Bone crushers

Originally published in the Ottawa Citizen in April 2004

Osteoporosis is defined as a loss of bone calcium more than expected for a person’s age, sex, and race. It is a major health problem that robs people of their independence. The areas predisposed to fracture include the spine, hip and upper arm.

Osteoporosis causes the destruction of the small bony interconnections within the bone called trabecula. The trabecular network in bone appears like a three-dimensional spider web. This structural design improves the bone’s strength and weight bearing capacity. Osteoporosis also thins out the outer layer bone wall or cortical bone.

Men tend to suffer fractures an average of ten years later than do women because of their greater bone mass. Our bones attain peak bone mineral density by our mid twenties. Thereafter bone mineral density will slowly decline. Hereditary factors, diet, hormone levels and environmental effects will influence peak bone density.

Indeed, it is imperative to encourage all adolescents to meet the dietary requirement of 1000 to 1500 milligrams of calcium a day along with adequate vitamin D intake to maximize his or her bone mineral density. Adolescent bones are like a savings account. You want to deposit as much calcium into the growing bone so that it will take a long time before the account runs dry when the regular withdrawals occur later in life.

One of the problems with osteoporosis is the need to identify those people at risk for fractures and indeed institute a therapeutic prevention program. Men have larger bone structure hence a greater bone mass. However, both sexes have similar bone mineral densities.

Thirty-one percent of men and 17 per cent of women die from the complications of hip fractures. One-half of men will have chronic pain at six months after their fracture and need help to walk. About one third will have to move into a nursing home or a relative’s house. Self-esteem suffers because of the loss of independence and physical change.

Hip fracture incidence increases after age 75. This incidence will further increase because of the aging baby boomers.

Bone loss begins after age 50 for men and women. Many associate osteoporosis more so for women. However about four to six per cent of men over 50 have osteoporosis. Thirty-three to 47 per cent will have osteopenia. Osteopenia is defined as a bone mineral density loss of that does not fulfill the criteria for osteoporosis.

Some other risk factors other than aging and genetic factors in men that can contribute to osteoporosis include tobacco and alcohol use, long-term steroid use (e.g. prednisone), anticonvulsant medications like phenytoin (Dilantin) and phenobarbital, low testosterone and low estrogen levels and thyroid disease.

Treatment of osteoporosis must include adequate calcium and vitamin D intake. Only 50 to 60 per cent of older adults consume the recommended intake of 1000 to 1500 milligrams of calcium per day. Vitamin D intake should be 400 to 800 IU per day.

Expert guidelines also recommend regular weight-bearing exercise, smoking cessation and reduced consumption of alcohol. Physical therapy and counseling to help those who have suffered a fracture can help prevent future injury and fractures. A physical therapist can provide assistance and teaching to help the patient increase their muscle strength and size, improve mobility and coordination and use assistance devices.

The goal of osteoporosis treatment is to slow its progression and try to increase bone mineral density. Treatment with alendronate (Fosamax) and risedronate (Actonel) has been shown to increase bone mineral density. There are several other specialized medications available for metabolic or hormonal disorders that cause osteoporosis but our beyond the scope of this column.

For women, raloxifene (Evista) is a nonhormonal means of preventing osteoporotic fractures. It is an option in addition to Fosamax and Actonel.

Discuss this issue with your doctor. Find out if you are at risk for osteoporosis within the next few years. Prevention is the key. Encourage your children to consume calcium-laden foods and ensure they meet the recommended vitamin D daily requirements of 400 IU per day. It is a great long-term investment.

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