Osteoporosis

Osteoporosis

Osteoporosis is a fairly common womens health problem among the post-menopausal. Because estrogen is a factor in encouraging proper bone growth, the loss of estrogen that occurs as a result of menopause often triggers the dramatic decrease in bone density known as osteoporosis.

The classic osteoporosis case is the stooped-over elderly woman, hobbling along with the assistance of a cane or cart. Her spine is deformed by years of painful, recurring fractures, and it seems the slightest bump or mishap causes another trip to hospital. Special alarm necklaces are available to make emergency calls, in case such individuals fall and break a hip, or worse. It's the nightmare of any healthy young woman to end up in the stooped elder woman's shoes.

Luckily, osteoporosis is now a well-understood disease. While there are a number of risk factors in the development of most cases of osteoporosis, the majority of them are preventable. A few that are not are: a personal or family history of fractures, female sex, old age, dementia (leading to increased risk of falls) and European lineage.

However, the list of preventable or modifiable risk factors is much more substantial:

• Tobacco smoking (cut down or stop)
• Drinking beverages containing phosphoric acid (fizzy drinks/soda)
• Low body weight (below 58kg/127lbs)
• Lack of estrogen (replaceable via hormone supplements)
• Prolonged amenorrhoea (more than one year -- can be caused by some birth control methods, or extremely low
• body fat/anorexia)
• Low calcium intake (enriched foods and vitamin supplements can help)
• Alcoholism (can contribute to mineral deficiency -- reduce or eliminate alcohol consumption)
• Inadequate physical activity (exercise helps increase bone mass)
• Excess/risky physical activity (anything that increases risk of injury and fracture)

The vast majority of osteoporosis cases are seen in post-menopausal women, but there are a number of other disorders and diseases associated with osteoporosis in other age and gender groups. Endocrine disorders (such as Cushing's disease and adrenal insufficiency) and 'hypo-gonadal' disorders (such as Turner syndrome or hypothalamic amenorrhoea) can cause bone density loss by interfering with the hormonal systems that contribute to healthy bone formation. Nutritional and gastrointestinal problems (including malabsorption syndromes and malnutrition) can lead to mineral deficiencies that prevent sufficient bone growth. Some forms of cancer can lead to osteoporosis as a secondary condition, and any disease that leads to a severe lack of physical activity will naturally lead to a loss of bone mineral density (BMD).

Most women, however, need only worry about regular age/estrogen related osteoporosis, which is highly preventable if proper lifestyle choices are made during the pre-menopause years, and reasonably preventable even after menopause with a reasonable regimen of calcium supplements and regular exercise. If osteoporosis is suspected, your doctor will likely test you for a variety of possible causes before recommending specific treatment, to rule out the diseases mentioned above.

Osteoporosis by itself is not a fatal illness though. While the hip and spinal fractures associated with advanced cases are certainly painful, and decrease the patient's mobility and overall quality of life, osteoporosis itself would rarely become a problem if not for the accidental falls and injuries that lead to bone fracture. Dementia and poor physical fitness are significant contributing risk factors for osteoporosis sufferers, because of the associated increased risk of injury and accidents. Perhaps the single biggest long-term preventative measure every woman can take is a regular exercise routine. Not only does regular physical activity in children and teens significantly increase bone density in the adult years, but even for adults, only thirty minutes of weight-bearing exercise (such as walking, jogging or aerobics) three times a week increases bone density and improves muscle tone and coordination, helping to reduce later risk of falls and fractures.

If you're in a known risk group (such as approaching menopause, severely restricted physical activity, using prescription steroids), your doctor may prescribe preventative calcium and vitamin D supplementation. If you're not in a known risk group, you can still help minimize your risk with the preventable risk factors list given above. A few minor lifestyle changes can make a big difference in your long-term health! In addition to adequate calcium intake (which should be from a variety of sources, not just dairy products), balanced intake of vitamin D and magnesium is important for proper calcium utilization.

But perhaps you have an older relative who is already suffering significant bone loss, or you've just found out osteoporosis has 'snuck up' on you before you took preventative measures. There are a number of medications currently on the market which can help after the onset of significant bone mass loss. Bisphosphonate drugs such as Fosamax (sodium alendronate) are often prescribed in daily or weekly doses, in some cases even before osteoporosis is diagnosed if you are in a very high risk group. Actonel is also a common bisphosphonate medication. Evista (raloxifene), another frequently prescribed treatment is a selective estrogen receptor modulator (SERM) rather than a bisphosphonate, and may be more suitable for some patients.

Newer osteoporosis medications include Forsteo (teriparatide), a recombinant parathyroid hormone, which may be prescribed on its own or with sodium alendronate. One new medication seems to actually act to increase bone rather than merely preventing further bone loss: oral strontium ranelate. However, both teriparatide and strontium are available primarily to patients for whom traditional bisphosphonate treatment has proven ineffective.

In any case, if you are concerned about osteoporosis, either for yourself or a loved one, consulting with a physician about options for high-risk individuals (or current osteoporosis sufferers) is always a good idea. Your personal physician will be able to offer advice and treatment/prevention options customized for your lifestyle and risk level. For young women and low-risk individuals, a regular habit of muscle- and bone-building exercise, combined with adequate intake of calcium and other needed minerals may be all the help you need, but certainly these basic steps would be good for any health individual to take in the interest of their overall health, whether osteoporosis is a concern or not.

Osteoporosis Links

UK - Osteoporosis Society Online

US - National Osteoporosis Foundation