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Issue Date: August 2005 Issue


The Osteoporosis Epidemic

Two broken bones in 10 months clued me in: I had osteoporosis, like 10 million to 12 million American women and a growing number of men. There's no cure, but exercise, changes in diet, medication and other therapies can help slow bone loss.
Eileen Beal

Risk factors for osteoporosis

Factors you can't control:

• Age: The older you are, the more likely you are to have osteoporosis.

• Gender: Eighty percent of those with osteoporosis and osteopenia are women.

• Ethnicity: Caucasians and Asians are at greater risk than African-Americans and Latinos.

• Thin or small body frame

• Periodic cessation of menstruation, due to anorexia or multiple pregnancies

• Family history: If a member of your family has osteoporosis, you have a higher chance of getting it too.

• Use of certain medications, such as anabolic steroids and anticonvulsants

Factors you can control:

• Lifelong diet low in calcium and vitamin D

• Smoking

• Excessive use of caffeinated or carbonated beverages

• Excessive alcohol use

• Sedentary, inactive lifestyle

I cringe when I remember the loud "pop" I heard when I stepped into a crack in front of my apartment building and broke my foot Jan. 14, 2001.

That was my "sentinel event" — the low-impact break that should have clued me to the fact that I had osteoporosis.

Despite the fact that I’m a medical writer, it didn’t register. However, 10 months later, when I cracked a rib, it did.

I called my doctor, explained what had happened and asked for a DEXA scan — a low-energy X-ray used to determine bone density of the spine, hip and wrist.

A week later I had the test. When the results printed, the lab technician said, "I think you need to see the doctor. Now."

Dr. Mark Binstock, director of Women’s Services at Kaiser Permanente, was kind, but he didn’t mince words. With a DEXA scan, any T-score below negative 2.5 indicates osteoporosis. My scores were in the negative 2.7 range, indicating that I had advanced osteoporosis — porous bone.

Why did I have weak, brittle and prone-to-break bones? Why was I at risk for becoming hump-backed and hospitalized with shattered hipbones?

Because, explained Binstock, due to my many risk factors (see sidebar), my body hadn’t been getting or using the calcium it needed to renew bone. And my body was destroying the bone I did have too quickly.

The same thing is happening to all 10 million to 12 million American women who have osteoporosis. About double that number have osteopenia, a pre-osteoporosis condition.

"We are in the midst of an osteoporosis epidemic in the U.S.," says Dr. Paul Hudock, department chairman of obstetrics and gynecology at Parma Community General Hospital. "Those numbers," he adds, "are only going to go up as the population ages."

While women make up 80 percent of those with osteoporosis and osteopenia, "men get it too, and for most of the same reasons women get it, but they tend to get it later in life," says Cleveland Clinic specialist Dr. Andrea Sikon. Women tend to be affected in their mid-to-late 60s, men in their mid-to-late 70s.

Children can get it too, if they "aren’t making enough bone, or the bone they are making is brittle due to genetic disorders," says Dr. Matthew Warman, a pediatric geneticist at University Hospitals.

There is no cure for osteoporosis. "But you can modify certain risk factors so that you develop a milder case and/or develop it later in life," says Dr. Carolyn Dziwis, a geriatrician at MetroHealth Medical Center, "which is why starting prevention measures early in life is so important."

Prevention means giving up smoking, carbonated beverages and coffee. Smoking slows your circulation, while the drinks make your blood more acidic and your body draws calcium from your bones to compensate.

It also means front-loading your bones with at least 1,000 milligrams to 1,200 milligrams of calcium a day so they are ready to battle osteoporosis when protective hormone levels drop at menopause (or, for men, as they age). (Men may want to consult a physician before taking calcium supplements, since some studies show elevated levels of calcium may be a risk factor for prostate cancer.)

"Most people are only getting about 600 milligrams of calcium a day from a normal diet, so you need supplements to boost intake," says Hudock. "And people over 50, because of slowed absorption in the intestine, need to boost it to 1,200 milligrams a day."

Recent studies indicate that taking high-dose vitamin D3 along with calcium leads to better intestinal absorption of calcium.

Exercise is the other preventive measure: The more you do, the stronger bones get. Power walking, treadmilling and tai chi are all good for spine, hips and legs, but you need to do upper-body workouts with weights, too. "Weight training doesn’t just help bones, it protects joints and develops muscles so you have better reflexes, too," says Sikon.

If your risk factors indicate you are a candidate for osteoporosis or you have hit 65, you should also have a bone mineral density test done, says Hudock. A DEXA scan is a shoulder-to-hip scan; a heel ultrasound measures density of the heel.

If scans note early bone loss — osteopenia — then treatments with osteoporosis medications can slow it down.

For me, and millions of other Amer-icans, prevention is no longer an option. We are working to keep bone loss to a minimum while increasing calcium deposits into the bone’s matrix to increase bone density and strength.

I’m exercising regularly and eating calcium-rich foods such as dairy products, bone-in salmon and sardines, tofu, kale and broccoli. I’m taking calcium supplements, and I’m also taking Fosamax, a prescription osteoporosis drug. Since osteoporosis is a chronic condition, I’m going to be taking Fosamax, or similar drugs, for the rest of my life.

Currently, there are four main osteoporosis drugs: Fosamax, Actonel, Boniva (which are all bisphosphonates) and Evista. "These drugs increase bone mineral density modestly," less than 10 percent, says Binstock. The bisphosphonates may be somewhat more effective than Evista, says Binstock.

For those who can’t take oral medications, Miacalcin, available as a nasal spray, is an option. So is a new low-dose estrogen patch, Menostar. Forteo, a hormone available as a daily injection, is the treatment for worst-case situations.

Most of these medications have side effects, ranging from nausea to blood clots or even strokes. And because part of their job is to scavenge calcium to rebuild bone, if you don’t take in sufficient amounts of calcium, they pull calcium out of some bones, especially the jawbone, to use in others.

Complementary therapies may also help, says Dr. Sherri Tenpenny, DO, the medical director at OsteoMed II, a Middleburg Heights clinic. She recommends vitamin K, boron, strontium citrate and fish oils rich in omega-3 fatty acids.

And based on information about the pathways for the degrading of bone and the formation of new bone, researchers are developing new drugs or other biological agents to manipulate those pathways. "So we should be seeing things coming down the pike in five to 10 years," says UH’s Warman.


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