The commonly held beliefs that osteoporosis is a disease confined to old women and an inevitable part of aging are putting millions of Americans at risk of the disease, without them even knowing it. Osteoporosis - quite literally “porous bone” - is a disease characterized by low bone mass and structural deterioration of the bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist.
It’s a major public health threat for an estimated 44 million Americans, or 55 percent of the population aged 50 years and older. In the U.S., 10 million people are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.
Why do we still think of osteoporosis as an “old person’s” disease? It’s true that osteoporosis becomes more common with age, but the factors identified as indicators of the disease have their grounding much earlier in our lives, beginning in our infancy. To tackle osteoporosis, we really need to identify the misinformation that surrounds it, and then some relatively simple steps to guard against it.
Many myths surround osteoporosis, making it difficult to separate truth from fiction when dealing with this disease. Some of the most common are:
Osteoporosis is an “old woman’s” disease…
Women, and men, can develop osteoporosis at any age. This is especially true if they have chronic asthma or arthritis that requires medications such as glucocorticoids (anti-inflammatory and immunosuppressant drugs) that can lead to bone loss.
Osteoporosis is an inevitable part of aging…
Not true. In most cases, osteoporosis is preventable. Prevention needs to starts early in childhood, and continue throughout a person’s life. By building a strong and durable skeleton from childhood through to early adulthood, the chances of developing osteoporosis in later life are greatly lessened.
There are four ways to build healthy bones and help prevent osteoporosis.
- Eating a balanced diet rich in calcium and vitamin D (eating a healthy balanced diet is important for many reasons; preventing osteoporosis is just one of them!).
- Take part in weight-bearing and high-impact exercises, choose exercises that place “stress” on the bones, including running, dancing, walking, sports and strength training.
- Choose to lead a healthy lifestyle by not smoking and not drinking excessive amounts of alcohol.
- Having your bone density tested and taking medication when appropriate.
There is a fair bit of conjecture within the medical profession about this last point. Many doctors argue that while bone density can be a factor in determining the risk of fracture, low bone density is not reason enough to medicate for osteoporosis. Many factors come into play when determining the risk of fracture, with bone density being just one of them. Age, diet, exercise program, general health, family history and other medications must also be taken into account. Medication for osteoporosis will not work as well (if at all) if the patient’s diet is poor, their vitamin intake is inadequate or if they do not exercise.
Rather than immediately medicating people with low bone density, actions to prevent falling, and therefore fracture, should be a primary course of action. For elderly or frail people this could be as simple as keeping house lights switched on, removing slippery floor rugs, having safety “grab” bars installed in bathrooms and other areas of the house and removing clutter.
Osteoporosis is not common…
As I mentioned previously, osteoporosis and low bone density affect over 50 percent of the population aged 50 and over. That’s 44 million people. Estimates put this number at over 52 million by 2010, and over 61 million by 2020. In the U.S. alone, osteoporosis is responsible for 1.5 million hip fractures every year.
Incredibly, a woman’s risk of hip fracture is equivalent to her combined risk of developing breast, uterine and ovarian cancer, and half of women over the age of 50 will have an osteoporosis-related fracture before they die.
I’d know if I had osteoporosis…
Osteoporosis is often called a "silent disease" because bone loss occurs without symptoms, until a fracture occurs. For example, loss of height is sometimes assumed to be a normal part of aging when it may be due to collapsed vertebrae that have been weakened by osteoporosis. As well as loss of height, collapsed vertebrae may initially be felt or seen in the form of severe back pain or spinal deformities such as kyphosis, otherwise known as curvature of the spine or stooped posture.
Risk Factors
So who’s at risk from osteoporosis? Well, women in the main. Eighty percent of osteoporosis sufferers are women, and with women losing up to 20 percent of their bone mass in the five to seven years following menopause, it’s no wonder they’re more susceptible to the disease.
People who are thin, who have a small frame, or suffer from an eating disorder like anorexia, are more at risk – not just from osteoporosis, but they’re more likely to suffer a fracture from falling, with less muscle and fat “padding” to absorb the impact.
People with poor diet, vitamin D deficiency and a poor life-time intake of calcium are at greater risk of developing osteoporosis. Similarly, smokers and people who drink excessive amounts of alcohol are at greater risk, with osteoporosis being one of the lesser known problems associated with these activities.
To find out if you have osteoporosis risk factors, take the International Osteoporosis Foundation’s One Minute Risk Test.
Who Should Be Tested?
Women should talk to their doctor about tests if they:
- Are estrogen deficient, including those who experienced early menopause (before 45 years of age) or an absence of menstrual periods for more than 12 months not related to pregnancy.
- Are undergoing prolonged corticosteroid therapy (prednisolone or equivalent).
- Have a maternal family history of hip fracture.
- Have a low body mass index. To determine your BMI in inches and pounds, multiply your weight in pounds by 703. Then multiply your height in inches by your height in inches again. The final step is to divide your weight equation by your height equation.
- Have chronic disorders associated with osteoporosis: anorexia nervosa, malabsorption syndromes including chronic liver disease and inflammatory bowel disease, primary hyperparathyroidism, chronic renal failure, hyperthyroidism, prolonged immobilization, or Cushing's syndrome.
- Have experienced a previous fragility fracture, particularly of the hip, spine or wrist.
- Have experienced loss of height, or thoracic kyphosis (widows hump).
Detection
For such a debilitating disease, detection is simple, painless and non-invasive. Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A BMD test can detect osteoporosis before a fracture occurs, help predict chances of fracturing in the future and determine rate of bone loss.
It can also monitor the effects of treatment if a Dual Energy X-Ray Absorptiometry (DXA) BMD test is conducted at intervals of one year or more. DXA is a special low radiation X-ray capable of detecting quite low percentages of bone loss. In the U.S., Medicare reimburses for BMD testing every two years.
Treatment
The biggest single factor in preventing and treating osteoporosis is maintaining an active and healthy lifestyle. The International Osteoporosis Foundation recently launched their new awareness campaign and released a report entitled Move It Or Lose It, highlighting the importance of weight-bearing exercise on building strong bones. The report looks at the importance of exercise at all ages, including its role in youth, in maintaining strong bones in adulthood and in preventing falls and speeding rehabilitation.
