By Christopher T. Welsch, M.D.
How often have you considered osteoporosis as a risk to your health? You may not realize that a woman's risk of hip fracture from osteoporosis is equal to her combined risk of breast, uterine and ovarian cancer! Osteoporosis is a vastly misunderstood disease. Many misconceptions may dominate a woman’s thinking about it, some of which are:
Osteoporosis is a disease of older women.
I don’t have any pain, so my bones must be fine.
It will not affect me.
I can’t prevent it so I won’t do anything about it.
Osteoporosis is when a person’s bones begin to weaken. Bone is not solid like a piece of rock. It is a living tissue that is constantly changing just like other tissues in our body. Osteoporosis occurs when the breakdown of bone exceeds the formation of new bone.
Osteoporosis is a significant health problem. Although men are affected, four times as many women are affected as men. It is estimated that in the U.S., ten million people already have osteoporosis and another 34 million are affected by low bone mass. Twenty percent of non-Hispanic white and Asian women, 10 percent of Hispanic women, and 5 percent of African-American women over the age of 50 have osteoporosis. However, osteoporosis can affect a woman at any age. One in two women and one in four men will get a fracture, or broken bone, due to osteoporosis in his/her lifetime.
Osteoporosis is often called a "silent disease" because, without testing, a person may not know the disease is present until a fracture occurs. Fractures most commonly occur in the vertebra, or spine, and the hip. They can be painless and manifest as loss of height or stooped posture, or they can be painful, especially if a woman breaks her hip. Fractures can also occur at the wrist and other sites in the body. Some frightening facts:
- 24% of hip fracture patients over the age of 50 will die within the first year
- 25% who could walk before their hip fracture require long-term care afterward
- Six months after a hip fracture, only 15% of individuals can walk across a room without assistance
Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis are called "risk factors" and include the following:
- Female gender
- Thin or small body frame
- Caucasian or Asian race
- Advanced age
- Family history of osteoporosis
- Estrogen deficiency as a result of menopause or surgery
- Cigarette smoking
- Inactive lifestyle
- Use of certain medications, such as corticosteroids or anticonvulsants
- Excessive use of alcohol
- Personal history or first-degree relative with history of fracture
- This list is not exhaustive but represents some of the major risk factors for osteoporosis.
Women, although at increased risk for osteoporosis, are not predestined to have this disease. There are many steps that can be taken to decrease the risk of developing bone weakness.
By age 20, a woman has developed about 98% of her bone mass, which peaks around the age of thirty. Building strong bones during childhood and adolescence can give a woman a strong advantage against developing osteoporosis later. Steps that can be taken to optimize bone health include a diet rich in calcium and vitamin D, a healthy lifestyle including avoidance of smoking and excessive alcohol intake, and regular weight-bearing exercise.
Women can lose up to 20% of their bone mass in the first five to seven years following menopause, so discussing bone health with your healthcare professional and initiating testing and treatment as appropriate is important.
Osteoporosis cannot be accurately diagnosed by physical exam, blood tests, or standard x-rays. Special bone density measurements of the wrist or heel of the foot can be helpful, but the gold standard is the Dual Energy X-ray Absorptiometry , or DEXA scan. The DEXA scan is a painless x-ray of the hip and spine that allows for the measurement of actual bone density, which can help to determine if additional therapy for bone health is needed or to evaluate a patient's response to medical therapy.
Although there is no cure for osteoporosis, if a woman develops this condition, there are many treatments to improve the strength of weakened bones or prevent further loss of bone. These medical therapies can be broken down into five major categories:
- Estrogen replacement therapy
- Selective estrogen receptor modulators, or SERMs (Evista®)
- Bisphosphonates (Fosamax®, Actonel®, and Boniva®)
- Calcitonin (Miacalcin®)
- Parathyroid hormone (Forteo®)
Discussion of the various benefits and clinical uses of these individual medications is beyond the scope of this article. If you develop osteoporosis, you should discuss with your health care professional which one may be best for you.
Osteoporosis is a significant health concern in the United States. It is important to recognize if you are at risk for osteoporosis and to take steps early in life to maximize your bone health. Talk with your doctor about whether you need bone density testing and if you may be a candidate for medical therapy for the maintenance of bone strength or treatment of bone weakness.
Dr. Welsch is a board-certified obstetrician/gynecologist in private practice with the Jackson Clinic. He has served on multiple national committees with the American College of Obstetricians and Gynecologists (ACOG) and has most recently been appointed to the Committee on Practice Management. He is a member of the Ethics Committee at Jackson-Madison County General Hospital and also serves on the boards of the Augustine School and the Jackson-Madison County Library Foundation.O