Physician’s Corner––

Osteoporosis: Thin And Brittle Bones

By: Christopher J. Cassels, MD

Osteoporosis –– thin and brittle bones –– is a condition that that affects millions of women, many of who are not aware that they have it. A serious and often debilitating disease, osteoporosis has become as common an ailment in women as is high blood pressure. Unchecked, the disease can result in debilitating back pain, spinal deformities, hip and other extremity fractures that can cause significant alterations in the quality of life.

The causes of osteoporosis are multiple, but far and beyond the most common cause is female gender. Human bones increase in strength and density through the early twenties, after which we lose bone mass gradually throughout the rest of our lives. Unfortunately, women suffer a sudden drop in bone density shortly after menopause, after hysterectomy, or with some other diseases affecting the female reproductive system. This occurs over a period of several years before the rate of bone loss resumes at the premenopausal rate. Hence, estrogen appears to be a major factor in controlling bone turnover.

Those who do not attain good bone strength by the early twenties will start out with a lower bone mass at the time we begin to lose bone and will develop weaker bones sooner in life. Many experts feel that poor childhood and adolescent nutrition is a significant contributor to developing osteoporosis in later adulthood. Gastrointestinal disorders such as lactose intolerance, celiac disease, and even eating disorders can also result in poor calcium intake and poor bone health. Short stature and weight below 125 pounds are strongly implicated as risk factors for developing this condition. A history of osteoporosis in a family member should trigger a concern for the condition in other family members.

Disease states such as diabetes and hyperthyroidism frequently predispose one to developing osteoporosis. Prolonged illness, some malignancies, and even prolonged immobilization will cause bone loss. Even certain medications, particularly long-term use of steroids, drugs to treat epilepsy, and some diuretics are known to promote this condition. Smoking is clearly implicated in the development of osteoporosis, as has been excessive alcohol intake.

The most common manifestation of osteoporosis is loss of height. We can all expect to lose an inch, perhaps even two by the time we reach 70, but those with osteoporosis will lose much more height and earlier in life. The cause is the gradual, sometimes painless collapse of the vertebrae in the spine. Sometimes the collapse is sudden and quite painful, often caused by a minor fall but sometimes by as simple an activity as trying to lift a stuck window. These fractures, though sometimes quite debilitating, are rarely life threatening. Multiple fractures, however, can result in a serious compromise to lung capacity. Once one has suffered one vertebral fracture, the risk of sustaining a second and third fracture increases significantly.

Fractures related to osteoporosis account for as many as 1.5 million fractures per year. While other bones can break, especially about the wrist, the most serious fractures occur in the hip. Statistics point out that 50 percent of patients who sustain a hip fracture will end up with a significant morbidity and only about 25 percent make it back to their prior level of activity. Almost 25 percent will die by the end of one year. The economical impact resulting from the treatment and long-term care following these fractures can be astronomical.

Treatment options are many, but the best treatment is prevention. Clearly, proper nutrition, weight-bearing exercises, and adequate intake of calcium and Vitamin D are the mainstays of maintaining bone health. The older we get, the more attention we have to pay to the prevention of falls. In the absence of any of the risk factors mentioned above, every peri- or postmenopausal woman should have at least one bone density study (DEXA) performed. Almost all insurance companies now pay for this simple though very important study. Those with other risk factors or disease states should have the test sooner in life.

Estrogen replacement therapy for postmenopausal women has been the gold standard in both preventing and treating the disease. Newer medications called bisphosphonates are quite effective in preventing and in some cases reversing bone loss. These medications can be used in conjunction with estrogens. Other medications such as calcitonin and raloxifine are also helpful but not felt to be quite as effective. A new medication, parathyroid hormone, is presently being studied as a treatment for severe cases. Some surgical treatments including injection of a “cement” into crushed vertebrae are showing promise.

Osteoporosis is fast approaching epidemic proportions. As we live longer we simply lose more bone mass. The condition is painless and, like high blood pressure, we often do not become aware of it until some unfortunate traumatic event occurs. Once this happens we often find ourselves on a downward cascade towards permanent disability and discomfort. Awareness is the most valuable tool we have to work toward prevention of this disease. For more detailed information, visit the websites of the National Osteoporosis Foundation (www.nof.org) or the American Association of Orthopaedic Surgeons (www.aaos.org)

Christopher Cassels, MD is a sports medicine and osteoporosis specialist at Danbury-based Connecticut Family Orthopedics.