By Caroline Raffi
Millions of 50+ Americans suffer from the so-called silent diseases osteoporosis and the related condition osteopenia (essentially, a milder version of osteoporosis) in which sufferers have lower than normal bone density. They’re called silent diseases because there are no obvious symptoms until, for example, a small impact or even a hard cough result in a major bone fracture.
Bone density is a measurement of how dense and strong the bones are. Contrary to popular belief, bone is living tissue that is constantly being replenished. Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone, causing bones to become weak and brittle.
While osteoporosis affects men, the vast majority of sufferers in the U.S. and worldwide are women:
- Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds.
- Osteoporosis is estimated to affect 200 million women worldwide – approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90.
- Osteoporosis affects an estimated 75 million people in Europe, USA and Japan.
- For the year 2000, there were an estimated 9 million new osteoporotic fractures, of which 1.6 million were at the hip, 1.7 million were at the forearm and 1.4 million were clinical vertebral fractures. Europe and the Americas accounted for 51% of all these fractures, while most of the remainder occurred in the Western Pacific region and Southeast Asia.
- Worldwide, 1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men aged over 50.
What are the symptoms of Osteopenia/Osteoporosis?
Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Osteopenia and osteoporosis are both manifestations of decreased bone density that often occur after women enter menopause, but these problems also occur in men. Osteopenia is usually asymptomatic, but when it progresses to osteoporosis, patients can experience pain in the affected joints, and the bone weakness can lead to an abnormal fracture that is very challenging to repair.
There typically are no symptoms in the early stages of bone loss, but once bones have been weakened by osteoporosis, you may have signs and symptoms that include:
- Back pain, caused by a fractured or collapsed vertebra
- Loss of height over time
- A stooped posture
- A bone fracture that occurs much more easily than expected
What are the risk factors for Osteoporosis or Osteopenia?
Risks factors include a history of an eating disorders (anorexia nervosa or bulemia), abnormalities in nutrient absorption, thyroid disorders, and sedentary lifestyle with little weight bearing exercise, smoking, moderate to heavy alcohol consumption, prolonged use of acid blocking medications, and menopause.
How can you find out if you have Osteoporosis or Osteopenia?
Osteopenia and osteoporosis are diagnosed using a bone density DEXA scan, which measures bone density in the spine, femur of the upper leg, and sometimes the radius of the arm. The results are given in comparison to a same age control (noted as the Z score) and to a 30-year-old healthy control (T score). By definition, if a patient’s T score is more negative than -1.0 to -2.5, the patient has osteopenia and has an increased risk of future fractures. If the patient’s T score is more negative than -2.5, the patient has osteoporosis, with an even greater increased risk of future fractures.
Who should take these tests?
All females should have a DEXA scan once they are one year into menopause, sooner if they have the above mentioned risk factors. I also would recommend a DEXA scan for male patients with the above risk factors and/or a history of an abnormal past fracture.
Can osteoporosis drugs prevent fractures?
The main medical therapy used for low bone density are the bisphosphonate drugs, such as Fosamax, Actonel, Reclast, and Boniva. Although all of the drugs have shown to result in an increase in bone density, the type of bone contributing to this density is older bone, which with time can result in much more severe fractures, specifically in the femur bones.
The reason comes from the drug’s mechanism of action that reduces bone loss versus stimulating cells to produce more bone.
Having consulted with several orthopedists, fractures in “older bone” are extremely challenging to repair and stabilize. These drugs also have a number of significant unwanted side effects, therefore, I do not recommend these drugs to help build healthy bone and reduce fracture risk.
Are there other side effects of taking osteoporosis medications?
Some side effects from taking bisphosphonate drugs include esophageal irritation and erosion, decrease in nutrient absorption including proteins and minerals and jawbone loss affecting dental health. Over longer use, these medications can increase your risk of esophageal cancer and increase your risk of more significant fractures in the femur.
Any other advice regarding osteoporosis medications?
Besides bisphosphonates, Forteo is a medication that has been used successfully to treat osteoporosis. Forteo is a parathyroid hormone analogue that stimulates new bone formation. Also looking promising as enters its final stages of clinical trials is the medication Romosozumab, an antibody that targets a molecule in bone that is involved in increasing bone density. Forteo has side effects of headache, nausea, dizziness, and limb pain. For Romosozumab, so far, injection pain has been stated, but until it has been used more widely, its side effects are still to be discovered.
Consult With Your Doctor
If you are entering menopause or have a family history of osteoporosis, consult with your doctor. A regimen of medication, exercise and nutrition, including a diet rich in fresh fruits and vegetables, can help you avoid the “silent disease.”
- http://nof.org/articles/7. What is Osteoporosis?
- http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/definition/con-20019924. Osteoporosis Definition.
- http://www.webmd.com/osteoporosis/. Osteoporosis Health Center.
- http://www.more.com/health/wellness/brittle-truth-about-osteoporosis-and-your-bones. The Brittle Truth About Osteoporosis and Your Bones.
- http://www.marceladominguezmd.com/. Dr. Marcela Dominguez SMD page.
- http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/symptoms/con-20019924. Osteoporosis Symptoms.
- http://www.webmd.com/osteoporosis/tc/osteopenia-overview. Osteopenia Definition Overview.
- http://www.completecarefamilymedicine.com/. Dr. Marcela Dominguez Family Practice Website.
- signaturemd.com. SignatureMD Website.
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