As the month of May is upon us, it seems fitting to write
this blog about a condition May is dedicated to. May is National Osteoporosis
awareness and prevention month. According to the US Surgeon General’s 2004
report Bone Health and Osteoporosis: A Report of the Surgeon General, the
number of hip fractures in the US may double or the numbers may be much worse
by 2020. This seems to be due not only to the increase in longevity of the
population, but also the lack of emphasis on bone health in the past.
The Numbers
About 10 million of Americans have osteoporosis and 44 million
are at risk of osteoporosis due to low bone density. An estimated 2 million
broken bones per year are due to osteoporosis with 1 in 2 women over 50 having
fractures due to osteoporosis. Yet about 80% of elderly Americans suffering
from bone fractures are not tested for osteoporosis.
Why should we care about osteoporosis?
Well a risk of fracture in a woman is equal to the risk of
breast, uterine and ovarian cancer combined!! The risk of breast cancer alone
is 1 in 8 or 12.5%.
What is the severity of these fractures?
About a quarter of patients over 50 who have hip fractures
end up dying within the following year. Of nearly 300,000 hip fracture patients
that survive hip fractures, a quarter end up in nursing homes, and half never
regain their previous abilities and function
Defining osteoporosis.
Osteoporosis is a systemic disease involving the skeleton
characterized by low bone mass, weakening of the composites of bone tissue
causing the bone to become fragile and susceptible to fractures.
Osteoporosis is defined as a bone mineral density that is
2.5 standard deviations or more below the young woman (t-score -2.5 or below)
Bones are part of the skeleton which is an active organ.
Bones have 2 functions: storage of certain minerals such as calcium and provide
structure for the body. Whenever the body runs low in these minerals (mainly
calcium), bone is broken down to release calcium into the blood stream. If
calcium is too low and too much of the stored calcium is released, bone can
become brittle and break.
Risks and causes of osteoporosis.
Risk factors that can’t be changed
- Older age, female gender, menopause, family history, small/thin body type, broken bones/height loss
Risk factors that are controllable
- Diet: calcium and vitamin D intake
- Recommended daily intake of calcium and vitamin D.
- Diet: fruits and vegetables
- Lack of exercise
- High alcohol consumption- more than 2 beverages a day is considered heavy consumption. Moderate consumption may improve bone strength in postmenopausal women.
- Diet: rapid weight reduction causes bone loss
- Smoking
Causes of osteoporosis
- Many conditions also cause bone loss including
- Inflammatory bowel disease
- Pancreatic disease
- Celiac disease
- Bariatric (weight loss) surgery)
- Blood diseases such as sickle cell anemia
- Lupus and others
- Epilepsy
- Stroke
- HIV
- Lifestyle
- Vitamin D insufficiency
- Smoking
- Low calcium intake
- Low physical activity
- High phosphate intake
- High salt intake
- Excess vitamin A
- Excess protein intake
- Alcohol abuse
- Medications that can decrease bone density
- Androgen blockers (Lupron)
- Anticonvulsants (Dilantin, phenobarbital)
- Anticoagulants (heparin)
- Cancer chemotherapy (Cyclosporine A, Tacrolimus, Methotrexate)
- Estrogen blockers (Tamoxifen)
- Steroids (cortisone, prednisone)
- Contraceptives (Depo-Provera)
- Thyroid replacement hormones (excess)
Let’s break the barrier to bone health by increasing
awareness and preventing osteoporosis!
The US preventive Services Task Force in 2011 recommended
all women age 65 and older to be screened with a type of X-ray called DEXA
(dual energy X-ray absorptiometry) scan to prevent osteoporotic fractures. In
2011, women younger than 65 were not mandated to be screened. But the North
American Menopause Society 2014 meeting revealed that the USPSTF guidelines
caused many missed 75% of women aged between 50-64 with osteoporosis. However,
in December of 2017, the USPTF reviewed these recommendations and added that
postmenopausal women younger than 65 who are at risk of osteoporosis,
determined by formal clinical risk assessment should also be screened for osteoporosis.
The new recommendations are still under review and are being updated.
The National Osteoporosis Foundation recommends 5 steps.
Focus on these steps even if you are young!
Focus on strengthening your
bones, because after all it turns out sticks and stones are not the only threat
to their health!!
Christel Francois
DUCOM 2018
References
Chapurlat R D et al:
Osteporosis. In : Jameson JL et al, eds: Endocrinology: Adult and Pediatric. 7th
ed. Philadelphia, PA: Saunders; 2016: 1184-1213, e6.
Cosman, F., de Beur, S.J.,
LeBoff, M.S. et al. Osteoporos Int (2014) 25: 2359. https://doi.org/10.1007/s00198-014-2794-2
National Osteoporosis Foundation. https://cdn.nof.org/wp-content/uploads/2017/04/Who-Gets-Osteoporosis-BONE-BASICS.pdf
https://www.medscape.org/viewarticle/461563
