From the library of

Frank Barnhill M.D.
 

Just in the United States, Osteoporosis or early thinning of bones through loss of bone density or mass, affects millions of women and hundreds of thousands of men yearly. Thousands will suffer spine and hip fractures and endure pain and difficulty walking, climbing stairs and even doing the normal daily things required to live independently.

This is very unfortunate, as most cases of osteoporosis are truly preventable. Just so you can understand this “quality of life changing disease” better, let’s take a closer look at specifics of the disorder from the ground up.

Most of your bone mass or density (92%) was acquired by the time you were age 16. Food intakes of calcium and Vitamin D and growth related hormone levels determined how rapidly or slowly this process of “laying down bone” occurred. Obviously, it’s not easy to change hormone levels, but we do have control of the quality and quantity of what we eat. It is really important that both Vitamin D and Calcium dietary intakes be sufficient from birth to assure normal bone growth.

Vitamin D is necessary for the body to use calcium in “laying down bone”.
The term, “Laying down bone” refers to the process by which layer after layer of bone is literally laid down one on top of another to build a thickened strong bony structure. Under a microscope, bone has a woven lattice appearance. Without Vitamin D, such a bone would be much weaker and fracture or bend easily as in a condition called Rickets.

Women tend to develop osteoporosis at an earlier age due to factors such as menopause, fewer weight bearing exercises and work related bone stresses. In those with osteoporosis, compression fractures of the spinal or vertebral column are most common, followed by hip and wrist fractures.

The National Osteoporosis Foundation suggests screening should start at age sixty-five if you have never had a fracture in the above locations or have no other predisposing health factors. By the time osteoporosis or thinning of bones is seen on a regular bone x-ray, experts estimate at least 30% of your bone mass has been lost to the disease.

Screening for osteoporosis is best done by testing bone density and should cost no more than $30 to $35. A more intensive study called DEXA or dual energy x-ray absorptiometry may be required if your screening test is positive. DEXA is highly accurate and can be used to follow treatment progress every two to three years. Your doctor will receive what is called a T-score or a standard deviation from bone density compared to a healthy age 30 year old comparison graph as a result of your testing. T-scores of 0 to –1 are considered normal. A t-score of –1.0 to –2.5 is considered bone thinning or osteopenia and T-scores lees than –2.5 are diagnostic for osteoporosis or bone loss. Currently Medicare pays for bone densiometry treatment follow-up about every two years.

You are at risk of early osteoporosis if you have Cushing’s Disease, hyperparathyroidism, chronic renal insufficiency, multiple myeloma, COPD or emphysema and/or are taking long-term steroids or tetracycline for any disease. Then, regardless of your age, you will need screening for osteoporosis. Other life style factors, which predispose you to this terrible disease, are smoking, early menopause without estrogen replacement, poor exercise habits, excessive caffeine intake, and of course low calcium-vitamin D diets.

So, now that you understand a little about the problem, what can you do to solve it? Well, of course the best solution is to prevent osteoporosis, so you should discuss it with your children, grandchildren and friends. To help yourself, you should adjust your diet and lifestyle as follows:

If you use tobacco, stop smoking, dipping or chewing now. It’s the nicotine that affects bone growth!
Avoid excessive caffeine. Caffeine is nicotine’s first cousin!
Start a minimum three times a week weight bearing exercise program. Unfortunately, riding a bicycle and swimming do little to help osteoporosis.
Change your diet to include as much “natural” calcium and Vitamin D as possible. Good sources are milk products and eggs. If you can’t use natural sources, then “fortified” foods are next best.
Lastly, you may opt for vitamin and mineral supplements. For more info on calcium and Vitamin D see our article: “Calcium, Bones, Vitamin D, and Stones”.
If you are already experiencing the low back and joint pains of osteoporosis, your doctor can help by prescribing medications such as Fosamax, Actonel, Evista, and Calcitonin to help in treatment of this disorder. These mostly help retard the loss of further bone and build little new bone. Calcitonin can be used nasally to relieve the pain of vertebral-spinal compression fractures and can slightly improve bone density over a period of two to three years.
A new drug, Teriparatide (Forteo) can be injected daily just under the skin over a couple of months to improve bone density rapidly.

Once any therapy has begun, your doctor will probably delay your next DEXA for two years, since doing the test earlier will not detect adequate bone density changes. Remember, your family physician is your best source of information and accurate diagnosis for osteoporosis and is your partner in the quest to help you live a long and healthy life.

Dr. Frank