Osteoporosis is a disease in which bones lose their strength. Bone mass is low and this makes bones fragile and weak. Persons with osteoporosis have a significantly increased risk of bone fracture.
Risk factors Women develop osteoporosis more frequently than men. Eighty percent of persons with osteoporosis are women. Certain medical conditions will predispose to the development of osteoporosis, but the change of developing osteoporosis increases in all women after menopause.
Modifiable risk factors are activities that you can change to reduce your risk for the development of osteoporosis. The following are modifiable risk factors for the development of osteoporosis:
Physical inactivity
Cigarette smoking
Excessive alcohol intake
Inadequate nutrition
Inadequate intake of calcium and Vitamin D
Estrogen deficiency
Low body weight (less than 127 pounds)
Chronic use of certain medications including steroids, thyroid hormone and anticonvulsants
Non-modifiable risk factors are characteristics that cannot be altered. The following are non-modifiable risk factors for the development of osteoporosis:
Female sex
Family history
Caucasian or Asian ethnicity
Chronic health conditions
Prolonged immobility
Effects of Osteoporosis Having osteoporosis increases the risk for bone fractures with resultant health risks and reduction in quality of life. Postmenopausal women rapidly lose bone in the first three to seven years after the cessation of menstrual periods. Bone loss in the spine typically becomes significant earlier than bone loss at the hip. Fractures of the spine and hip are associated with serious medical complications, including additional fractures, blood clots and death. Also significant is the negative impact that chronic pain and the loss of independent mobility can have on elderly adults.
Recommendations for screening
Any person with a history of nontraumatic fracture
Any person on chronic steroid therapy or other medication which increases the risk for osteoporosis
Any person with a medical history which places them at risk for osteoporosis
Any postmenstrual woman with rick factors for osteoporosis
All women age 65 and older
Diagnosis Bone densitometry (Dexa scan) is the current standard method of testing bone mineral density. A Dexa scan is a quick and painless procedure much like having an X-ray performed. Results are readily available to be interpreted by a physician.
The Dexa scan compares your bone density, at the spine and at the hip, to women who have optimal bone mass. In other words, the standard for comparison is young pre-menopausal women who are at their maximum bone density and bone strength. "T-score" is the measurement most commonly utilized to determine normal or abnormal bone density. A T-score equal to 0.0 means that your bone mass is exactly equal to controls, or young healthy women. A positive T-score (T-score above 0.0) means that your bone mass is better than controls, and a T-score less than 0.0 means that your bone mass is lower than controls.
In general, a T-score above -1.0 is considered normal, and does not place you at increased risk for fracture. A T-score from -1.0 to -2.5 indicates that you have decreased bone mass and may be at risk for fracture. Prevention and possible treatment should be considered after evaluation of all risk factors. A T-score below -2.5 indicates a significant risk for fracture and requires treatment.
Prevention and Treatment of Osteoporosis
Nonpharmacologic PREVENTION:
Alter lifestyle to reduce those risk factors which can be reduced
Increase weight bearing exercise
Maintain adequate dietary intake of Calcium and Vitamin D. Menopausal women should take 1200-1500 mg/day of Calcium with 400 IU of Vitamin D. Premenopausal women should take 1000mg/day of Calcium with 200 IU of Vitamin D.
Pharmacologic PREVENTION of osteoporosis:
Estrogen replacement therapy
Bisphosphonates, alendronate (Acetonel) and risendronate (Fosamax)
Raloxifene (Evista)
Pharmacologic TREATMENT of osteoporosis:
Utilize all available nonpharmacologic interventions to promote bone health. However, once osteoporosis has developed, utilizing these interventions alone will not restore bone mass.
Bisphosphonates, alendronate (Actonel) and risendronate (Fosamax)
