Article Written by Ronald W. Orso, M.D., FACOG, FACS
Osteoporosis causes bones to become weak and brittle-so brittle that a fall or even mild stresses, such as bending over or coughing can cause a fracture. As we age, both men and women lose bone strength, but an abnormal loss results in osteopenia and then osteoporosis. Osteoporotic fractures usually involve the hip, wrist and spine. It affects women six times more often than men and is especially prevalent after menopause. White and Asian women are at highest risk. Fractures are responsible for considerable pain and disability and one in every five women over age 65 that fall and fracture a hip will die from the event within the next 12 months. For those who don’t die from the fracture, many will fracture the other hip within the next 24 months and it is usually the beginning of a long downward spiral of decreasing health and mobility.
Who is at Risk of Osteoporosis?
Bone is living tissue that is constantly being formed and broken down. Normal bone density increases during childhood and peaks by about age 25. This is why it is so important that our children’s diets be rich in foods high in calcium and vitamin D. The higher the bone density, the stronger the bones become. Bone density is then maintained from age 25 to 35 but after age 35 men and women both lose about 0.4% of their bone density per year as part of the normal aging process. Estrogen is important in maintaining bone density in women. During the first ten years after menopause, women can lose up to 4% per year. This accelerated bone loss is referred to as post-menopausal osteoporosis. This is true even in women who are totally asymptomatic and in good health and have no major risk factors.
What are the Risk Factors of Osteoporosis?
Key risk factors of osteoporosis include:
- genetics
- thin and small frames
- excessive alcohol intake
- lack of exercise
- poor diet
- high or low thyroid function
- insufficient sunshine
- nicotine addiction
- and chronic steroid use.
Bone is made of protein, collagen and calcium. When we do not receive 1200 mg of calcium per day in our diet, our bodies have to take calcium out of our bones to carry on other important body functions such as muscle contraction and blood clotting. The best way to obtain calcium is through a dairy rich diet, but for those who cannot tolerate milk, calcium supplements are essential. Excluding dairy products, the average American diet has approximately 250 mg of calcium per day. An 8 ounce glass of milk has 300 mg of calcium and an 8 ounce serving of yogurt has 450 mg. Approximately half of American females are deficient in vitamin D and our bodies cannot absorb calcium without adequate levels of this important vitamin. The source of vitamin D is mainly through our diet and through sunshine. Everyone should avoid sun excess, but reasonable amounts are beneficial. For those low in vitamin D, supplements of 1000 to 5000 units per day are suggested.
One of the worst risk factors for osteoporosis is nicotine addiction. Smoking is a major risk factor for heart disease, peripheral artery disease, lung cancer and brittle bones. Lung cancer has now replaced breast cancer as the #1 cancer killer in women. It also has replaced prostate cancer as the #1 cancer killer in men. Smoking cessation is essential in the treatment and reversal of osteoporosis.
When Should I Get Tested for Osteoporosis?
The National Osteoporosis Foundation recommends bone mineral density testing or DEXA scans for patients that are high risk and for everyone over age 65. This is a ten minute, in-office test that is available in our office at Birmingham Ob-Gyn.
How Can I Prevent or Treat Osteoporosis?
Lifestyle modifications are important in the prevention and treatment of his disease. A calcium rich diet and vitamin D supplementation are essential. Weightbearing exercises, mild sun exposure, smoking cessation and reduction of excess alcohol intake are required to treat osteoporosis. Fall prevention techniques for the elderly, such as removing throw rugs, use of nightlights, avoiding being outside in icy or snowy weather, and stopping use of high-heel shoes are encouraged for those that are at high risk for falls.
Osteoporosis can be treated and with aggressive management can be reversed. Various medications that stop bone loss, such as Evista, Fosamax, or Actonel are available in oral form. Injections such as daily Forteo, yearly intravenous Reclast, or intramuscular Prolia every six months are powerful agents that can reverse this disease. However, these medications do not work without proper calcium and vitamin D. Hormone replacement therapy at menopause can also help to prevent further bone loss.
Osteoporosis Testing and Treatment For Women in Birmingham
You can do a lot to keep your bones strong and to treat them if they are brittle. Our physicians are dedicated to the diagnosis and treatment of this important aging process and will be glad to help you with any concerns. Please contact Birmingham Ob-Gyn if you think you are at risk of osteoporosis.