Published May 2004

Bone up on osteoporosis prevention

By Kimberly Hilden
SCBJ Assistant Editor

More than 25 million Americans — 20 million of them women — suffer from osteoporosis. Many aren’t even aware they have the condition, however, until a sudden strain or fall puts them in the emergency room with a fractured bone.

There they learn that their low bone mass has made them susceptible to fractures, which can lead to an increased risk of morbidity and mortality, Dr. Jonathan Witte said.

“To think that osteoporosis can shorten life, especially hip fractures,” said Witte, a doctor of rheumatology at The Everett Clinic. “Within the year after suffering a hip fracture there is a 20 percent higher risk of mortality.”

He added that 50 percent of those suffering hip fractures are not able to return to their normal life, and 25 percent of women suffering such a fracture require long-term care.

All this comes with a cost, an estimated $20 billion annually, Witte said. “It really has quite an economic impact.”

To get a better handle on the disease, which leads to 1.5 million bone fractures annually, Witte advocates prevention, testing and treatment.

Building, maintaining strong bones
Unlike diseases that chart their progression with increasing symptoms, osteoporosis seems to come out of nowhere for its sufferers in the form of a fractured hip, wrist or other bone. In reality, the “silent disease,” as it is known, develops over years as natural bone loss occurs.

On average, a person’s maximum bone mass is reached between the ages of 35 and 40, Witte said. After that, bone mass declines by about half a percent annually. For women, that holds true until menopause when, for a period of five to 10 years, bone mass declines by 1 to 2 percent annually, due to a decrease in estrogen, which slows bone loss.

Because of that, and the fact that women tend to have a lower peak bone mass than men do, women are four times more likely than men to develop osteoporosis, according to the National Osteoporosis Foundation.

The key to preventing osteoporosis, then, is to build strong bones early and help maintain them through diet and exercise, Witte said.

According to the National Osteoporosis Foundation, there are four important steps in the prevention of osteoporosis, including:

• A balanced diet rich in calcium and vitamin D, which helps the body to absorb calcium. Appropriate calcium intake falls between 1,000 and 1,300 milligrams daily. For vitamin D, experts recommend a daily intake between 400 and 800 IU.
• Weight-bearing exercise, such as walking or climbing stairs, can help keep bones strong. “It doesn’t take a whole lot of exercise, a half-hour to an hour a day is plenty to maintain bone mass,” Witte said.
• A healthy lifestyle with no smoking or excessive alcohol use.
• Bone density testing and medications when appropriate.

Testing and treatment
It used to be, doctors could only detect osteoporosis after a fracture occurred, Witte said. Today there are bone mineral density tests, such as DEXA (Dual Energy X-ray Absorptionmetry) screenings that can detect bone loss early in the development of osteoporosis.

The noninvasive screenings are especially helpful for patients with a higher risk of developing the bone disease, Witte said, including:

• Women 65 years or older.
• Women 60 years or older with a small or thin body frame and not on estrogen or other bone-maintenance therapies.
• Patients on chronic systemic corticosteroids, which are used to treat diseases such as asthma and arthritis.
• Patients with a history of “fragility fracture,” a fracture that occurs without trauma or from a fall of standing height or less.
• Younger women with a history of anorexia or disrupted menstruation.
• Patients who are chronic smokers.
• Patients with a family history of osteoporosis.

If low bone density is found, then treatment can be prescribed to prevent further deterioration.

According to the National Women’s Health Information Center, lifestyle changes and medical treatment go hand-in-hand to prevent future fractures.

And the arsenal of drugs used to prevent or treat osteoporosis has grown to include Alendronate, which reduces bone loss and increases bone density in the spine and hip of postmenopausal women; Calcitonin, which slows bone loss and increases spinal bone density in women who are at least five years beyond menopause; and estrogen replacement therapy.

That last therapy, however, has come under scrutiny following the July 2002 decision by the National Heart, Lung, and Blood Institute of the National Institutes of Health to stop a clinical trial of the risks and benefits of combined estrogen and progestin in healthy menopausal women. The reason: an increased risk of invasive breast cancer, coronary heart disease, stroke and pulmonary embolism found in those women taking estrogen plus progestin.

“Overall, the investigators that did the study felt that the risks outweighed the benefits (of hormone therapy) for the average person,” Witte said. “But for a person who has a strong family history of osteoporosis, but no risks of vascular diseases, she might benefit from the therapy. We have to look at each case individually.”

Back to the top/Business Women 2004 Main Menu