Healthy Headlines - Osteoporosis

4/26/2013

                During the month of May we have much to celebrate and be thankful for.  We will be observing Memorial Day, Mother’s Day (make sure you don’t forget this one), Armed Forces Day, and Cinco de Mayo to name only a few.  The month of May is also recognized as National Osteoporosis Awareness month.

                Osteoporosis is a disease process that is characterized by low bone density or mass.  Osteoporosis is a progressive disease in that continued bone loss will occur without proper intervention.  This disease process results in thin bone and a resulting risk of fracture.  The most common fractures due to osteoporosis are within the hip, spine, and wrist.  For the people who suffer from osteoporosis these fractures can be life-altering experiences.  In 2009 there were 279,000 hip fracture hospital discharges with an average length of stay of 6.3 days. (National Hospital Discharge Survey 2009.)  Activities of daily living can be severely limited for many who sustain one or more of these fractures.  Osteoporosis may affect men as well as women; although, osteoporosis is more prevalent within the female population.

                In America alone two percent of men aged 50 years and over are afflicted with osteoporosis of the hip.  The population size in this group is approximately 800,000.  The percent of women aged 50 years or older who have osteoporosis of the hip is ten percent.  The number of women aged 50 years or older with osteoporosis of the hip is 4.5 million. (NHANES, 2005-2006.)  

                There are many factors that increase the probability of osteoporosis: post-menopausal women, older adults, diet low in calcium, and physically inactive people are only a few.  Considering these risk factors one realizes there a number of interventions that can help prevent osteoporosis.

                As with most disease processes proper diet is key for long-term success.  Calcium is required for healthy bones and teeth.  Calcium is also used in the body for many critical functions including but not limited to: the heart, kidney, muscle, and nerves.  Calcium cannot be synthesized by the body so outside resources are needed for absorption.

                Foods that tend to be high in calcium are dairy products, green leafy vegetables, as well as, “calcium fortified” foods.  Orange juice is one of the products that are sometimes labeled as, “calcium fortified.”  The makers of such products will add calcium during their production.  Most products that are, “calcium fortified” will have the label identifying it as such.  It is recommended that a person aged 50 and/or older consume approximately 1,200mg every day.  Vitamin D is also needed to aid in bone development; it assists with calcium absorption as well.  This is why the majority of calcium supplements will also have Vitamin D within their product.  Sometimes people may suffer from Vitamin D deficiency which can cause deleterious effects with bone synthesis and structure.  A vitamin D level may be checked by a simple blood test.  Your physician may consider getting a vitamin D level if he or she is concerned with such a disease process.

                Weight-bearing exercise is a great way to prevent osteoporosis.  Investing fifteen to thirty minutes of mild exercise daily can really help protect current bone structure as well as help increase bone mass.  Getting out and exercising has numerous benefits; improving bone mass is only one.  Be sure to speak with your physician or health-care provider before starting an exercise program.

                There are many different medications that can aid a person with osteoporosis.  One of the categories of such medications is the bisphosphonates.  This class of medications is the most popular and is frequently used as the first-line choice for medical providers.  These medications help with osteoporosis by decreasing bone resorption and turnover rate.  There are numerous medications within this class.

                Another class of medications used frequently is the parathyroid hormone antagonists.  The most commonly used medication in this class is calcitonin.  This medication inhibits bone resorption and helps with calcium regulation within the body.  Calcitonin is found naturally in the human body.  Calcitonin (also known as thyrocalcitonin) is a hormone that is produced in humans primarily by the parafollicular cells (also known as C-cells) of the thyroid. 

                Hormone replacement therapy is another option for postmenopausal women.  After menopause, bones lose mass and density more rapidly than before menopause. Postmenopausal women are more likely to experience broken bones, such as hip fractures and compression fractures of the spinal bones due to persistent bone loss. Women who have osteoporosis frequently lose height because of bone loss.  Long-term hormone replacement therapy reduces a woman's risk of developing osteoporosis, especially among women who have increased risk factors for osteoporosis.   However, hormone replacement therapy is not without potential side-effects and/or risks.  Hormone replacement may increase the risk of health problems for some women, including blood clots, stroke and breast cancer.  Be sure to speak with your physician regarding hormone replacement therapy and its potential side effects.

                These medications have benefits as well as potential risks.  Be sure to speak with your physician regarding these and any other medications you are currently taking.

                Surveillance exams are necessary not only for the initial diagnosis of osteoporosis but also to map its progression.  One of the more popular choices is the DEXA scan (Dual-energy X-ray absorptiometry).  Two X-ray beams with different energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by the bone. The lumbar spine and hip are the most common areas investigated during a DEXA scan.   Dual-energy X-ray absorptiometry is the most widely utilized surveillance exam.  Many factors are considered when to order an initial DEXA scan as well as continued surveillance scans.  Be sure to discuss surveillance options with your physician during your next visit.

                The month of May provides us with ample opportunities to get out and enjoy the Kansas Spring weather.  Multiple celebrations are in store during this month including Osteoporosis Awareness.  During the month of May take some time to discuss the topic of osteoporosis with your physician or healthcare provider.  If you, a friend, or family members have been diagnosed with osteoporosis consider the above interventions.  To the reader, I wish a very enjoyable month of May and continued good health.

 

                As with all medical conditions, always feel free to contact your physician or healthcare provider with any questions or concerns.

                Dr. Charles Weintz is the author of, “Healthy Headlines.”  He is a family physician at Stanton County Family Practice.

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