Osteoporosis ... Isn’t Normal at Any Age
My mother was recently diagnosed with osteoporosis. What causes this disease and is there anything that she can do to help and what can I do to prevent this from happening to me?
Osteoporosis is a condition that is associated with weakened and brittle bones. It should not be confused with osteoarthritis, which is a disease of the joints and is a completely different problem. As it worsens, a person with osteoporosis becomes much more likely to break bones with minimal if any trauma. It is usually a result of aging and the hormonal changes that occur as a person ages. Women are at much higher risk than men are, but men can also suffer from the disease. Osteoporosis is a public health problem that is getting worse as the population ages. Almost 1.5 million fractures per year in the United States result from osteoporosis.
Osteoporosis is usually painless and most people have absolutely no symptoms from the disease. The first symptom that usually occurs in someone with osteoporosis is a broken bone. A patient with severe osteoporosis can break a bone just by tripping on a loose rug, or even by standing up from a chair, coughing, or sneezing.
The goal of treating osteoporosis is to prevent fractures. The most common fractures to occur because of osteoporosis are vertebral “compression” fractures where one or more of the bones (vertebrae) that make up the spinal column collapse. The result of these fractures is a loss of height, pain, and other problems. If you have noticed that your height has decreased by more than an inch, it is possible that you have had a compression fracture. Many compression fractures are painless and are discovered only by chance. If several vertebrae are involved, a patient may develop a stooped posture, or “hunchback.”
The second most common fracture related to osteoporosis is a hip fracture. Typically, hip fractures occur after a fall from a standing height. If osteoporosis is severe, however, a hip can break just from walking or twisting the leg with no other trauma or injury. Hip fractures are very painful and usually require surgery to fix. This surgery can be risky, especially for the elderly and for people who have other medical problems. In addition, having a hip fracture increases your short-term mortality. In other words, having a hip fracture increases your chances of dying within the next six to twelve months. Hip fractures cause significant disability, and many people will need to stay in a nursing home after breaking a hip.
The third most common fracture to occur because of osteoporosis is a wrist fracture. These usually occur when a person tries to break a fall by reaching out with a hand. The person then lands directly on the hand, which can snap one or both bones in the forearm at the wrist. Wrist fractures can be very painful and cause significant disability.
Conditions that increase risk
Certain conditions increase the risk of osteoporosis, such as being Caucasian (white) or Oriental (Asian), being very thin, having an eating disorder (anorexia or bulimia), having certain thyroid conditions, having a family history of osteoporosis, smoking, and being post-menopausal. Certain medications also increase the risk of developing osteoporosis, especially steroids and some medications used to treat seizures.
Osteoporosis can sometimes be diagnosed on plain x-rays. However, the osteoporosis must be very severe before it can be seen on these standard x-rays. A much better test is called a bone densitometry. There are several kinds of bone densitometry tests, but all of them calculate your risk of suffering a fracture. Some bone densitometry tests use a special x-ray machine; some use a CAT-scanner, and some use ultrasound. With any of these tests, your results are compared to a person of your same sex and race who has peak bone density. In women, bones are strongest between the ages of 20 and 30. When an older woman gets her bone density checked, her result is compared to the results of a “typical” 20 or 30-year-old woman. This comparison predicts how much more likely you are to break a bone than someone who is at the age when bones are strongest.
People who should be tested for osteoporosis include women who have gone through menopause (either naturally through aging or because of surgery to remove the ovaries), people receiving chronic steroid treatment, people who have already had a fracture of the spine/hip/wrist, people with certain hormonal disorders, and anyone else who is considering treatment for osteoporosis if doing the test would make the decision easier.
There are several different medications available for the prevention and treatment of osteoporosis. However, it is most important to take calcium and vitamin D. Calcium is found in many different foods, especially dairy products. The recommended intake of calcium is 1,200 mg (milligrams) every day. However, the average American takes in only 800 mg or less per day, which means he/she needs at least 500 to 1,000 mg of additional calcium daily. Calcium is available in several over-the-counter preparations, many in combination with vitamin D.
Vitamin D is normally produced in the skin when it is exposed to sunlight. However, as people get older, they may not get as much sun as they used to, and the amount of vitamin D produced by the skin becomes less. In addition, the skin doesn’t make as much vitamin D as it gets older, even with enough sun exposure. People who live in colder climates are at especially high risk for low vitamin D levels. Vitamin D helps the body absorb the needed calcium to prevent osteoporosis. The recommended intake of vitamin D is 400 to 800 IU (International Units) per day. Vitamin D is available in several different over-the-counter preparations, many in combination with calcium. Prescription medications are available, also for the treatment and prevention of osteoporosis. Your doctor can help you decide which, if any, of these would be best for you. If you are prescribed a medication for osteoporosis, be sure to take it exactly as instructed.
It is also important to get plenty of exercise to prevent osteoporosis. This exercise must be weight bearing in order to keep your bones strong. Walking is the easiest way to get this kind of exercise. Swimming or bicycling may be great for the heart, but because these activities do not bear weight on your bones, they don’t help much with osteoporosis. Exercise also improves balance, which will help prevent the falls that most often cause the fractures related to osteoporosis. Finally, because smoking cigarettes makes bones get thinner faster, it is important that anyone with osteoporosis stop smoking.
Osteoporosis is a common problem as people grow older, but it should not be considered normal at any age. With your doctor’s help, osteoporosis can be treated and your risk of fractures lowered.
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"Osteoporosis ... Isn’t Normal at Any Age"
Dr. Charnond earned his M.D. degree from the University of Missouri, Kansas City. He is member of the AMA and ACP-ASIM, and Alpha Omega Alpha (honors medical fraternity). He currently practices comprehensive inpatient and outpatient care in St. Louis...