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The Nitty-Gritty About Your Bones

People think of their bones as being dead structural material, like rocks or cement blocks. In reality, our bones are “dynamic”, that is they are microscopically the site of much activity. Bones are Dynamic They are constantly being broken down and rebuilt/ or remodeled. In osteoporosis, one loses bone faster than it is being replaced, and this leads to brittle bones that are more likely to break. Osteoporosis means low bone mass as well as microarchitectural deterioration. Now, with our current technology, we can only measure the bone loss, not the architectural change. Luckily, more than 80% of a person’s fracture risk can be predicted by bone mineral density alone.

Some bone loss is inevitable as we age, but “severe” bone loss is a disease. Severe osteoporosis can cause pain, deformity, decreased mobility, fear—of fracture, and even result in death. There are 28,000,000 Americans with increased fracture risk! A full 10 million of these are osteoporotic. Women make up 80% of those with osteoporosis. Osteoporosis is responsible for 1,500,000 fractures per year in America, and 250,000 of these are hip fractures. Spinal fractures are more common, but hip fractures are usually more detrimental. Here are some very sobering facts: approximately 25% of those with osteoporotic hip fractures will die within a year; 50% will suffer decreased mobility; and 25% end up with long term nursing care.

These are facts and figures regarding osteoporosis and women in this country.

Did you know that 40% of women older than 50 will develop an osteoporotic fracture in their lifetime?

Before the age of 80, 40% of females will suffer a spinal fracture. Women have more fractures from osteoporosis per year, than suffer from heart attacks, stroke, and breast cancer combined! Here is some startling information: in the first 5 to 10 years following menopause, women can lose up to 25% of their total bone mass. After these years, the rate of bone loss slows down.

What are some of the risk factors for developing osteoporosis: family history; thin with a small build; smoking history; frequent alcohol intake; lack of weight bearing or resistance exercises; insufficient dietary calcium ; a prior fracture history after the age of 45; the absence, or insufficient amount of estrogen in women, and testosterone in men; hyperthyroidism; hyperparathyroidism; long term steroid (glucocorticoid) use… Caucasians and Asians of Chinese and Japanese descent also have a higher risk of developing osteoporosis than other races.

Exercise is key to combating osteoporosis.

Please ask your physician for exercises that would be appropriate for you to do. Milk - dietary source of calcium (Bicycle riding and swimming are not too helpful for this particular disorder.) Another key component in your arsenal is calcium. Dietary sources of calcium are dairy, nuts, beans, spinach, and broccoli. Calcium supplements that can be purchased contain calcium citrate, calcium carbonate, calcium hydroxyapatite, and an amino acid chelated calcium. It is important to get enough sunshine for Vitamin D, or to take it in supplement form, and Magnesium also needs to be present in proper amounts for optimum calcium absorption.

If you already have osteoporosis, taking Calcium and doing the proper exercises are very important, but you may also need to speak to your doctor about treating the condition with medication. Among the medications available are hormones, Serms / (selective estrogen receptor modulators) such as Raloxifene, and Bisphosphonates such as Alendronate or Risedronate.

How can you discover if you are at risk for an osteoporotic fracture?

The following are different methods for reading bone mineral density and assessing fracture risk: QCT/ QUANTITIATIVE COMPUTED TOMOGRAPHY, (this assesses your lumbar spine, gives off the most radiation, and is the most expensive, but it is very accurate); RA/ RADIOGRAPHIC ABSORPTIOMETRY, (this looks at your fingers, and takes a long time for results); ULTRASOUND, (this assesses your heel); SXA/ SINGLE ENERGY X-RAY ABSORPTIOMETRY, (only assesses heel and forearm); DEXA/ DUAL ENERGY X-RAY ABOSROPTIOMETRY, (the gold standard, used for spine, hips, and wrists—the most frequent areas for osteoporotic fractures, fast, inexpensive, and minimal radiation, as well as the method used in almost all of the research studies); and finally, X-ray which will only show bone loss after there has been more than a 30% decrease!)

If you are elderly, female and menopausal, or have major risk factors, ask your doctor about being tested for bone mineral density and fracture risk. Remember, this is a disease that can be prevented if we can ascertain risk, and treat it, if it already exists.

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