Osteoporosis presents a serious health threat
Osteoporosis is as common as cancer and heart disease, and it’s a leading cause of fractures, chronic disability, difficulty with walking, severe pain and a poor quality of life. The World Health Organization reports that osteoporosis ranks second to cardiovascular disease as a global health care problem. And research shows that a 50-year-old woman has the same risk of dying from complications of a hip fracture as from breast cancer.
In 2010, 30 million women and 14 million men will either suffer from osteoporosis or have osteopenia, a significant thinning of bone that hasn’t reached the severity of osteoporosis. The most important complication of osteoporosis is a fracture.
The disease is more common in women — 1 in 3 will suffer a fracture during their lifetime. After age 50, the fracture risk increases to 50 percent.
Men are not immune. Their risk of fracture is 20 percent under the age of 50 and 30 percent over the age of 60.
Fractures of the hip, wrist or back usually follow a fall. Occasionally, an osteoporotic bone may be so thin that a spontaneous fracture can occur without injury. Following a hip fracture, the risk of death within the next year is 20 percent, and another 20 percent require admission to a nursing home because of an inability to walk. Only a third of those who have a hip fracture return to their normal level of function.
Vertebral fractures can occur spontaneously or following a fall. An acute vertebral fracture causes severe pain. If vertebral collapse is noted, a vertebroplasty should be considered. During a vertebroplasty, a needle is inserted into the vertebra. A balloon is used to expand the vertebra into its normal shape and cement is injected to prevent the collapse from reoccurring.
Vertebral fractures can occur gradually and at multiple sites, leading to loss of height and curvature of the upper spine referred to as a dowager’s hump. These fractures, as well as microscopic fractures of very thin bone, lead to chronic pain that can be debilitating and affect gait and balance. It also can cause an increased risk of becoming physically dependent on others and a poor quality of life.
We must do everything we can to prevent osteoporosis, detect it early and provide treatment to reverse the problem and avoid complications. Osteoporosis can be prevented by ensuring adequate intake of calcium during the growing teenage years and thereafter.
The average daily diet should contain about 500 milligrams of calcium from nondairy sources and 1 ounce of cheese or a glass of milk. If no dairy products are consumed, 500 milligrams of calcium plus 200 units of vitamin D should be taken with meals twice daily, beginning with the teenage years. Exercise that builds muscle and bone is just as important.
Every woman should be screened for osteoporosis at menopause. This involves a noninvasive test called a DEXA scan. Follow-up screenings usually are recommended every three years. However, a recent study in the New England Journal of Medicine indicated that if the DEXA scan was normal, a repeat scan was not needed for 10 years. If bone thinning or osteopenia is identified, a scan should be repeated in five years. Only those at very high risk should be scanned every three years or sooner.
If osteoporosis is diagnosed, therapy with medications can build bone and reduce the risk of fracture by 50 percent or more. Bisphosphonates such as Fosamax and Boniva are commonly prescribed. They can be given orally or intravenously every three months, or annually. In most circumstances, the generic alendronate should be prescribed first.
Although rare, side effects include gastrointestinal distress, jawbone problems and an unusual fracture of the thighbone. Because of these risks, a complete dental checkup should be conducted before starting a bisphosphonate. In addition, complications can be reduced if the medication is stopped after seven years. This is called a drug holiday and should last anywhere from one to three years.
Remember, osteoporosis is as serious a problem as cancer. The deleterious effects on quality of life make it imperative that we do everything we can to reduce the risk of this devastating illness.