Osteoporosis is an important topic that has received much attention in recent years. According to the National Osteoporosis Foundation the risk of osteoporosis for women is equal to the risk of breast, ovarian, and uterine cancers combined. It is important to know the facts about this common disease, which can affect the quality of life for so many, particularly post menopausal females. Let’s go over the basics of this condition.
Osteoporosis is a disorder of very low bone mass causing bones to become thin, weak, and brittle. Osteopenia refers to the disorder where bone density is lower than normal but not severe enough to meet the criteria for osteoporosis.
Peak bone mass is usually reached between the ages of 18 and 30 because of calcium and estrogen’s effects on the skeleton. At approximately age 40, bone will start to break down faster than it is replaced, therefore causing a decrease in bone mass. This is especially true in the first five years after menopause when estrogen levels quickly decline.
This condition is not acutely life threatening but can lead to debilitating fractures of the hip, spine, and other sites like the wrist. Individuals are still at risk for fractures even if bone density is slightly decreased. These fractures may result in long hospitalization and rehabilitation periods. Osteoporosis is often referred to as a “silent disease” because there may be few or no symptoms prior to a painful fracture. For example, some individuals may experience moderate to severe back pain, loss of height, change in posture or development of a “hump” in the upper back.
Early diagnosis and risk assessment for osteoporosis is crucial. Below are the major risk factors for osteoporosis:
1) Age (older age, especially after age 50)
2) Gender (females are at higher risk than males)
3) Ethnicity (Caucasian and Asian females have higher risk)
4) Early age of menopause
5) Low bone mineral density detected by DEXA (T score of -2.5 or lower)
6) Prior fractures and falls
7) Family history
8) Body mass index (very thin people have higher risk)
9) Smoking and moderate to excessive alcohol use
10) Steroid use and certain medications
11) Chronic diseases such as rheumatoid arthritis, thyroid disease, chronic lung disease, multiple sclerosis, inflammatory bowel disease, and anorexia.
Other factors to be considered include vitamin D deficiency, inactive lifestyle, and low estrogen and testosterone levels.
Every patient at risk for osteoporosis should have the physician obtain a thorough clinical history and a bone density test (DEXA).
Recently the World Health Organization (WHO) has created an online tool called FRAX, which can be utilized to quantify a patient’s 10-year probability of a hip or major osteoporotic fracture by using bone mineral density and risk factors.
In conclusion, osteoporosis is a major public health problem that can result in fragility fractures that cause substantial disability, rising health care costs, and morbidity among postmenopausal women and older men. It is necessary to provide education concerning fracture prevention.
Magdalena Cadet, MD is the Director of Rheumatology and Osteoporosis Services
New York Hospital Queens and Assistant Professor of Medicine at Weill Medical College of Cornell University
