Doctor's Blog

Osteoporosis
September, 2009

Osteoporosis is a disease of the bones characterized by low bone mass and disruption of the bone architecture. These changes lead to abnormal thinning of the bones and an increased risk of fractures; particularly the hip, spine and wrists.

Nearly 44 million Americans, or 55% of people over the age of 50, either have osteoporosis or osteopenia (pre-osteoporosis). In 2005, osteoporosis-related fractures were responsible for an estimated $19 billion in costs to the health care system. The potential severity of the disease often goes unnoticed and untreated, leading to significant morbidity and mortality. Women are four times more likely than men to be effected.

Those at greatest risk for developing osteopenia or osteoporosis often fall into one or more of the following categories.

• Advanced age (especially women >65 years old)
• Female gender
• Caucasian or Asian background
• Menopause (including premature and surgical)
• Family history of osteoporosis
• Previous fracture with little or no trauma to the area
• Long-term steroid therapy
• Low body weight (ie. less than 127 lb)
• Cigarette smoking
• Excess alcohol intake
• Malnutrition or eating disorders like bulimia or anorexia

At risk individuals should be screened using dual-energy x-ray absorptiometry (DEXA), a type of full body low dose X-ray machine. Measurements are reported as T-scores. T-scores reflect the amount of standard deviations from the normal average, by comparing the patient’s bone mineral density to that of a normal average young person.

Category	T-Score =  Standard Deviation from Normal Average
Normal	Within 1
Osteopenia	Greater than 1 but less than 2.5
Osteoporosis	Greater than 2.5

      To improve overall bone health, all individuals are advised to quit smoking, limit alcohol intake, participate in 30 minutes of weight bearing exercise (weight lifting, jogging or walking) 3 times a week. Total daily intake of calcium and vitamin D should total 1000-1500mg and 800mg, respectively.

      In addition to lifestyle modification, persons with osteoporosis should be started on an oral bisphosphonate. Alternative medications for those intolerant of oral bisphosphonates include zoledronic acid (Reclast®), raloxifene (Evista®) and Forteo®.

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