WHAT IS OSTEOPOROSIS?

By its definition osteoporosis means “porous bones.” This condition occurs when bone density decreases, when the body stops creating bone mass, or a combination of the two. The result is weaker bones which increases the risk of fractures – during a fall, or even in a minor event.

WHO’S AT RISK?

While both men and women are affected by osteoporosis, post-menopausal women are more susceptible due to sudden decrease in estrogen. Other risk factors include:

  • Age: Bone density peaks around age 30 and after the age of 35 bones tend to become weaker.
  • Diet & Lifestyle: Tobacco usage, alcohol intake, diet and daily activity levels all contribute to overall bone health.
  • Bone Structure: Body types that are tall (above 5’7”) or slim (under 125 lbs) have an increased risk of osteoporosis.
  • Medications: Some medications can reduce bone mass. Glucocorticoids and corticosteroids (i.e. prednisone) is the most common type of drug induced osteoporosis.
  • Health Conditions: Cancer, thyroid issues, gastrointestinal diseases, COPD and other conditions can contribute to lower bone density.

While not all of the risk factors for osteoporosis are under our control, living an active lifestyle with a diet rich in calcium and Vitamin D is a great preventative measure.

WHY IT MATTERS …

Osteoporosis is a growing problem in the US. Currently 1/3 of women and 1/10 of men over the age of 55 will experience a broken bone as a result of the condition. These injuries include roughly 1.7 million hip fractures reported each year. By 2050, that number is expected to rise by 4 times.

This is not something that should be taken lightly, as hip fractures can severely impact quality of life. They often require major surgery along with prolonged rehab treatment. In a worst-case scenario, some patients wind up in nursing homes. To put it into perspective – 50% of women who fall and break a hip will never walk again, and 50% of men that fall and break a hip will die within one year.

PROPER TREATMENT

There are many options available for optimal bone health, but not all of them are created equally. Here are some of the benefits and challenges with each option …

  • Calcium: As most of us know, calcium is an important mineral to keep our bones strong at any age. The issue is that getting the appropriate amount of calcium isn’t as easy as drinking a bunch of milk. It must be combined with other nutrients and in many forms, it’s difficult for the body to absorb. We recommend Calcium Hydroxyapatite as our preferred form.
  • Biophosphonates: This class of drugs has proven successful in reducing the risk of fracture in post-menopausal women with osteoporosis. However, side effects after five years of usage include atypical fractures, osteonecrosis of the jaw bone and GI issues.
  • Hormone Therapy: Estrogen can maintain bone health, progesterone can aid in building bone, and testosterone can help with strengthening. Current statistics show that 93% of women who don’t take estrogen will have a fracture by the age of 85.

A CASE FOR HORMONE THERAPY

Compared to other treatment method there have been numerous medical studies indicating that hormone therapy positively impacts bone mass density in post-menopausal women. Here are some of the statistics …

  • After one year, bone density increased by 5.7% at the spine and by 5.2% at the neck of femur in those women who changed from oral estrogens to hormone implant therapy. Bone density remained unchanged in those women who continued with oral therapy1.
  • In a four year study, a group of 72 post-menopausal women with established osteoporosis were treated through a variety of methods, including hormone replacement therapy (HRT). The HRT treatment group realized a 0% increase in lumbar spine bone density and a 4.8% increase in the hip. Results were even more dramatic when HRT was combined with bisphosphonates2.
  • In a study of 35 women with a mean age of 67 years, those treated with estradiol implants for a mean duration for 16 years had a 20 to 25% higher bone mass density (BMD) at all measurement sites – distal radius, lumbar vertebrae, and femoral neck3.
  • After monitoring 12 surgically menopausal women for two years, it was determined that subcutaneous 17 beta-estradiol pellets can effectively maintain the bone mineral content of surgically menopausal women without inducing adverse cardiovascular side effects4.
  • Over a three year period, 29 post-menopausal women were treated with estradiol implants. On average the group saw a 2.4% increase in total body calcium, a 3.3% increase in spinal bone mineral density, and a 1.2% increase in radial bone mineral content5.

NEXT STEPS:

If you’re over the age of 50 or have other risk factors, the National Osteoporosis Foundation recommends diagnostic testing. Our team at Amy Brenner, MD & Associates is here to help you assess your overall bone health and, if necessary, determine a treatment plan that’s right for you. Give us a call to set up an appointment or to find out you’re at risk for osteoporosis.

– Sources – 

  1. Br J Obstet Gynaecol.1992 Sep, King’s College Hospital, Denmark Hill, London, UK.
  2. Am J Med.1998 Mar, Department of Medicine, Royal Postgraduate Medical School, London, England.
  3. Br J Obstet Gynaecol.1993 May, Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden.
  4. Obstet Gynecol.1987 Nov, Center for Climacteric Studies, Inc., Gainesville, Florida.
  5. Clin Endocrinol (Oxf).1994 Jan, Department of Medical Physics, Singleton Hospital, Swansea.
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