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OSTEOPOROSIS — THE SILENT DISEASE BY IHOR MAGUN, M.D., F.A.C.P. Osteoporosis, a word derived from the Greek lan guage, is the reduction in the quantity of bone. It is estimated that about 25 million people in the United States of America, 80% of them women, are affected by this disease which results in 1.5 million fractures annually. The most common sites of fracture are the spine, the hip and the arm, but any bone may be involved. Some vertebral fractures occur during routine daily activites and may not involve any specific trauma. Other involved areas are usually associated with a fall. Loss of height is commonly seen with vertebral fractures. Height loss can be as much as eight inches and spinal deformities may accompany these fractures. Other changes in the spine are due to structural defects that become more apparent with aging. Our peak bone mass is achieved between the ages of 30 to 35. There is an inherited genetic component that establishes this peak level. The bone mass in the later years is subjected to an age-related, environ mentally mediated loss. Some environmental influences and risk factors are modifiable and some are not. The nonmodifiable risk factors include gender (women), a small frame, positive family history, race (white), premature menopause (before age 45), other coexisting medical problems (diabetes, excess thyroid hormone, kidney problems, certain anemias, malnutri tion, chronic rheumatoid arthritis, hereditary bone or specific syndrome defects) and certain medications. Modifiable risk factors include minimal regular physical exercise, poor calcium intake, cigarette smoking, increa sed caffeine intake, and excessive alchohol intake. If you are at risk for osteoporosis, the goal is behavior modification — increase calcium intake, increa se exercise and reduce or eliminate factors, such as smoking or excessive alchohol intake, that contribute to bone loss. The National Institute of Health Consensus Confe rence on Optimal Calcium Intake recommends the following totaly daily calcium intake (in mgs.): AGE MEN WOMEN 11-24 1200-1500 1200-1500 25-50 800 1000 51-65 1000 1500 (1000 if taking estrogen) over 65 1500 1500 (1000 if taking estrogen) Best absorption occurs in divided doses when taken with meals. Calcium carbonate is the most commonly recommended supplementation but may cause bloating and, in some individuals, constipation. Calcium citrate is recommended for individuals with a history of kidney stones. These supplements should be taken only with the consent of a physician. Dairy products do contain calcium but it is also present in vegetables such as broccoli and in numerous greens. Excessive fiber ingestion can speed elimination of calcium, and caffeine, salt, protein and carbonated beverages increase excretion of calcium from the body. A final note on behavior modification and risk reduction must include estrogen replacement therapy. This recommendation should be discussed with your physician as there is contradictory evidence regarding estrogen replacement (with or without progesterone) with an increased risk of cancer. The use of hormonal supplementation slows bone loss and maintains bone mass at levels much higher than with calcium supple mentation alone. The benefits continue only as long as estrogen is taken orally. Other calcium therapies are available, but are beyond the scope of this article. How can an individual go about finding the status of his or her bone mass? The preferred method is known as DEXA which stands for Dual-energy X-ray absorption absorptiometry. The test takes only several minutes to be completed, has good precision and a low radiation dose. Routine x-rays done for other reasons are not a suitable screen for osteoporosis but only confirm osteopenia — decreased calcification of bone. The results of the DEXA test must be interpreted in the correct context and must be individualized. It is not by all means necessary for everyone, but it provides information that will be of use for future repeated studies. Studies show that nearly 40% of postmenopausal women have normal bone density in their 50’s but go on to fracture sometime in their lifetime. These repeated studies would be most beneficial in such cases. Addi tional blood testing as well as special urinary studies focusing on calcium excretion are also available. ’’НАШЕ ЖИТТЯ”, ЛЮТИЙ 1996 19
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