Os­teo­poro­sis presents a se­ri­ous health threat

The Washington Times Daily - - Life - DR. DAVID LIPSCHITZ

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.

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