Osteoporosis

The Silent Disease

Osteoporosis is an orthopedic condition in which there is loss of bone mass and a breakdown in the microarchitecture of the bone. It is often called "the silent disease" because its victims feel no pain as bones gradually thin to the point where even a slight bump or a fit of coughing can cause a fracture. Bones become so weak and brittle that a mild stress, such as bending over, lifting a vacuum cleaner, or even coughing can cause a fracture of the hip, spine, or wrist. In addition to an increased rate of bone and skeletal fractures, patients with osteoporosis have a corresponding increase in morbidity and mortality, with twelve to twenty percent of sufferers dying within a year after a fall resulting in a broken hip. Osteoporosis is currently one of the most under-diagnosed and under-treated disorders in the country.

Osteoporotic Bone vs. Healthy Bone

Osteoporotic bone (top) is porous and fragile, increasing the chance of fracture. Normal bone (bottom) is strong and dense. Osteoporosis is commonly considered a geriatric disease, but its roots are in childhood and adolescence when peak bone mass should be achieved.

Osteoporosis is commonly considered a geriatric disease, but its roots are in childhood and adolescence when peak bone mass should be achieved. It can strike at any age, resulting in loss of height, severe back pain, and deformity (the classic curvature of the spine is called a Dowager's Hump), and can impair a person's ability to walk. Hip fractures due to osteoporosis can lead to immobility, loss of muscle tone, and decreased body strength. This can result in prolonged or permanent disability, an inability to care for oneself, and complete dependence on others.

Although approximately 8 million women and 2 million men suffer from this debilitating disorder, osteoporosis is not an inevitable part of aging. Osteoporosis is a disease condition that is both preventable and treatable. In persons who are already suffering from osteoporosis, treatment can diminish additional bone loss and prevent fractures. The misperception that osteoporosis is a normal part of aging results in too many women, mostly over the age of 50, unnecessarily suffering significant pain, deformity, or death.

Loss of bone accelerates in women at the time of menopause and in men at about age 55, thus fracture rates increase in both sexes. Women can lose up to one fifth of their bone mass in the five to seven years following menopause, putting them at an even greater risk. The World Health Organization defines osteoporosis as a generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture. There are two types of osteoporosis:

Type I osteoporosis (postmenopausal osteoporosis) commonly develops in women after menopause when the amount of estrogen in the body declines and a resorption of bone increases. This familiar form of osteoporosis occurs in women more frequently than in men, and typically develops between the ages of 50 and 70. The process usually results in a decrease in the amount of trabecular bone (the spongy bone inside of the hard cortical bone). The decrease in the overall strength of the bone leads primarily to wrist and vertebral body (in the spine) fractures.

Type II osteoporosis (senile osteoporosis) characteristically develops after the age of 70 and affects women twice as frequently as men. This form of osteoporosis involves a thinning of both the trabecular bone and hard cortical bone. This process often leads to hip and vertebral body (in the spine) fractures.

Traditional Risk Factors for Postmenopausal Osteoporosis

• Female (gender)
• A family history of osteoporosis
• Thin and/or small frame body structure
• A diet low in calcium
• Advanced age
• Menopause (including early or surgically induced menopause)
• Abnormal absence of menstrual periods (amenorrhea)
• Anorexia nervosa or bulimia
• An inactive lifestyle
• Cigarette smoking
• Excessive use of alcohol
• Low testosterone levels in men
• Being Caucasian, Asian, or Hispanic
• Use of certain medications, such as corticosteroids and anticonvulsants

Medical Conditions That May Have a Negative Effect on Bone Health

• Chronic alcoholism
• Chronic gastrointestinal malabsorption
• Chronic kidney disease
• Cushing's disease
• Diabetes
• Early menopause because of surgery or chemotherapy
• Eating disorders
• Exercise-induced amenorrhea
• Gastrectomy
• Hyperthyroidism
• Hyperparathyroidism
• Immobility
• Inflammatory bowel disease
• Lactose intolerance
• Liver disease
• Menopause without estrogen therapy

Medications That Can Reduce Calcium Absorption

• Aluminum containing compounds
• Antibiotics
• Anticoagulants (ex. heparin, warfarin)
• Anitconvulsants (ex. phenobarbital, phenytoin, carbamazepine)
• Bisphosphonates (ex. aledronate, etidronate, risedronate)
• Calcium Channel Blockers (ex. nifedipine, verapamil, diltiazem)
• Cholesterol lowering agents
• Cyclosporine
• Digitalis glycosides
• Diuretics
• Glucocorticoids
• GnRH Antagonists
• Gonatropin - releasing agents
• Isoniazid
• Laxatives (over-night)
• Lithium
• Methotrexate
• Retinoic Acid
• Thyroid hormones