Osteoporosis

Osteoporosis is the most common metabolic bone disease in the world affecting over 200 million individuals. In the United States alone, over 25 million individuals, most of them women, are affected by this disease which is defined by the World Health Organization as a disorder of bone architecture leading to increased bone fragility and a consequent increased risk of fracture.

All of us have had relative who have fallen and broken a hip only to suffer significant morbidity and mortality. 20% of individuals who break a hip due to osteoporosis die within six months, due to complications, and of the 80% that survive the fracture, 50% are unable to ambulate independently and end up in a nursing home.

In the United States alone in 1997, the cost of caring for osteoporosis hip fractures was over 14 billion dollars. Clearly, the prevention of osteoporosis should be high on the list of priorities for all primary care physicians.

Happily, today, it is easy to screen for osteoporosis. The dual x-ray absoptiometry scan or DEXA scan is a convenient, safe and easy way to determine whether an individual, male or female, is either developing or has established osteoporosis. The does of radiation is small, the cost is reasonable and the accuracy high.

After menopause, women, typically, have an accelerated period of bone loss for the first 5-8 years, which may, in some cases, place the individual rapidly at risk for osteoporosis and consequent increased risk of pathologic bone fracture.

There are now several classes of medications, which are available to either prevent or treat osteoporosis. While much of the risk of osteoporosis is genetically determined with Caucasians and Asians being at much greater risk than African Americans, lifestyle plays a role in determining who develops osteoporosis as well. Individuals who smoke cigarettes, drink alcohol to excess, have a sedentary lifestyle, have a poor intake of calcium, or weight less at age 65 than when they were 20 years old, are at significantly greater risk of osteoporosis. Certain medications, particularly corticosterioids, also are a great cause of secondary osteoporosis. Many diseases such as systemic lupus erythematosus, rheumatoid arthritis, premature ovarian failure, thyroid disease and hypterparathyroidism also cause increased risk of osteoporosis. In addition to insuring adequate calcium and vitamin D intake for our patients and making appropriate lifestyle modifications - the prevention of osteoporosis in women can be effectively accomplished through the use of either estrogen replacement therapy after menopause or reloxifen - a new agent for the prevention of post-menopausal osteoporosis.

Calcitonin in the form of either nasal spray or injection is effective for building bone in the spine and pelvis. The bisphosphonates (Fosamas) are very effective in building bone and treating and preventing osteoporosis both in the hip, wrist and spine.

In the end, however, it is much easier to prevent osteoporosis than to treat it once it has developed and announced its arrival by virtue of a painful, debilitating and potentially fatal hop fracture. We would all be wise to discuss osteoporosis prevention and/or treatment with our affected patients.