Current statistics state that osteoporosis affects 10 million Americans and 8 million women, or 55% of people over 50 are predicted to be affected by osteoporosis. 1 in 2 women will it is predicted have an osteoporosis-related fracture in their lifetime. This is a significant cause of morbidity as hip and spine fractures cause serious impairment of mobility and health concerns related to immobility. There is much in the news about medications and recommended supplements to take, as well as lifestyle changes to help combat osteoporosis. Understanding the disease process helps to understand how these different treatments impact bone density, thereby enabling women to make informed decisions regarding their treatment of osteoporosis and osteopenia.
The majority of bone density, up to 90%, is formed by age 18 in women and age 20 in men. There are two types of cells which form and maintain healthy bone, osteoblasts are responsible for laying down healthy bone matrix which then undergoes mineralization with the aid of calcium, which adds strength. Osteoclasts are cells which are responsible for resorbing older bone, in so doing, the osteoclasts ensure that remaining bone is healthy. In the early years of our lives, the activity of osteoblasts are balanced with osteoclasts. In osteoporosis, the osteoblasts have slowed in their formation of bone, however resorption of bone has continued at its usual rate. Because of this imbalance, bone slowly thins placing a woman at risk of a break or fracture. A number of factors can influence the balance and imbalance of this process:
- Parathyroid hormone
- Vitamin D metabolites
- Sex hormones
Osteoporosis is a term referring to loss of bone density to the extent that a fracture is possible, osteopenia is a term reflecting a degree of bone loss not severe enough to place a person at risk for a fracture. A person’s bone density is determined most accurately by a test, Bone Mineral Density test. The most accurate of these types of tests is the Central DXA, or dual energy x-ray absorptiometry. In this test, the bone density is calculated, and then compared to women of same age and height to determine if there is a process besides aging causing increased bone loss. This calculated density is also compared to women of same height at 30 years of age, and then the calculated difference of bone density determines the degree of bone density loss.
Who Is At Risk For Osteoporosis And Osteopenia?
Women with decreased estrogen ie. Postmenopausal women, premature ovarian failure
Women undergoing chemotherapy for breast cancer, use of aromatase inhibitors
Women who have been on prolonged use of depo-Provera
Women and men who have been on steroids for long periods of time, anticonvulsants. Lithium,heparin
poor dietary intake of calcium and vitamin D
inactive and sedentary people
People of Caucasian, Asian and Latino more so than African American ethnicities
People who use of alcohol excessively (>3/day)
individuals with certain forms of arthritis and gastrointestinal illnesses