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Osteoporosis
Osteoporosis: What Every Woman
Needs to Know
Roger H. Emerson, Jr. MD.
Osteoporosis is a condition of weakened bone sometimes called
brittle bone disease. The bone that is present is biologically
normal, but there is a deficiency on the amount of bone substance.
There are other very rare conditions where the bone is not
normal, and may or may not be mechanically weaker.
According to the National Osteoporosis Foundation, it is
estimated that half of white women will experience at least
one osteoporosis-related broken bone in their lifetime. These
fractures come about from the loss of bone substance, most
of which is lost after menopause. Men and other women are
more protected, but from time to time can also have osteoporosis.
While our main interest at the Texas Center for Joint Replacement
is artificial joints, there is a close relationship between
the strength of the bone supporting the joint prosthesis and
the long-term success of the implant. We are only now realizing
how important the surrounding bone is in protecting the joint
implant from loosening and other damage. Patients with weaker
bones are more likely to have a problem with their joint prosthesis.
This bone strength is one of the things we monitor when you
come for an implant check. The good news is that much can
be done to maintain good bone strength, and new treatments
are on the way. Most of the lifestyle modifications and treatments
that your medical doctor has recommended for your overall
skeleton will also benefit the supportive bone around your
implant.
Typically bone loss starts after menopause, and progresses
over time. All bone loss is bad, but as bone loss progresses,
complications can arise, such as fractures, curvature of the
spine, and back pain. While some risk factors for osteoporosis
and not under our control, such as age, gender, ancestry,
and family health history, other risk factors can be affected
by our behavior. These include smoking, excessive alcohol
consumption, lack of exercise, and avoidance of calcium-rich
foods. If you have suffered a bone fracture, especially of
the hip, wrist or spine, bones that are most frequently involved
with osteoporosis, you probably already have some osteoporosis.
In this circumstance, treatment for bone weakness is justified
and is very important.
If you have one or more of these risk factors for osteoporosis
and are under age 65 years of age, then the National Osteoporosis
Foundation recommends that you have your bone strength measured.
All women over age 65 should have their bone strength tested.
This is a covered service by Medicare and all Medicare HMOs.
Most other insurance plans will cover this test also. If your
bone is strong, then no special treatment will be needed.
Mild loss of bone strength can be observed without any special
treatment, although weight-bearing exercise and calcium-rich
diet are good ideas.
Bone strength is assessed with a bone density test, somewhat
like a bone x-ray. A special machine measures the resistance
of the bone to an x-ray beam or ultrasound waves. The best
tests are those which measure the strength of the spine or
hip, but newer tests of the heel bone are becoming more popular.
The test gives a bone thickness measure, or bone mineral density.
This reported as a T score, which compares the patient's bone
being tested to that of a normal woman. The actual score is
a number, usually from 0 to 3 or 4. If the number is positive,
the patient's bone is stronger than expected for a normal
young woman, or negative, weaker than expected. For example,
a T score of -1 to -2.5 is of concern, whereas below -2.5
means there is significant osteoporosis, with an increased
risk for a fracture.
Simple measures that are important for good bone health is
an adequate dietary intake of calcium, 1200 mg per day is
recommended. An 8-ounce glass of milk has 300 mg of calcium.
The amount of calcium in foods is included on the labels.
TUMS is a popular source of calcium, with 200 mg in each wafer.
Along with calcium, it is important to take at least 400 units
of vitamin D, found in all over-the-counter multivitamins.
Another simple measure is to get daily weight-bearing exercise,
such as a walking program.
Medical treatment of osteoporosis is targeted at decreasing
the amount of bone removal by the body that occurs after menopause.
The mainstay of this type of treatment has been estrogen-replacement
therapy. Newer drugs that are not hormones can be used when
hormone replacement is too risky, associated with too many
side effects or is not working to maintain bone strength.
After treatment is started, a bone density test should be
repeated every two years. If drugs are necessary for bone
maintenance, they may be necessary for a lifetime, although
this has not yet been determined.
Diet
Goal: 1200 mg of calcium
Milk, 8 oz - 300 mg
Cheese, 1 oz - 200 mg
Yogurt, 8 oz - 400 mg
Calcium-fortified orange juice
Calcium pills (Calcium carbonate, calcium citrate)
Goal: 400 to 800 units per day Vitamin D
Multivitamins, 400 units/tablet
Fortified milk, 400 units/quart
Lifestyle
Exercise
- Low-impact, weight bearing best
- Walking, Nordic Track, treadmill
- Aquatic program
Avoid smoking
Avoid sudden rapid movement, heavy lifting Limit alcohol
Medications
Hormone (Estrogen) Replacement Therapy, (HRT)
Least expensive, proven efficacy enhanced with calcium (1000
mg, Vit. D)
Protective for heart disease, bladder problems, dementia
Reduces hot flashes (climacteric symptoms)
Side-effects: vaginal bleeding, breast tenderness, venous
thrombosis (blood clots), gall bladder problems
Concern about uterine cancer, diminished if estrogen combined
with progestins
Concerns about breast cancer, possible increase after 5 years
of use if younger than 65, possible increase after 10-year
use if over age 65
Aldendronate (Fosamax)
If cannot take HRT or fail HRT
FDA approved, 5 mg prevention, 10 mg treatment
Very effective, expensive, $55/month
Strict guidelines for taking, (upright with water)
Side-effects: "heartburn", <1% esophageal ulcers
Calcitonin (Miacalcin)
If cannot take HRT or Fosamax
Less effective than Fosamax, more expensive,
$60/month
FDA approved for treatment
Side-effects, minimal
Raloxifene (Evista)
If cannot take HRT
New class of drugs called selective estrogen receptor modulators
FDA approved for prevention
Side-effects: precipitate hot flashes, same venous thrombosis
risk of estrogen
Benefits of estrogen without stimulation of uterine or breast
tissue. Same bone and heart benefits, $60/month
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