Osteoporosis
Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue. Osteoporosis causes bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist. Osteoporosis is a major public health threat for an estimated 44 million Americans. It affects 55 percent of the people 50 years of age and older. In the U.S., 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. Of the 10 million Americans who have osteoporosis, eight million are women and two million are men. Significant risk has been reported in people of all ethnic backgrounds. While osteoporosis is often thought of as an older person’s disease, it can strike at any age.
WOMEN
Eighty percent of those affected by osteoporosis are women. The following
estimates of women are shown with osteoporosis and also those with low
bone mass:
- 20% non-Hispanic white and Asian – osteoporosis
- 52% non-Hispanic white and Asian – low bone mass
- 5% non-Hispanic black women – osteoporosis
- 35% non-Hispanic black women – low bone mass
- 10% Hispanic women – osteoporosis
- 49% Hispanic women – low bone mass
Osteoporosis is under-recognized and under-treated in all groups of women.
MEN
Twenty percent of osteoporosis occurs in men. The following estimates of men are shown to have osteoporosis and also those with low bone mass:
- 27% non-Hispanic white and Asian men – osteoporosis
- 35% non-Hispanic white and Asian men – low bone mass
- 4% non-Hispanic black men – osteoporosis
- 19% non-Hispanic black men – low bone mass
- 3% Hispanic men – osteoporosis
- 23% Hispanic men – low bone mass
FRACTURES
One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture in her/his remaining lifetime. Osteoporosis is responsible for more than 1.5 million fractures annually, including:
- Over 300,000 hip fractures
- Around 700,000 vertebral fractures
- Around 250,000 wrist fractures
- Around 300,000 fractures at other sites.
Hip fracture risk is increasing most rapidly among Hispanic women. Women
with a hip fracture are at a four-fold greater risk of a second fracture and the
risk factors are similar to those for the first hip fracture. Osteoporotic
fractures lower a patient’s quality of life. The estimated national direct care costs for osteoporotic fractures are $18 billion per year in 2002 dollars, and the costs are rising.
Osteoporosis is often called a “silent disease” because bone loss occurs
without symptoms. People may not know that they have osteoporosis until
their bones become so weak that a sudden strain, bump or fall causes a
fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities.
Certain people are more likely to develop osteoporosis than others. Factors
that increase the likelihood of developing osteoporosis and fractures are called “risk factors”. These risk factors include:
- Personal history of fracture after age 50
- Current low bone mass
- History of fracture in a first degree relative
- Being female
- Being thin and/or having a small frame
- Advanced age
- A family history of osteoporosis
- Estrogen deficiency, menopause
- Abnormal absence of menstrual periods (amenorrhea)
- Anorexia nervosa
- Low lifetime calcium intake
- Vitamin D deficiency
- Use of certain medicines (steroids, chemotherapy, seizure meds, etc)
- Presence of certain chronic medical conditions
- Low testosterone levels in men
- An inactive lifestyle
- Current cigarette smoking
- Excessive use of alcohol
- Being Caucasian or Asian
Women can lose up to 20 percent of their bone mass in the five to seven years following menopause, making them more susceptible to osteoporosis. Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A BMD test can:
- Detect osteoporosis before a fracture occurs
- Predict chances of fracturing in the future
- Determine rate of bone loss and/or monitor the effects of treatment
- Medicare reimburses for BMD testing every two years.
