Early Screening For Osteoporosis Can Be Lifesaving

By Dottie Evans

Older people dread falls and for good reason.

A hip fracture is something that happens to many over the age 70, and especially to women in that age group. It is associated with loss of independence and the need to go into a nursing home, which is not necessarily a place anyone wants to be at an advanced age.

Dr Michael Spiegel, of Arthritis Associates of Connecticut and New York, spoke rather bluntly about the role that osteoporosis plays in this scenario during an interview held at the Bee recently.

“It’s a disease that 3causes bones to lose mass and become brittle, and its most feared complication is hip fracture. A person with a hip fracture can end up in a nursing home and not leave.”

Dr Spiegel has been in practice for 17 years and he has lived in Newtown for six years. He received his medical degree at the State University of New York in Brooklyn, and he completed his residency training at St Francis Hospital in Hartford. After finishing his rheumatology training at Brown University Medical School, he joined Dr Kenneth Miller and Dr Jerry Green at Arthritis Associates with offices in Danbury and New Milford.

“My specialty is rheumatology and osteoporosis with an emphasis on clinical research,” he said, adding that he especially likes helping people with osteoporosis because of two very hopeful factors: There is a very reliable screening method for diagnosing osteoporosis in its early stages, and there are several pharmaceutical options for preventing further bone loss or even reversing the trend.

“I work with the pharmaceutical companies to research new drugs,” Dr Spiegel said, “and luckily, we’ve got the best screening tool possible right in our own office, which is the DXA or bone density machine. Every woman who is going through menopause should have a bone scan and then repeat the test on an average of two years, depending upon the findings.”

There is no recommended screening age for men, he said, “but that doesn’t mean they don’t get osteoporosis. It turns out 20 percent of our patients are men, though it doesn’t show usually up until after age 70.

“The DXA machine measures loss or lack of bone –– and where it’s beginning to thin, the machine picks it up. When bone loses its infrastructure, it becomes more like Swiss cheese than a tightly woven lattice,” Dr Spiegel explained.

The word osteoporosis literally means bone (osteo) that is porous or filled with holes (porosis), and the disease affects approximately 28 million people, 80 percent of which are women.

Bone is a constantly changing, living tissue with a honeycomb-type structure that is packed full of calcium and mineral deposits. During a lifetime, bone is constantly being rebuilt with peak bone mass reached at age 25. By age 40, bone mass begins to decline and after menopause, women lose bone mass rapidly due to a loss in estrogen.

“That’s why the DXA screening is so important. We want to diagnose before the onset of a fracture, and the good news is that there is very effective medication for stopping and reversing bone loss.”

Medication Options

The first category of medications known as the bisphosphonates include Fosomax, Actonel, and Boniva. These are not hormones and they do not affect anything other than bone, according to Dr Spiegel.

Another category is the selective estrogen receptor modulators (or SERM drugs).

“Currently, Evista is the best known of these that has been approved for treatment of osteoporosis. It has the potential to provide other benefits since it is the mirror image of estrogen, and it may reduce the risk of breast cancer.

“A definitive study is underway with 20,000 women participating that compares Evista to Tamoxofin and the results should be out in 2006. I’m very excited about the possibilities here. I predict the results will be big news when they come out,” Dr Spiegel said.

In addition, Evista is being studied for its ability to reduce the risk of heart attack and strokes.

A third drug is Forteo, which he described as a parathyroid hormone for osteoporosis in men and women.

“It works on bones and is the only drug that has been shown to rebuild the microarchitecture. It’s very  new on the market –– only out for two to three years –– and it is given by injection.”

Dr Spiegel summarized the fight against osteoporosis the following way:

“Beyond having regular DXA screenings or taking any of these medications, my message to your readers is this. Take calcium, 1,200 to 1,500 mgs a day, and vitamin D, 400 to 800 units a day.

“Walk and do weight-bearing exercises because that builds strong bones. If you have strong bones you are less likely to fall. Falling is the result of a lot of things in combination –– difficulties with vision, sensation, balance, internal strength, and arthritis.”

Other risk factors for osteoporosis include genetics and heredity, having a small frame, and being a  heavy alcohol  user.

“Smoking is the worst of all –– mind-bogglingly bad,” Dr Spiegel said, because smoking lowers calcium absorption and lowers women’s estrogen levels meaning an earlier onset of menopause.

“You might not be able to correct all of these risk factors, but you can stop smoking and you can work on the bones.”