Osteoporosis
By M. J. Galceran, M.D.

Osteoporosis is a disease of the bones, characterized by excessive thinning, to where the bones become at risk of breaking with normal activities or stresses. Although it affects the entire skeleton, certain parts (e.g. the hips, lower spine) are more vulnerable to fracture due to their location and greater chance of inadvertent trauma, especially from falls. Whether you develop osteoporosis or the less severe osteopenia, depends on many factors, including family history, lifestyle habits, diet, and activity level. It has been linked to the natural aging process, and especially to the decrease in hormone production of estrogen in women and testosterone in men.

Although both men and women can develop osteoporosis, it is seen much more often in women, who are four times more likely to develop it than men. Most women start developing it around menopause, between the ages of 45 and 55. However, women of European and Asian ancestry are at greatest risk.

The risk of osteoporosis increases with age, and much more rapidly after menopause. Other factors that increase the risk of osteoporosis includes a family history of osteoporosis, smoking, excess alcohol use, getting little or no weight bearing exercise, a thin body build, and a diet with inadequate intake of the minerals calcium and phosphorous, and the vitamin D.   

Certain medications can also increase the risk of osteoporosis. The long-term use (greater than six months) of cortisone or corticosteroids can also increase the risk developing osteoporosis. Excess use of aluminum containing antacids also poses a risk, due to the aluminum removing calcium and phosphorous from you body.

Certain illnesses such as hyperthyroidism, and eating disorders like anorexia nervosa can increase the risk of osteoporosis. Female athletes who have infrequent menstrual cycles are also at risk due to the decrease in estrogen production.

For the most part, osteoporosis is not apparent or symptomatic, until an inadvertent fall causes a broken hip or compression fracture of the spine. Sometimes, back pain may be a warning sign. Other signs may be an actual reduction in height, as well as development of a curved upper back.

Prevention is the best treatment for osteoporosis. Although bone thinning cannot be stopped, it certainly can be delayed. Eating a healthy diet, high in calcium, and getting regular exercise, early in a person’s life, will greatly increase the thickness of a person’s bone, and delay the development of osteoporosis later on. Women in particular, should also consider starting calcium supplementation in their late 30’s or early 40’s.

If your physician suspects osteoporosis, testing for it can be done with a bone mineral density test or DEXA scan. If you have osteoporosis, other test may be needed if causes other than aging or menopause are suspected. X-rays are not used to diagnose osteoporosis, as they are too insensitive to pick it up in the early stages. Screening for osteoporosis should be done in women who have gone through menopause, especially if other risk factors are present, patients who have fractures that may have been caused by osteoporosis, medical conditions associated with osteoporosis, and those with findings suggestive of osteoporosis.

The treatment of osteoporosis starts with improved calcium and vitamin D intake as well as increasing weight bearing exercises. Medications are available that help increase bone thickness and reduce bone loss. These include Actonel, Fosamax, and Evista. Hormone replacement therapy has become unpopular due to the increase risk of breast cancer. In men, testosterone could be replaced if the levels are low. Taking precautions to prevent falls is very important if you already have osteoporosis. Smoking cessation and reducing alcohol intake are also helpful.

If you think you may have osteoporosis, see your doctor and get properly evaluated, and discuss the proper regimen for you situation. A healthy lifestyle from early on is always the best prescription for prevention.