An increase in BMD testing and osteoporosis treatment was associated with a decrease in hip fracture incidence. Bone density is an important determinant of fracture risk even in nursing home patients. There has been a five-fold increase in office visits for osteoporosis in the past 10 years. By the age of 20, the average woman has acquired 98 percent of her skeletal mass. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. There are five steps, which together can optimize bone health and helps prevent osteoporosis. They are:
- A balanced diet rich in calcium and vitamin D
- Weight-bearing and resistance-training exercises
- Healthy lifestyle with no smoking or excessive alcohol intake
- Talking to one’s health care professional about bone health
- Bone density testing and medication when appropriate
PREVENTION
CALCIUM
Calcium plays an important role in maintaining bone. Calcium alone cannot prevent or cure osteoporosis, but it is an important part of an overall prevention or treatment program. Yet, national surveys have shown that many Americans are not consuming enough calcium. Many women, in fact, consume less than half of the daily recommended amount of calcium. See the list of recommended daily calcium intake below:
- Children/adolescents – 1-3 yr 500 mg
- 4-8 yr 800 mg
- 9-18 yr 1,300 mg
- Adult women/men 19-49 yr 1,000 mg
- 50-life 1,200 mg
- Pregnant/lactating less than 18 yr 1,300 mg
- Over 18 yr 1,000 mg
One way to increase the amount of calcium in your diet is to eat calcium-rich foods like low-fat milk, cheese, broccoli and others. Many foods are fortified with calcium and are readily available and affordable. Foods like orange juice, cereals and breakfast bars have calcium added to them, so it is easier than ever before to consume the recommended level of calcium for every age. Having extra calcium in a variety of foods also makes it easier for parents who are trying to ensure that their adolescent daughters, especially, are getting enough calcium. Another easy and economical way to boost the calcium content of many meals is to add nonfat powdered dry milk to puddings, homemade cookies, breads, muffins, soups, gravy, casseroles and even a glass of milk. A single tablespoon of nonfat powdered dry milk adds 52 mg of calcium and 2-4 tablespoons can be added to most recipes. If you are unable to get enough calcium through your diet, your doctor can recommend an appropriate calcium supplement. Since, there are several different types of calcium and a variety of supplements available, you should discuss the choice of calcium with your doctor. The calcium in supplements needs to be easily absorbed by the body. You can be sure of this if the tablet dissolves almost entirely in a small glass of warm
water or vinegar within 30 minutes. Also read the label to determine the actual amount of calcium in the supplement, which is usually referred to as elemental calcium. Some people are lactose intolerant and have difficulty digesting dairy products. They have difficulty with their digestion because they lack the enzyme lactase which is needed to break down the milk sugar lactose. Milk fermented with certain bacteria (called acidophilus) is well tolerated, as yogurt and hard cheeses. If you are lactose intolerant, you can treat lactose-containing foods with commercial preparations of lactase or buy milk products that have already been treated. Getting enough calcium, whether through diet or supplements, is essential to maintaining bone strength and can play a vital role in preventing osteoporosis related fractures.
VITAMIN D
Vitamin D plays a major role in calcium absorption and bone health. The relationship between calcium absorption and vitamin D is similar to that of a locked door and a key. Vitamin D is the key that unlocks the door and allows calcium to leave the intestine and enter the bloodstream. Vitamin D also works in the kidneys to help resorb calcium that otherwise would be excreted. Vitamin D is manufactured in the skin following direct exposure to sunlight. The amount of vitamin D produced in the skin varies depending on time of day, season, latitude and skin pigmentation. Usually 10-15 minutes exposure of hands, arms and face two to three times a week is enough to satisfy the body’s vitamin D requirement. Use of sunscreen markedly diminishes the manufacture of vitamin D in the skin, as do window glass, clothing and air pollution. Skin color also affects vitamin D production, the fairer you are, the
more you make. As adults age, the ability to make vitamin D through skin decreases. People who are housebound and experience no sunlight exposure are unable to make vitamin D. The major food sources of vitamin D are vitamin D-fortified dairy products, egg yolks, saltwater fish and liver. Some calcium supplements and most multivitamins contain vitamin D. According to the National Osteoporosis Foundation, adults under age 50 need 400 – 800 IU of vitamin D daily. Adults age 50 and older need 800 – 1000 IU of vitamin D daily. Vitamin D3 is the form of vitamin D that best supports bone health. It is also called cholecalciferol.
EXERCISE
Just as a muscle gets stronger and bigger with exercise, a bone becomes stronger and denser with exercise. You cannot see your bones respond to exercise. Two types of exercises are important for building and maintaining bone mass and density. These two types of exercises are weight-bearing exercises and resistance exercises. Weight-bearing exercises are those in which your bones and muscles work against gravity. This is any exercise in which your feet and legs are bearing your weight. Jogging, walking, stair climbing, dancing and soccer are examples of weight-bearing exercise with different degrees of impact. Swimming and bicycling are not weight-bearing.
The second type of exercises are resistance exercises or activities that use muscular strength to improve muscle mass and strengthen bone. These activities include weight lifting, such as using free weights and weight machines found at gyms and health clubs. Most weight-bearing and resistance exercises place health demands on bone. Daily activities and most sports involve a combination of these two types of exercises. Thus, an active lifestyle filled with varied physical activities strengthens muscles and improves bone strength. information taken from the National Osteoporosis Foundation website at nof.org. 10-2007
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