Dr. M.J. Bazos, MD, Patient Handout
Osteoporosis

WHAT IS OSTEOPOROSIS?
Osteoporosis is a skeletal disease characterized by an abnormal decrease in bone mass and strength leading to an increased risk of bone fractures. It is the major cause of bone fractures in older people, especially postmenopausal women. Osteoporosis has no clear beginning, and until recently its first visible sign was a fracture of the hip, wrist or spine.
CAUSE
Bone strength reaches its peak in the early 20s. About the age of mid-30s, most people begin to lose bone strength at a slow rate. Bone loss accelerates at menopause, and some women lose up to 30% of bone mass in the first five years of menopause. A variety of medical and lifestyle factors may increase bone loss, causing osteoporosis to occur at a younger age. Menopause is the most predictable medical cause of osteoporosis in women due to a decrease in estrogen levels. Estrogen loss, whether by menopause or surgical removal of the ovaries, has been shown to result in rapid bone loss. Though women, especially Caucasians and Asians, are more susceptible, osteoporosis frequently occurs in men and children who suffer from certain diseases and/or take specific medications. Osteoporosis can be very serious even in children and men, and often goes undiagnosed. Bone loss results in reduced bone strength that can easily lead to fractures in the wrist, spine and hip.

Risk factors for developing osteoporosis are:

• Menopause
• Small bone structure
• Family history of osteoporosis
• High consumption of alcohol or caffeine
• Cigarette smoking
• Some medications, such as corticosteroids, thyroid replacement, heparin, and dilantin
• Some diseases such as thyroid disease, parathyroid disease, rheumatoid arthritis and conditions that interfere with the intestinal absorption of calcium
• Low amount of calcium in diet
• Lack of exercise

HEALTH IMPACT

• 28 million people are affected in the United States.
• Women are affected four times as often as men are.
• Fewer than 5 % of patients with osteoporosis-related fractures are referred for appropriate evaluation and treatment
• Osteoporotic hip fracture often leads to disability and can be fatal
• The direct medical costs incurred in the treatment of osteoporosis exceeds $14 billion dollars per year

DIAGNOSIS
Dual energy X-ray densitometry (DEXA), ultrasound, quantitative CAT scan and plain X-rays can detect low adult bone density. DEXA, in particular, is currently considered the imaging modality of choice to diagnose osteoporosis and monitor the response to treatment.
TREATMENT
The best treatment for osteoporosis is prevention. Adequate calcium consumption (more than 1,200 mg per day) and weight-bearing exercise by adolescent and young adult women can increase peak bone mass, which can lower the risk of fractures in later years. Weight-bearing exercise improves bone strength throughout life. Adequate consumption of calcium and vitamin D is essential throughout adulthood for healthy bones. The elimination of risk factors such as smoking, heavy alcohol and caffeine intake, along with the appropriate use and close monitoring of medications known to produce bone loss are considered important adjuncts in the prevention of osteoporosis. Estrogen replacement is an effective treatment to prevent postmenopausal bone loss and is effective in the prevention of fractures in women with osteoporosis. If a postmenopausal woman with established low bone mass or osteoporosis has a condition that prevents hormone replacement therapy, there are other effective treatments to prevent bone loss. Exercise such as walking and back extension exercises can stabilize or slightly increase bone mass and improve balance, and can strengthen muscles to revent falls and fractures. Other medications used to treat osteoporosis include bisphosphonates (such as etidronate (Didrocal), alendronate (Fosamax), and risedronate (Actonel), calcitonin (Micalcin) and raloxiphene (Evista). Though frequently under used, learning how to prevent falls - especially for the elderly - and about the use of hip protectors may have a positive impact in reducing the number of avoidable fractures. New surgical techniques designed to treat osteoporosis-related spinal fractures are presently in use and under study.