Thursday, April 26, 2018

Bone Health: Beyond sticks and stones…


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





https://www.medscape.org/viewarticle/461563