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Osteoporosis Revisited by Ihor Magun, M.D., F.A.C.P. The natural history of bone formation is a constant remodeling - buildup and breakdown of bone. This is a continuous process, but not always a balanced process. With osteoporosis, the body loses bone faster than it can be replaced; hence, bone mass is decreased. As a result, bones weaken and become thinner. Frac tures are more likely to occur. The most common "fracture zones" associated with osteoporosis are the spine, the hip, and the forearm. Osteoporosis affects a large portion of our society. It is estimated that approximately 10 million people in the United States already have osteoporosis. It affects women at a rate four times greater than it affects men. Studies suggest that every other woman and one out of every eight men over the age of 50 will experience an osteoporotic fracture at some time. There are many factors contributing to osteo porosis. Genetics plays a role and so does race, with the white race being most at risk. Smoking, consuming large quantities of alcohol, and leading a sedentary life style increase the risk. Lack of adequate calcium intake during the first three decades of life is another contrib uting risk factor. Many people do not know they have osteopo rosis, because there are often no signs of it until a frac ture occurs. Forewarned, as they say, is forearmed, and it is a good idea to know if the condition exists. A painless bone evaluation called the DEXA measures bone density. The results of the test are interpreted as a T- score. A T-score of -2.5 or below indicates osteopo rosis. A T-score between -1 and -2/5 indicates some decreased bone density or osteoperia. A T-score of -1 or higher indicates normal bone density. Treating osteoporosis with estrogen (hormone replacement therapy) was at one time considered the preferred therapy. Unfortunately, the evidence now shows that treatment with estrogen is not all that help ful. Estrogen therapy has also been linked to a number of other potential health problems, especially to poten tial increased risk for breast cancer. Several other treatment options currently ex ist. Among these are oral agents called bisphospho- nates. Two such agents currently available by prescrip tion are Fosamax and Actonel. Provided they are in gested as directed, they have a good safety record. Both are available in daily or weekly doses and both must be taken first thing in the morning with a full glass of water on an empty stomach. Nothing should be consumed for half an hour after taking the medica tion; it is important to remain in an upright position for the entire 30 minutes. A nasal spray known as Miacalcin is also available. Daily administration is required and it is commonly prescribed for individuals who cannot or will not tolerate orally administered medication. While the treatment is helpful, it is not as beneficial as the oral agents described above. Currently under investigation is a third option, a yearly intravenous injection of zoledronic acid. While this treatment by annual infusion is still experi mental, researches claim the results look very promis ing. As always, taking steps to prevent a medical condition is a good idea, and this goes for osteoporosis as well as other ailments. It is imperative, for example, to make sure that young individuals have the proper calcium intake during the crucial first thirty years of their lives. Additionally, ingestion of calcium should be a life-long commitment. Pre-menopausal women should be ingesting 1000 mg of calcium daily and post-menopausal women should take 1500 mg of cal cium daily. 1000 mg daily for adult men is considered sufficient. It is important to recognize, however, that cal cium ingestion is not sufficient for individuals with osteoporosis. For proper bone density to be maintained or strengthened, calcium should be ingested in con junction with proper medication. As we enter the holiday season, let's all raise a glass of milk and drink to better, stronger, and health ier bones!
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