May is Osteoporosis month, and as such it is an excellent time to review information about this major public health problem. Many have heard of osteoporosis, but few understand its meaning, scope and impact on their health. Hopefully, after reading this article, you will be motivated to reevaluate your own lifestyle and habits as well as talk to your doctor or provider about what you can do to prevent or treat this disease.
Osteoporosis is the most common bone disease in humans. It is a silent disease until it is complicated by fractures. It is characterized by low bone mass, deterioration of bone tissue and disruption of bone architecture, compromised bone strength, and an increase in the risk of fracture. Osteoporosis is an intermediate outcome for fractures and is a risk factor for fractures just as hypertension is for stroke. Osteoporosis affects numerous people of both sexes and all races. It is estimated that more than 10 million Americans have osteoporosis and an additional 33 million have low bone density of the hip.
Fractures and their complications are the relevant clinical outcome of osteoporosis. The most common fractures are those of the spine, hip and wrist. These fractures may be followed by full recovery; however, chronic pain, disability or death may also occur. Psychological symptoms such as depression and loss of self-esteem can occur as patients grapple with pain, physical limitations, and lifestyle and cosmetic changes. Dependency associated with these fractures often strain interpersonal relationships and social roles for patients and their families.
A patient with a hip fracture has a 10-20% chance of death within the first year and a 10% chance of another osteoporosis-related fracture within the first year. Up to 25% of hip fracture patients require long-term nursing home care, and 60% never regain their pre-fracture level of independence. Spinal fractures also increase mortality and can cause significant complications including back pain, height loss and kyphosis.
The economic toll of osteoporosis-related fractures creates a heavy burden. Over 432,000 hospital admissions, almost 2.5 million medical office visits and 180,000 nursing home admissions occur annually in the United States due to fractures. An estimated $17 billion was spent by our health care system in 2005 as a result of osteoporosis-related fractures, and this number is expected to double or triple by 2040 due to our aging population.
A person’s bone is constantly being remodeled. A woman’s bone mass peaks between ages 25 to 30 years after which time bone is subsequently lost. This shift in greater bone removal than bone formation is magnified with menopause and advancing age. The loss of bone tissue leads to disordered skeletal architecture and an increase in fracture risk. Other age-associated declines in functioning such as an increased propensity for falls magnifies the increased fracture risk.
There are numerous conditions and diseases that cause or contribute to the development of osteoporosis. These include lifestyle factors such as low calcium intake, Vitamin D deficiency, alcohol (3 or more drinks/day), smoking and inadequate physical exercise. Certain genetic & endocrine disorders as well as gastrointestinal and hematologic (blood) disorders can predispose one to the development of osteoporosis. You should discuss with your health care provider if you are at risk. Many people forget to consider medications that place them at risk. These include anticoagulants such as heparin, glucocorticoids used to treat rheumatologic conditions or chronic lung diseases, chemotherapy drugs and anti-seizure medications.
Any condition that increases a propensity for falls should also be evaluated. Environmental factors such as low level lighting, loose throw rugs, obstacles in the walking path or slippery outdoor conditions should be considered. Medical risks include poor vision, irregular heartbeat, depression, impaired mental capacity or drops in blood pressure with standing. Poor balance, weak muscles and fear of falling also increase one’s risk.
The diagnosis of osteoporosis should be established by measurement of bone mineral density (BMD), usually using a dual-energy x-ray absorptiometry (DEXA) scan. This technology is now used to establish or confirm a diagnosis of osteoporosis, predict future fracture risk, and monitor patients by performing serial assessments. There are numerous indications for BMD testing, but whether you qualify may be limited by your insurance, especially Medicare. Algorithms supplied by the World Health Organization (WHO) are now available to calculate the 10-year probability of a hip fracture and the 10-year probability of any major osteoporotic fracture.
Universal recommendations for all patients include 1) adequate intake of calcium and Vitamin D, 2) fall prevention, 3) avoidance of tobacco use and excessive alcohol intake. Medical therapy should be considered in appropriately selected patients after a thorough history and physical exam and appropriate testing. There are safe and effective therapies available but discuss with your provider whether one is right for you. The National Osteoporosis Foundation provides excellent material for your review.