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Osteoporosis: Thief of Bones
by Roberta Greenwood

For Renton resident Leslye Bergan, it wasn’t the fall, resulting wrist fracture, or even her lengthy recovery that proved difficult; it was the diagnosis. “I remember the awful feeling in my stomach when my health care provider informed me I had thinning bones. I felt like I was being sentenced to the life of a frail old woman with fragile bones,” she recalls. “I’ve always been active — raised my three boys, and worked with infants and toddlers in an energetic program. I felt healthy until I heard my doctor say my bones were becoming brittle. Now I think about falling again all the time — and it scares me.”

She’s not alone. Current estimates indicate that 44 million women and men are at risk from the effects of osteoporosis (a disease characterized by progressive loss of bone density, thinning of bone tissue and increased vulnerability to fractures) — with women comprising 80 percent of that number. Sometimes referred to as the “silent disease,” osteoporosis affects the body over time, and typically is only revealed when a break or fracture occurs. The National Osteoporosis Foundation (NOF) reports that in the U.S. alone, osteoporosis contributes to 1.5 million fractures annually — and half of women over the age of 50 will suffer such a fracture before they die.

These fractures occur most commonly in the hip, spine and wrist. Hip fractures are by far the most troubling of these types of breaks; 24 percent of patients die from complications within the first year of the fracture. Twenty percent of patients spend recovery time in nursing home facilities, and six months after a hip fracture, only 15 percent of patients can walk unassisted across a room. Clearly, osteoporosis and the resulting fractures that often occur are factors that affect quality of life. So what’s the best hope for managing this condition — and once diagnosed, how can it be managed so women can sustain an active life?

UNDERSTANDING OSTEOPOROSIS
Once thought of as a disease only of the aging, osteoporosis can develop at any age, according to the NOF. Bone is living tissue, and to keep bones strong, the body constantly breaks down old bone tissue, replacing it with new. As people age, more bone is broken down than is replaced, and the result is a “honeycomb” effect in the bones. But aging isn’t the only factor that leads to bone loss.

People who suffer from chronic diseases such as asthma or arthritis that require long-term treatment with glucocorticoids (such as prednisone) can develop bone loss over time. Bone loss or low bone mass (osteopenia) is considered a warning sign that osteoporosis will develop later in life.

Health care organizations now advocate steps, beginning in early childhood, that can help prevent osteoporosis. The National Institute on Aging suggests building strong bones during childhood and adolescence by eating a balanced diet rich in calcium and vitamin D, doing weight-bearing exercise, and maintaining a healthy lifestyle that doesn’t include smoking or drinking alcohol excessively. For millions of patients who already have the disease, these lifestyle changes can also help slow the progression of the condition and improve recovery outcomes should a fracture occur.

EIGHT COMMON MYTHS
In its “Standing Tall for You” program, the NOF debunks the following myths about osteoporosis:

1. Osteoporosis is an inevitable part of aging. Experts now agree that prevention is possible. Even starting preventative measures after a fracture can increase quality of life and limit a severe disability.

2. Osteoporosis is a disease of “older women.” Twenty percent of those affected with osteoporosis are men. Men over the age of 50 have a greater risk of suffering an osteoporosis-related fracture than developing prostate cancer.

3. Osteoporosis isn’t common. The NOF expects that by 2020, over 61 million Americans will suffer from low bone mass and osteoporosis. A woman’s risk of hip fracture is equal to her combined risk of breast, ovarian, and uterine cancer.

4. Only Caucasian women get osteoporosis. While it is true that white and Asian women are at greater risk for osteoporosis, 49 percent of Hispanic women and 35 percent of African American women over 50 are thought to have low bone mass.

5. Patients “know” if they have the disease. Osteoporosis progresses slowly and most patients are symptom-free until a fracture occurs. Even loss of height can be an indicator of the disease. The NOF recommends patients talk to their health care provider if they notice a height loss of more than one inch.

6. Osteoporosis isn’t serious. Fractures caused by osteoporosis can be painful and life-altering. Hip fractures aren’t the only devastating injuries — vertebral fractures, which are difficult to diagnose and often go untreated — have a survival rate about equal to that of hip fractures.

7. Medical costs aren’t high. The NOF estimates the cost to the health care system of treating patients with osteoporosis will exceed $60 billion by 2030.

8. If I have osteoporosis, I can’t do anything about it. Several treatment options are now available which can slow bone loss and even build new bone. Healthy lifestyle changes (adding more calcium and vitamin D to the diet, increasing weight-bearing exercise and quitting smoking) can also slow the disease.

STEPS THAT CAN HELP
Bone density tests can help health care providers diagnose both osteopenia and osteoporosis. DEXA scans, the common test approved by most insurers, can determine the risk of a future fracture or break. These tests measure current bone density against healthy pre-menopausal levels; osteoporosis is diagnosed when bone mass density (BMD) is 2.5 points below standard. Most health care providers suggest a baseline test beginning at age 60 unless there are other factors that indicate the possibility of early bone loss.

Once low bone loss is diagnosed, several treatment options are available. Some prescribed medications will slow bone loss, while others can actually rebuild bone. The most common of these medications, bisphosphonates (commonly marketed as Actonel and Fosamax), slow the breakdown of bone and can increase bone density. While they make it less likely that a fracture will occur, they have several side effects that can be difficult to manage. Joint pain, nausea, heartburn and stomach pain are common complaints, and in the case of Fosamax, there have been several instances where its use has been linked to bone death (osteonecronosis) in the jaw. Additionally, these types of medications must be taken in a precise manner (with a full glass of water, when you first get up, before eating, etc.).

Estrogen or HRT (hormone replacement therapy) is sometimes prescribed as it also slows bone loss, but the NOF cautions women to first thoroughly discuss its use with their health care provider. Calcitonin is another hormone that can increase bone mass and even lessen pain from existing fractures. It is administered by injection or nasal spray, and can cause allergic reactions such as nausea and diarrhea.

Short of medication support, women can improve their bone health by increasing weight-bearing exercise and eating a nutrient-rich diet. Increase leafy green vegetables, fruits, whole grains and healthy fats, and decrease the use of refined carbohydrates and simple sugars. Protein is also helpful for maintaining bone health, but choose lean meats and fish whenever possible. Limit alcohol consumption, and if you smoke, stop. Most health care providers also recommend 15 minutes of sunlight daily, to insure adequate vitamin D absorption.

In Chinese medicine, osteoporosis is often considered a manifestation of not being supported in life. As women, our aging bodies need additional support from us by way of increased knowledge, improved diet and exercise, and when necessary, medication. As Leslye Bergan adds, “It’s just a matter of not giving up. I’ll add exercise and good eating to my daily plan; I’m going to live healthy and strong for many years to come!

Roberta Greenwood is a frequent contributor to Seattle Woman.

©2007 Caliope Publishing Company