Osteoporosis
By James R. Allman, M.D.
Board Certified in Obstetrics and Gynecology
Ashland Women’s Center
419-289-2464
The bony skeleton is in a constant state of remodeling. Osteoporosis is characterized by an increase in bone resorption relative to bone formation, and is usually associated with an increase in the rate of bone turnover. This process begins after peak bone mass is achieved, around age 25-30.
In the U.S. alone, osteoporosis results in approximately 1.5 million bone fractures every year and nearly $17 billion in health care and loss-of-productivity costs. This disease is usually asymptomatic.
The life time risk of having an osteoporosis-related fracture is 50% for Caucasian women. Many studies have shown that the risk of osteoporosis is greater for Caucasian and Asian women than for African-American women. Vertebral (back bone) fractures, which occur in approximately one in five postmenopausal women, are associated with an increased risk of mortality.
Approximately 13-18% of US women aged 50 years and older have osteoporosis while another 37-50% has low bone mass (osteopenia).
Bone strength is mostly dependent on bone mineral density (BMD), accounting for 70% of bone strength, but is also affected by bone quality, as determined by the make up of your bones.
The standard method of BMD measurement is called DEXA. An individual is exposed to a small amount of radiation (less than being on a coast-to-coast airplane flight). The single largest factor influencing a woman’s bone mass is genetics. Up to 80% is attributable to genetic factors alone.
After menopause, bone density values decline and the incidence of most fractures increases. For the first 5 to 10 years after menopause, a 1% to 3% loss in bone density per year is common. In the elderly, the decline in bone density tapers off to approximately 0.75% per year.
Common sites of fractures are vertebral bodies, hip fracture and wrist fractures. Vertebral fractures may present with loss of height or with acute or chronic pain associated with a stooped posture.
Osteoporosis is a preventable condition. Interventions include adequate calcium and vitamin D intake, regular weight-bearing exercise, fall prevention and avoidance of tobacco use and alcohol abuse have been shown to reduce fracture risk. A good start is oral intake of at least 1200mg per day of calcium and 400 to 800 IU per day of vitamin D.
Therapeutic agents available for the treatment of osteoporosis include antiresorptive agents, which inhibit bone resorption (including bisphosphantes, calcitonin and raloxifene); and anabolic agents which stimulate bone formation. Estrogen is known to decrease bone resorption and with appropriate evaluation and counseling some individuals are candidate for use of estrogen.
Speak to your health care provider for more information on what treatment would be best for you.
