, Endocrinologist
The Saint Barnabas Osteoporosis and Metabolic Disease Center
In 2004, the Surgeon’s General report on bone health and
osteoporosis was published. It identified a lack of awareness of
the importance of bone disease among both the general public and
health care professionals. The statistics show that 15 million individuals
suffer a fracture (broken bone) due to osteoporosis each year. This
leads to pain, immobility, decreased independence and, in some cases,
death.
 These statistics emphasize the need to reduce the incidence and
prevalence of the disease. The Surgeon General’s report calls
for federal, state and local government to join with the private
sector and community organizations to promote bone health. It emphasized
the importance of identifying people early who are at risk for the
disease and helping to prevent the disease by treating them.
It is a disease characterized by
progressive loss of bone mass, causing the bone to be porous, which
increases one’s risk for developing fractures. Osteoporotic
fractures are most common in the hip, spine and wrist but many other
bones can be affected. Women are affected about four times as often
as men. In America, there are an estimated 10 million over age 50
with a diagnosis of osteoporosis; 34 million with osteopenia (low
bone mass but not as significant as osteoporosis); and others not
yet diagnosed.
Osteoporosis is a silent disease. When a fracture occurs at the
hip, there is pain, difficulty with movement often requiring long
term use of canes or walkers, and increased risk of death. When the
spine has a fracture there is often terrible pain, height loss, and
significant posture changes.
Prevention should be our goal. One builds the bones up until approximately
age 20 to 30. This is done by consuming a diet rich in calcium products,
and having adequate amounts of vitamin D. Also, weight-bearing exercise
and muscle-strengthening exercises are very important. In women,
normal menstrual function is vital because of the positive effect
of estrogen on bones.
Screening, it is important to identify those at risk and treat
them. (This list is not complete, and keep in mind that drugs that
help manage an illness should always be continued. Your healthcare
professional can help you to avoid bone loss while taking these drugs.)
- women in menopause, especially before 45 and those with surgical
menopause
- women who are or had amenorrhea (no periods for more then
6 months)
- women with a history of eating disorders
- age: the older the greater
risk
- race: Caucasian and Asian are at a higher risk
- family history of
fracture, osteoporosis or personal fracture history at an older
age
- lifestyle:
poor calcium intake, sedentary lifestyle, smoking, excess alcohol,
weight less then 126
- medications: prolonged use of steroids, anti
seizure drugs, immunosuppressives, too high doses of thyroid medications
- diseases:
Some rheumatic, intestinal diseases and endocrine diseases
- history
of falls, poor health or decreased vision.
By doing a test called a bone mineral density test. The Osteoporosis
and Metabolic Bone Disease Center at the Saint Barnabas Ambulatory
Care Center has two such machines. It uses very little radiation
and is a good way to assess if you have low bone mass and a diagnosis
of osteopenia and osteoporosis. It is also an excellent way to follow
a patient over time or to see if treatment is working. It is very
important to return to the same place where you had your original
bone density scan.
Diagnosis of low bone density may lead to some further testing
to be sure that there are no other less obvious reasons for having
lost bone and your physician would decide on this requirement.
Once you know you are at risk for fracture what can you do? The
field of bone health has developed significantly in the last 10 to
15 years and it continues to evolve. The ground work on which prevention
and treatment are based is: calcium consumption in diet and supplements
up to 1500 mg; vitamin D 800 units; and weight bearing exercises
along with muscle strengthening exercises if there are no contraindications.
Estrogen was once the common mode of treatment but since the Women’s
Health Initiative study came out identifying risks, it is no longer
the treatment of choice.
Drugs that prevent the bone from further breakdown include:
- Bisphosphonates, such as Alendronate (Fosamax), Risedronate
(Actonel), Ibandronate (Boniva)
- Selective estrogen receptor modulator:
Raloxifene (Evista)
- Calcitonin (Miacalcin)
- There is also a drug that builds bone:
Teriparatide (PTH (1-34) Forteo) which is injected with pen system
on a daily basis.
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The FDA has approved drugs for postmenopausal women
to prevent and/or treat osteoporosis. (See box) The best choice of
drug can be determined with your physician.
In conclusion, the whole area of osteoporosis is an evolving field
in medicine and prevention of fracture is very important. Education,
calcium and vitamin D, exercise and screening, and treating those
at risk is the way to improve bone health and prevent this costly
and under diagnosed disease from growing in number.
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