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
Treatment for osteoporosis is usually provided in the form of bisphosphonate therapy. These drugs, the bisphosphonates (Fosamax and others) work by slowing the activity of osteoclasts in bone. Other treatment includes estrogen which attenuates the resorption of bone or the osteoclast activity. Calcitonin is a thyroid derived peptide which also inhibits osteoclast activity. This form of therapy has not been shown to be as effective in preventing vertebral fractures.
The bisphosphonates are a very effective treatment in helping to produce new bone, although it has been recently speculated that this bone may not be as healthy as natural bone. For women that have enough bone loss to place them at serious risk for a fracture however, this bisphosphonate induced bone can be protective to some extent. In recent studies by Orthopedic Surgeons, it was noted that bone integrity was improved early on in therapy but that benefit was lost after more than 4 years of treatment. As with many things in medicine, there are risks and benefits to be weighed when considering osteoporosis medication. It is important to discuss this with you provider before stopping any medication.
Life style changes are equally important in preventing and treating osteoporosis and osteopenia.
Exercise and diet also play an important role in preventing and treating osteoporosis.
Muscle building exercise helps to activate the osteoblasts to lay down new bone,
Calcium in our diet helps to make that bone strong, and
Vitamin D helps our body to absorb and process the calcium.
Muscle building exercise of 90 minutes a week is recommended for bone health. An increased exercise time of 150 minutes a week is recommended for heart health and to lower insulin resistance. This muscle building exercise does not have to be a high impact; brisk walking is excellent, but as far as we know now, swimming will not help your bones as it is not weight bearing.
Calcium supplements will suffice to replace or augment dairy products. 1200-1500 mg of calcium daily is the recommended dose for postmenopausal women. There are several different types of supplements, and they are all good but are tolerated differently, experimentation will yield the best-tolerated brand for any given person.
Vitamin D3 capsules or pills are recommended as it is difficult to get adequate Vitamin D in the diet. Vitamin D3, or ergocalciferol, is the recommended type as this last longer in the body. It is important to get a brand that does not contain Vitamin A as the body cannot regulate this efficiently and toxicity, as well as overdose, is possible.
Osteoporosis is a silent but serious disease which can be easily prevented and treated. Screening is painless and usually covered by insurance companies if medically indicated. It is important for women to approach their medical providers for screening and information for both themselves and for male partners who may also be at risk.