up to 20% of their bone mass in the 5-7 years following menopause, making them more susceptible to osteoporosis.

* Children with a low body mass index (BMI) are likely to have a lower-than-average peak bone mass.

Treatment Options

Although there is no "cure" for osteoporosis, there are some medications and treatments available to slow bone loss and, in some cases, even help you build bone mass.

• Calcium and/or vitamin D supplementation.
• Osteoporosis treatment medications (such a calcitonin or biophosphonates).
• Low-dose estrogen replacement therapy is one preventive and therapeutic option for women, but the treatment does have known side effects.
• Testosterone replacement or use of other medications specifically indicated for men.
• Even a moderate increase in physical activity (walking, weight training, riding a stationary bike or low-impact aerobics) can increase bone mass and, potentially, decrease long-term fracture risk. However, physical activity alone is not sufficient to fully offset the damaging effects of osteoporosis.

* It is important to consult your physician and thoroughly discuss all treatment options available and potential risks involved before making a decision.

Prevention (lifestyle changes, diet, exercise)

Prevention of osteoporosis begins at childhood and continues throughout life. Exercise plays an important role in the acquisition of bone mass in youth; can help maintain or even modestly increase bone density in adulthood and; can assist in minimizing age related bone loss in older adults. Many factors influence the normal growth, development, and maintenance of bone and here are some steps you can take to promote and maintain bone health:

• Ensure a balanced diet with adequate intake of calcium and vitamin D (excessive intake of other nutrients, such as sodium, can decrease calcium intake).
• Maintain a physically active lifestyle. Regular weight-bearing exercises (walking, jogging, riding a stationary bike, using a rowing machine, weight training or playing tennis) helps to build bone and muscle strength.
• Avoid smoking.
• If you drink, do so in moderation.
• Bone density testing and/or medications (when appropriate).

*Calcium is the main building block of bone and is essential for bone health. But calcium intake alone will not ensure healthy bones.