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Show Page 12 THE OGDEN VALLEY NEWS Volume X Issue III May 15, 2004 Osteoporosis What is osteoporosis? Osteoporosis is a condition of the bones. Bones are living tissue that is constantly changing. For many reasons, bones can become weak and porous, thus becoming brittle, fragile, and easily broken. A person with this condition is said to have osteoporosis, or low bone mineral density (BMD). Under most conditions, a person’s bones continue to grow stronger up into their 30’s; thereafter, bones begin to break down faster than they are formed. At menopause, a woman’s risk of developing osteoporosis increases as her ovaries stop producing estrogen—a bone protecting hormone. Approximately 10 million people over the age of 50 are affected with this preventable condition. An astounding 80% are women. Thirty-four million more individuals have low bone mass, a precursor to osteoporosis. Fifty percent of women over age 50 will have an osteoporotic fracture some time in their life. Finally, statistics show that thirty percent of post menopausal women already have osteoporosis. Why is it important to address these statistics? Osteoporosis can lead to painful, debilitating, expensive, and even life threatening fractures. Because of low bone mineral density, a person with osteoporosis can incur a fracture without even suffering any significant physical trauma. Something as simple as bending over, standing up, or picking up a grandbaby can cause a fracture. A non traumatic hip fracture, which can even occur by standing, can lead to a fall, inducing further injury and consequences. Many hip fractures are not caused by falls; conversely, the fall is created by the non traumatic hip fracture. Osteoporosis can also produce progressive deformity and resulting dysfunction. Who is at risk for osteoporosis? Women Smokers Steroid users Individuals who are thin or small framed Those who consume significant amounts of alcohol Those who consume excessive amounts of soda Those whose physical activity is limited i.e., they have a sedentary lifestyle Those who exhibit anorexic behaviors or have amenorrhea Those with a family history of osteoporosis (Since statistics show that 50% of women over the age of 50 will have an osteoporotic fracture some time in their life, there’s a substantial chance that you do have a family history of osteoporosis, even if you are unaware of it!) Additionally, other physical conditions and medications can lead to the development of osteoporosis. These factors include hyperthyroid disease, parathyroid disease, and intestinal absorption diseases; also the ingestion of such medications as heparin, anti-seizure drugs, methotrexate, lithium, depo-provera, and cyclosporine. How is osteoporosis diagnosed? The only truly valid current test is a DEXA (dual energy x-ray absorptiometry) test, which is painless and brief. No clothing needs to be removed during testing. Using the DEXA-dual energy x-ray, the technician or doctor should examine both the hips and spine to ensure there are no conflicting factors that would interfere with the validity of the test results. Any other type of test may be inconclusive. A true diagnosis of osteoporosis is based on “T” scores. A “T” score with a standard deviation of 1 or below is normal. A score of 1.0 to 2.5 means you have low bone mass (osteopenia). If you have a “T” score above 2.5, you would be diagnosed as having osteoporosis. A doctor may also use an age matched “Z” score, but this score may obscure the need for the treatment for osteoporosis; it is best to rely on the “T” score as a determinant for treatment. Who should be tested? Every woman should be tested for osteoporosis within a year of the onset of menopause unless you are at high risk of developing osteoporosis, e.g., thin, small framed, family history. If you are at high risk for developing osteoporosis, you should be tested earlier, when any one of the risk factors named above become evident. Thereafter, as a preventive measure, you should be tested every two years. What can you do to help prevent the development of osteoporosis? The intake of calcium and vitamin D supplements is one of the easiest ways to prevent osteoporosis. Calcium supplements can come in the form of calcium carbonate, calcium citrate, or calcium phosphate. It is best to avoid calcium sources that say they are from oyster shell, dolomite, or bone meal. Take supplements with a full glass of water one hour prior to, or after meals. Staggering the dosage, such as half in the morning and the other half in the evening, is preferable, as any calcium the body does not utilize is expelled and absorption is generally poor at best. Recommended dosages are as follows. Recommended calcium intake: 800 mg Age 4 – 8 1,300 mg Age 9 – 18, or through pregnancy 1,000 