Osteoporosis

Risk Factors / Prevention / Diagnosis / Treatment Options

There are 44 million Americans at risk of developing osteoporosis, 80% are women. This disease is known as the “silent stalker” because of its unnoticed symptoms – classified by low bone mass and deterioration of bone tissue. Osteoporosis happens slowly, over years and is generally recognized when a slip or fall turns into a painful event due to bone fragility.  A combination of genetic, dietary, hormonal, age-related and lifestyle factors all contribute to this condition.  Women, especially over the age of 50, are the most frequent sufferers of the disease.  This is due in part to the slowing of estrogen during menopause.  Although there is no cure for osteoporosis there are ways to diagnose the early stages, be knowledgeable about preventative measures, and treatment options.

To diagnose osteoporosis, Covenant HealthCare offers Bone Density Testing at both our Mackinaw campus and State Street location.  Bone Density Testing measures the mineral content and density of a person’s bones.  The test involves extremely small amounts of radiation which determine the bone density of the spine, hip, finger, wrist, or heel. The Bone Density Test is simple, safe, painless and generally only take a few minutes.  Once the density has been measured, treatment options to prevent further bone loss can be administered. 

Risk Factors
A variety of factors can affect your chances of developing osteoporosis.  The good news is that you can control some of them.  Even though you can’t change your genes, you can still lower your risk with attention to certain lifestyle changes that will help build and maintain bone mass.  The younger you start, and the longer you can continue, the better. Controllable factors are:

• Get enough calcium and vitamin D.
• Engage in regular exercise such as walking.
• Don’t smoke.
• If you drink alcohol, do so in moderation.

A sedentary lifestyle, smoking, excessive drinking and low calcium intake all increase risk.

There are other factors that are not controllable but, by being aware of them, you can be more active in taking care of yourself by controlling the above noted factors.  Uncontrollable risk factors include:

• Ethnic Heritage - typically White and Asian women are at highest risk; African-American and Hispanic women are at lower, but still significant risk.  Men and women of other ethnic backgrounds can also develop osteoporosis.
• Age – individuals 50 years and older are at risk.
• Low body weight.
• Small bone structure.
• Early Menopause – estrogen deficiency in women who experience menopause before age 45, either naturally or resulting from surgical removal of the ovaries.
• Prolonged use of some medications such as excessive thyroid hormone; some antiseizure medications and glucocorticoids.
• Growth hormone deficiency in children and youth.

Prevention of Osteoporosis
Taking care of yourself beginning in early childhood and adolescent life is crucial to the formation of bone structure. By the age of 20 women have already developed 98% of their skeletal mass.   

Essential Vitamins
Calcium and vitamin D supplements are an integral part of all osteoporosis treatments. Vitamin D is a necessary nutrient in helping the digestive system absorb calcium.  Without it the digestive system will take calcium from your bones, causing them to weaken.   Fortified milk and sunlight are the best sources of vitamin D.  Other foods rich in vitamin D include fortified egg products, egg yolks, saltwater fish, and liver.

Calcium intake is critical and those that who need it most – young woman and girls – may not get enough.  Adequate amounts of calcium intake will increase bone mass, improve bone strength during growth and slow bone loss in postmenopausal women. Calcium is also needed for the heart, muscles and nerves to function properly.  Food sources rich in calcium include: milk, cheese, ice cream, dark-green leafy vegetables like kale, turnip greens, and broccoli, canned sardines and salmon, fortified cereal products and orange juice. 

Lifestyle Changes
Studies have shown that smoking lowers estrogen in a woman’s bloodstream therefore weakening the bones. Quitting smoking can help prevent osteoporosis.

Weight bearing exercise, such as walking or biking, helps build and maintain bone mass and muscle.  The greatest benefit for older people is that physical fitness reduces the risk of fracture because better balance, muscle strength and agility make falls less likely.  Exercise also provides many other life-enhancing psychological and cardiovascular benefits. The best exercises for your bones are walking, jogging, stair climbing, racket sports, dancing, and hiking.  Bone loss can occur anytime bones are inactive. Just 30 minutes of exercise a five times a week will help reduce the risk of bone loss.  

Diagnosis
Changes at menopause increase a woman’s risk and many physicians feel it’s a good time to measure a woman’s bone mass, especially if she has other risk factors for osteoporosis.  Routine x-rays can’t detect osteoporosis until it’s quite advanced, but other radiological methods can.

Bone Density Test
A Bone Density Test, offered at both the Covenant HealthCare Mackinaw and State Street location, can measure the mineral content and density of a person’s bones in the early stages.  Once the density has been measured, treatment options to prevent further bone loss can be administered.  The Bone Density Test involves extremely small amounts of radiation which determine the bone density of the spine, hip, finger, wrist, or heel. Bone density tests are simple, safe, painless and generally only take a few minutes. 

Ultrasound
A newer technique for evaluating bone strength involves using Ultrasound.  This method is generally used as a screening tool.  Results from ultrasound may determine of a Bone Density Test is necessary.

Treatment Options

Estrogen Replacement Therapy (ERT) has been shown to reduce bone loss, and increase bone density in the spine and hip. When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer). Physicians therefore recommend Hormone Replacement Therapy (HRT).  This is formed by the combination of estrogen and progestrogen.  Not only does HRT help maintain bone mass but it also increases bone mass and is great for cardiovascular health.

Calcitonin, an alternative to HRT, is a hormone produced in the thyroid gland that affects calcium levels and bone growth.  Calcitonin stops the breakdown and loss of bone mass.  This treatment is intended to stop or prolong bone loss and lessen fractures.  Calcitonin is available as an injection or nose inhalant.

Fosamax (alendronate) works by decreasing activity in the cells that cause bone loss.  Studies show that Fosamax can increase bone mass as much as 8 percent and reduce fractures as much as 30 to 40 percent.

Actonel (risedronate) and Evista (raloxifene) are other drugs recently approved by the FDA.  Both drugs have been shown to reduce the risk for fracture of the spine.

Sodium Fluoride , known for fighting dental cavities, has been shown to stimulate bone formation.  Debate has speculated about fluoride though.  Too much fluoride can cause digestive disorders and the structure of new bone was not as strong as normal bones.  

Remember, it’s always best to speak with your physician openly and honestly about your health concerns and what method of diagnosis and treatment is optimal for you.