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Osteoporosis Update
Approximately 1.3 million osteoporosis related fractures occur each
year. 20% die from this condition, 25% require long-term care, and
50% have loss of mobility. It is associated with back pain,
deformity, and depression.
Risk factors
Premature menopause, small or slender build, white or Asian descent
are at higher risk. Behavioral factors include cigarette smoking,
excessive alcohol intake, and eating disorders. Medications such as
steroids, heparin, anticonvulsants, methotrexate, and excessive
thyroid hormone raise one’s risk.
Testing
Bone
mineral density measurement (BMD) is the gold standard for diagnosis
and follow-up. A T-score of -1.0 to -2.5 indicates osteopenia, while
a score of over -2.5 is considered consistent with osteoporosis.
A
Z-score over -2.5 requires testing for secondary causes such as
liver enzymes, parathyroid hormone, and a 24 hour urine collection
to check for calcium loss.
Women
over 65 years of age, those with a history of non-vertebral
fractures, and 1st degree relative with osteoporosis,
should be screened. Those with osteoporosis on therapy should have
testing every two years.
Lifestyle Approaches to
Management
Balanced
diet with adequate calcium and vitamin D should be started during
adolescence. 1000 mg. of calcium for women who are premenopausal or
on hormone replacement therapy; 1500 mg. of calcium for those not on
hormones. Best food sources include milk, yogurt, broccoli, nuts,
and soy products. Avoid carbonated beverages. There is conflicting
scientific data for the use of magnesium or isoflavones. 400 IU of
vitamin D is adequate.
Exercise
improves BMD such as walking, running, high-impact aerobics.
Swimming and cycling are less helpful.
Smoking,
as well as more than 7 drinks per week, increase bone loss.
Modification of these habits is essential.
Drug Therapy
Estrogen
replaces bone lost through turnover and resorption.
Evista (raloxifene)
prevents vertebral factures in 35-50% of patients and is recommended
for postmenopausal women without hot flashes, but with bone loss or
osteoporosis. Side effects include hot flashes, leg cramps, and
blood clots.
Bisphosphonates include Fosamax and Actonel. These drugs increase
spinal BMD by 8% and hip by 4% which reduces spinal fractures by 50%
and non-spinal fractures by 35-50%. Currently, these drugs appear
to provide the most robust fracture protection of all treatments
available. Most common side effect is an upset stomach. If a
patient stops using this drug, studies indicate that protection
persists for at least two years. There are no long term adverse
effects.
Practice Good Bone Health
Remember
to increase your intake of calcium rich foods, exercise, moderate
your alcohol intake, stop smoking, and screen for osteoporosis with
a BMD every few years. |
