OSTEOPOROSIS Major Risk of Fracture

Osteoporosis is the thinning of bone tissue and loss of bone density over time. It is the most common type of bone disease. It is a major public health threat which afflicts 55% of Americans age 50 and above. It affects 44 million Americans, striking one in three women and one in five men. It is responsible for millions of fracture annually mostly involving hip, vertebrae, and wrist.

The leading cause of Osteoporosis is a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Because of this, women over the age 50 and men over the age 70 have a higher risk for osteoporosis.

Medical causes of osteoporosis include immobilization, chronic rheumatoid arthritis, and chronic kidney disease, and vitamin D deficiency, use of prednisone, alcohol and smoking. High dose cortisone is the second most common cause of Osteoporosis. Others include low weight, low calcium intake and poor health. Sign and symptoms include bone pain, tenderness, fractures, loss of height over time, low back pain as well as stooped posture.

Hip and vertebrae fracture are responsible for the most serious consequences of osteoporosis. In the US more than 300,000 hip fractures and 700,000 vertebral fractures are attributed to osteoporosis. The wrist fracture (250,000) is the third most common kind of fracture.

Dual energy x-ray absorptiometry (DEXA) is considered Gold standard for diagnosis of osteoporosis. FDA approved indications for a bone density test includes estrogen deficient women at clinical risk for osteoporosis, vertebral abnormalities on x-ray suggestive of osteoporosis, prednisone 7.5 mg or more for more than 3 months, primary hyperparathyroidism, monitoring response to medication. DEXA can be repeated every two years or more frequently if medically justified.

The US Preventive Services Task Force (USPSTF) recommended in 2011 that all women 65 years of age or older should be screened with bone densitometry. In men screening will be cost effective in those ages 80-85 years of age.

Lifestyle changes like smoking cessation, decrease alcohol intake, and improved nutrition with more calcium and vitamin D supplement are important in prevention. They are recommended to avoid Omega-6 based oil such as corn oil instead use olive and Coconut Oil. Animal and Plant based Omega-3 fats are highly beneficial. Vitamin K2 supplement found in green leafy vegetable can reduce fractures as well. Weight bearing exercise will be another remedy against Osteoporosis.

Biphosphonate (Fosamax) and alendronate (Actonel) and ibandronate like Boniva are the first line treatment of osteoporosis. Annual infusion of Zoledronic Acid reduced the risk of any fracture as well. Estrogen replacement therapy remains good treatment for prevention of osteoporosis. Toriparatide (Forteo) is effective treatment for osteoporosis. Calcium is required to support bone growth, bone healing and is part of treatment of osteoporosis. US health agencies recommend 1200 mg of calcium plus Vitamin D 1000-2000 international units a day.

Hip fracture can increase mortality due to complication of fractures like deep venous thrombosis, pulmonary embolism and Pneumonia. The six-month mortality rate following hip fracture is approximately 13.5%. Low bone mass has been linked with Alzheimer’s disease. Research shows that the patients with lowest bone mass were more than twice as likely to develop Alzheimer’s disease as their healthy counterpart.

Osteoporosis is something that can be prevented and cured. Patients need careful monitoring of their diet, exercise and bone density test in order to definitely diagnose the problem. Any small amount of effort can prevent future bone fracture and complications.

[Anis Ansari, MD, is Board certified in Internal Medicine and Nephrology, Clinton, Iowa, USA.]