mg Age 19- 50 1,200 mg Age 50 and older Vitamin D is also an important vitamin in the prevention of osteoporosis. It plays a critical role in the body’s ability to absorb calcium. You can ensure adequate daily allowances of Vitamin D through supplements; diet; and/or 15 minutes, 3 times a week of exposure to sunshine. The recommended dosage from a supplement is 400 to 800 IU a day. Foods high in vitamin D include cod liver oil, salmon, mackerel, sardines, egg yolks, and fortified milk. In addition to ensuring the intake of adequate amounts of calcium and vitamin D, physical activity and weight bearing exercises are also important. Also, avoid risk factors as mentioned above, such as the ingestion of large quantities of alcohol and soda. Can osteoporosis be treated? Yes, with hormone replacement therapy, or the use of doctor prescribed actonel, evista, forteo, fosamax, or miacalcin. But remember, prevention is the best medicine. Also 30 to 60% of people with osteoporosis have an underlying associated medical condition that needs to be evaluated. Injuries related to osteoporosis can also be reduced through preventive measures. Thirty percent of people over the age of 70 suffer injury from falls. Ten to fifteen percent of these falls cause serious injury. If you can take measures to decrease your risk of falling, or if you can alter the way you land if you do fall, you may be able to avoid becoming a statistic. If you are two standard deviations below normal on your bone density (mildly osteoporotic), even minimal trauma can cause a serious fracture. To help in the prevention of falls, improve your sense of balance through movement and balancing exercises; one’s sense of balance can be developed and improved through use. Strength training and resistance exercises are also imperative, as they contribute to bone strength and development. Walking is a great weight bearing exercise. You are never too old to begin a regular program. Talk to your health care professional or a professional trainer. Falls can also be prevented though simple preventive measures related to body mechanics. If you are already at high risk for osteoporosis, avoid lifting, bending, twisting, or strong coughing. Safety proof your home: make sure rugs are securely placed; avoid walking on icy or slick surfaces; be mindful and take extra care when walking on uneven terrain or surfaces; keep floors free of objects that you can be easily tripped over; and make sure your stairs are carpeted and appropriate handrails are installed and utilized for safety and support. Also, avoid jumping up quickly. The 30 second rule is important to remember. After you have been sleeping or lying down, sit at the edge of your bed or chair for 30 seconds before standing, ensuring an adequate maintenance of your blood pressure in order to prevent a black out or fainting spell. If you have had a prior fracture, your risk of incurring another multiplies by six. In addition to the pain and/or lack of mobility a bone fracture produces, or the debilitating and improper bone formation from osteoporosis, it is even more critically important to prevent this condition because it can often be life threatening; statistics show that thirty-one percent of men and seventeen percent of women die within one year of suffering a hip fracture. Since falls can occur, even after the best preventive measures are implemented, learning to fall correctly can also be helpful. If you have even a split second to anticipate a fall, try to direct that fall; if you think you are going to fall, try to just SIT DOWN, “bottom” first! Try to plop down on your seat. This can avoid fractures to wrists and hips. Be pro-active with your grandmothers, mothers, sisters, daughters, and yourself! Remember, osteoporosis is a preventable, manageable, and treatable disease! Educate yourself, then educate those whom you care about; if you manifest even one high risk factor, be properly tested for osteoporosis. Finally, implement a preventive regiment to reduce your risk factors. Osteoporosis does not have to cause the deformity, pain, and disability that it currently does. If you are at high risk for osteoporosis, insist that your family health care provider order a DEXA-dual energy x-ray for you as part of your routine health care. Sadly, this is not a standard test recommended by most health care professionals, even if you exhibit high risk factors related to age, size, or personal habits. You may want to ask to be referred to an endocrinologist or a rheumatologist for testing or care for osteoporosis. For more information, visit the National Osteoporosis Foundation’s web site at <www.nof.org> or the National Institutes of Health—Osteoporosis and bone related diseases’ web site at www.osteo.org Note: Information courtesy of Eden Orthopaedic Surgeon Susan Puls M.D. |