ARE YOU AT RISK FOR OSTEOPOROSIS?

Osteoporosis is the most common metabolic bone disease. It results from the loss of calcium in the bones, causing the bones to become brittle and susceptible to breaking. Osteoporosis, which means "porous bone," is also called the "silent disease" because it is usually not diagnosed until the person suffers a fracture, or broken bone. Osteoporosis affects 15 million to 20 million people in the Unites States. Women are affected eight times more often than men are. Osteoporosis primarily affects the vertebrae and the hips, wrists, and rib bones. Fractures can occur without any outside force being placed on the bones, especially in the spinal column. Hipbones are broken most often. Women suffer from hip fractures two to three times more often than men do. The vertebrae may compress and cause a stooped appearance or outward curvature of the back. The result is a loss of height and back pain.

How do bones function?

Bone is living tissue that is being formed and shaped continuously. Bones go through a process of formation (building up the bone) and resorption (breaking down the bone for other uses) throughout your life. Bones store calcium for other body functions, and the body takes the calcium out by resorption. Bone mass (the amount of bone in your body) increases as you grow through childhood, adolescence, and into adulthood. Bone mass is at its greatest when you are about 35 years of age. Up to that time the process of formation occurs faster than the process of resorption. However, as you age, resorption naturally occurs faster than formation, resulting in a gradual decrease in bone mass. Bones become brittle and susceptible to fractures. Women suffer the greatest loss of bone mass within the first 5 years after menopause (the ceasing of menstruation). The decrease in bone mass is slower in men.

Why are women affected more often?

One out of four women and half of the women over 65 years of age have osteoporosis to some extent. Most are white women who have gone through menopause. Generally, blacks have greater bone mass than whites, and men have greater bone mass than women do. There are several categories of women with increased risks of developing osteoporosis: 1. White, American Indian, and Asian women, largely for unknown reasons 2. Women who exert minimal stress on their bones, such as petite women with small bones and thin bodies 3. Women who have decreased estrogen blood levels, such as those who have had total hysterectomies or completed menopause and chose not to take hormone replacement therapy, and those who smoke cigarettes 4. Women who consume alcohol daily, because it suppresses synthesis of new bone (More than two drinks daily increase the chance of hip fracture by 25% to 50%, and more than 4 drinks daily increase the risk of vertebral fracture by 50%.) Osteoporosis is also caused by low estrogen levels that occur in women after menopause. Although the role of estrogen is not clear, it is linked to the processes of bone formation and resorption. Estrogen is thought to reduce bone resorption, reduce calcium loss through the kidneys, and increase calcium absorption in the digestive tract. Estrogen protects women who have had an inadequate intake of calcium in their growing years. However, when estrogen levels drop after menopause, bone resorption in women increases greatly.

What are the risk factors?

Two major factors for osteoporosis are lack of exercise and an inadequate intake of calcium, vitamin D, and protein. Osteoporosis caused by calcium and vitamin D deficiencies affects men and women 70 to 85 years of age. Other risk factors contributing to the disease include the following:

Mosby items and derived items 2006, 1999 by Mosby, Inc. an affiliate of Elsevier, Inc.

1. A family history of osteoporosis 2. Smoking and consuming too much alcohol and caffeine, which interfere with the absorption of calcium 3. A prolonged use of drugs or medications such as steroids, magnesium-based antacids such as Maalox, and heparin 4. Disease and hormonal disorders such as rheumatoid arthritis, liver disease, certain cancers, and an overactive thyroid 5. Poor calcium absorption in the intestines Although osteoporosis primarily affects middle-aged or older people, it can occur in young adults. Injuries that result in paralysis or long periods of immobility can lead to osteoporosis.

How is osteoporosis diagnosed?

Osteoporosis is diagnosed by several methods. A physical examination can reveal bone thinning. X-rays can show bone loss of 25% to 40% or more, but they are only helpful in later detection. A more specialized x-ray technique (complete tomography) can detect bone loss as slight as 2%, which is useful in measuring a patient's response to therapy. Absorptiometry, another specialized x-ray technique, can detect bone loss as little as 2% in the wrist and hand.

How can osteoporosis be prevented?

Osteoporosis can be prevented by regular exercise to stress bones, which maintains deposition of calcium in the bones, and an adequate intake of calcium. The daily amount of calcium recommended is 1 gram for premenopausal women and 1.5 grams for postmenopausal women. Also, based on the risk factors listed above, limiting alcohol consumption, stopping smoking, and using estrogen replacement therapy are other preventive strategies for osteoporosis.
This guide may be printed for free distribution to patients and families. All rights reserved. Copyright 1998 by Mosby.

Mosby items and derived items 2006, 1999 by Mosby, Inc. an affiliate of Elsevier, Inc.