Medical Matters

Osteoporosis
By Bill Acker, MD.
Walking Connection Member Since 8/94

Chapter 2 - Bones And How to Protect Them

This is part 2 of the series about “Bones and how to protect them”. This segment will explain osteoporosis and the extent of the disease within the United States.

What is Osteoporosis?
The word is derived from the Latin “OSTEO” meaning bone and the Greek “POROS” meaning porous or spongy. A formal definition was developed by the National Osteoporosis Foundation and the World Health Organization in 1994:

“A systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture.”

Let’s start with a lesson on bones and the skeletal system of the human body. Our bones are constantly changing. They are living tissue and are made up of collagen and a variety of minerals (most notably- CALCIUM). There is an underlying microscopic “lattice-like” framework to bone which accounts for its structural rigidity. Bone is formed from a cartilage “template” in youth.

Bone expansion and growth stops in young adulthood, but bone is continually “remodeled” throughout life. The bone mineral density (BMD) and strength of the bone normally increases until reaching a maximum in the late 20s. In middle life, the bone density begins to decrease, and this thinning and weakening of the bone tissue is particularly prominent in women after menopause.

Estrogen appears to have a protective effect on bone density. Men also can get osteoporosis, but it usually occurs later in life as men have greater bone mass than do women throughout life. There also appears to be some racial differences in the prevalence of the disease. Caucasian and Asian populations are at a greater risk for osteoporosis.

There are 2 basic clinical types of osteoporosis, primary and secondary. The primary type affects people without any definable cause or underlying medical condition. The secondary form of the disease is caused by a variety of medical conditions and medications. Both types cause weakening of the bones and susceptibility to fractures.

How big is the problem?

It is estimated that as much as 55% of the population over age 50 has diminished bone density, either mild (osteopenia) or severe (osteoporosis). This widespread problem could affect as many as 28-30 million Americans. The major risk of osteoporosis is a bone fracture associated with the fragile nature of the weakened bone. There are about 1.5 million fragility fractures each year in the U.S., including 700,000 vertebral (spine) fractures, 300,000 hip fractures, 200,000 wrist fractures and 300,000 fractures of other bones.
The prevalence of osteoporosis increases with age.

About 20% of women in their 60’s have osteoporosis, but over age 80, more than 70% have significant bone loss. The cost of osteoporotic fractures to society and to the individual is staggering. In 2002, treatment and loss of function cost approximately $17 BILLION, and this is projected to increase to $50 BILLION by 2040.

Osteoporosis is a silent disease with no symptoms until a fracture occurs. Here are some interesting facts about the most common types of fractures associated with decreased bone mineral density (BMD).

Hip Fractures:
· 95% require surgery
· 50% lose the ability to walk independently after surgery
· 66% never regain pre-fracture level of ordinary activities
· 25-30% need institutional long term care
· the rate of hip fracture is 2-3 times higher in females that males
· a woman’s risk of hip fracture is equal to her combined risk of breast, uterus and ovarian cancer

Vertebral fractures:
· only 30% are clinically evident
· cause back pain and functional limitation
· 5% of 50 year old females and 25% of 80 year old women will have at least one vertebral fracture ( this can lead to the stooped over deformity known as “Dowagers hump”)
· can cause loss of lung volume and respiratory problems.

Osteoporosis in men:
Men also lose bone mass with age, although not as rapidly as women experience with the decrease in estrogen at menopause. It is usually related to poor calcium intake, lack of exercise, or declining testosterone levels and age related changes in bone metabolism. Cigarette smoking, medications and low body weight may also play a role as it does in women. Although there are fewer hip fractures in men, they tend to have a higher mortality rate.

Fortunately, the loss of bone is a slow process and can be halted or reversed with proper treatment. Next time we’ll talk about risk factors, and how to diagnose bone loss. The final segment will discuss prevention and treatment.

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