What is
it?
Osteoporosis, or porous bone, is a disease characterized by
low bone mass and structural deterioration of bone tissue, leading to
bone fragility and an increased susceptibility to fractures of the hip,
spine, and wrist.
Prevalence
Osteoporosis is a major public
health threat for 28 million Americans, 80 percent of whom are women. In
the U.S. today, 10 million individuals already have osteoporosis and 18
million more have low bone mass, placing them at increased risk for this
disease.
One out of every two women and one in eight men will have
an osteoporosis-related fracture in their lifetime. By age 75, one third
of all men will be affected by osteoporosis. While osteoporosis is often
thought of as an older person's disease, it can strike at any age.
Osteoporosis is responsible for 1.5 million fractures annually,
including:
- 300,000
hip fractures
- 700,000
vertebral fractures
- 200,000
wrist fractures
- more
than 300,000 fractures at other sites
Cost
The estimated national direct expenditures
(hospitals and nursing homes) for osteoporosis and associated fractures
was $14 billion ($38 million each day) and the cost is rising.
Symptoms
Osteoporosis is often called the "silent
disease" because bone loss occurs without symptoms. People may not know
that they have osteoporosis until their bones become so weak that a
sudden strain, bump, or fall causes a bone to fracture or a vertebra to
collapse.
Collapsed vertebra may initially be felt or seen in the
form of severe back pain, loss of height, or spinal deformities such as
stooped posture or dowager's hump.
Risk
Factors
Certain people are more likely to develop osteoporosis
than others. Factors that increase the likelihood of developing
osteoporosis are called "risk factors." The following risk factors have
been identified:
- Being
female
- Thin
and/or small frame
- Advanced
age
- A family
history of osteoporosis
- Early
menopause
- Abnormal
absence of menstrual periods (amenorrhea)
- Anorexia
nervosa or bulimia
- A diet
low in calcium
- Use of
certain medications, such as corticosteroids and anticonvulsants
- Low
testosterone levels in men
- An
inactive lifestyle
- Cigarette smoking
- Excessive use of alcohol
Caucasian
or Asian, although African Americans and Hispanic Americans are at
significant risk as well. Women can lose up to 20% of their bone mass in
the 5-7 years following menopause, making them more susceptible to
osteoporosis. However, 2.0 million American men are affected by
osteoporosis and one out of eight men age 50 and older will develop
fractures.
White women
60 years of age or older have at least twice the incidence of fractures
as African-American women. However, one out of five African-American
women are at risk of developing osteoporosis.
Detection
Specialized tests called bone density tests
can measure bone density in various sites of the body. A bone density
test can:
- Detect
osteoporosis before a fracture occurs
- Predict
your chances of fracturing in the future
- Determine your rate of bone loss and /or monitor the effects of
treatment if the test is conducted at intervals of a year or more
Prevention
Building strong bones, especially before the
age of 35, can be the best defense against developing osteoporosis, and
a healthy lifestyle can be critically important for keeping bones
strong. So, to help prevent osteoporosis:
- Eat a
balanced diet rich in calcium
- Exercise
regularly, especially weight-bearing activities
- Don't
smoke and limit alcohol intake
- Talk to
your doctor if you have a family history of osteoporosis or no longer
have the protective benefit of estrogen due to natural or surgically
induced menopause.
Fractures
The most typical sites of fractures related
to osteoporosis are the hip, spine, wrist, and ribs, although the
disease can affect any bone in the body.
Forty percent of all women
will have at least one spinal fracture by the time they reach age 80.
Spinal
osteoporosis is eight times more likely to afflict women than men.
The rate of
hip fracture is two to three times higher in women than men; however,
the death rate for men within one year after a hip fracture is 26
percent higher than in women. A woman's risk of hip fracture is equal to
her combined risk of breast, uterine and ovarian cancer. In 1991, about
300,000 Americans age 55 and over were admitted to hospitals with hip
fractures. Osteoporosis was the underlying cause of many of these
injuries.
Individuals
suffering hip fractures have a 5 to 20 percent greater risk of dying
within the first year following that injury than others in their age
group. Among those who were living independently prior to a hip
fracture, 15 to 25 percent are still in long-term care institutions a
year after the injury.
Treatment and Care
Although there is no cure for
osteoporosis, there are treatments available to help stop further bone
loss and fractures: Studies have shown that estrogen can prevent the
loss of bone mass in post menopausal women. Alendronate, a
bisphosphonate, has been approved by the Food and Drug Administration
for treatment of post menopausal osteoporosis. Calcitonin is a treatment
that can be used by women and men for osteoporosis. This drug has been
shown to slow bone breakdown and also may reduce the pain associated
with osteoporotic fractures. Treatments under investigation include
other bisphosphonates, sodium fluoride, vitamin D metabolites, and
selective estrogen receptor modulators.
