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Osteoporosis

Osteopenia is defined as low bone mass. Osteoporosis is more severe loss of bone mass. The internal architecture of the bone becomes thinner and more fragile over time leading to an increased risk of fractures which may occur even in the absence of significant trauma. These fractures may occur in the wrist, spine or hip and result in significant morbidity, including pain; deformity; loss of independence; and reduced cardiovascular, respiratory, and even digestive function. Hip fracture has been associated with a 15 -20 % mortality rate within a year of fracture. 37 -50 % of US women aged 50 years and older have osteopenia and approximately 13 -18 % have osteoporosis.

Diagnosis

The World Health Organization has defined osteopenia and osteoporosis based on the measurements of bone density of the lumbar spine or hip using dual-energy X-ray absorptiometry (DEXA). The definition is based on the T-scores, a measurement comparing you to a mean peak bone density of a normal, young adult population (about 30 years old).

Normal T Score:
greater than or equal to -1
Osteopenia:
-1 to -2.5
Osteoporosis:
less than or equal to -2.5

Testing should be performed on the basis of an individual woman’s risk profile. It should be performed on all post menopausal women aged 65 years or older and recommended to postmenopausal women younger than 65 who have 1 or more risk factors for osteoporosis. Postmenopausal women with fractures should have testing to confirm the diagnosis of osteoporosis and determine the severity of disease.

Risk Factors for Osteoporotic Fracture in Postmenopausal Women

  • History of prior fracture
  • Family history of osteoporosis
  • Caucasian race
  • Dementia
  • Poor nutrition
  • Smoking
  • Low weight and body mass index
  • Estrogen deficiency
  • Early menopause (age younger than 45 years) or bilateral removal of ovaries
  • Prolonged premenopausal amenorrhea (no periods) > 1 year
  • Long term low calcium and Vitamin D intake
  • Excessive Alcohol intake
  • Inadequate physical activity
  • Certain medications, including long term steroid or thyroid usage

Treatment

Treatment may start with lifestyle changes including increased activity with resistance training/weight bearing at least 3 -4 times per week, limiting alcohol intake to no more than 1 -2 /day, avoiding excessive coffee and carbonated cola beverages and quitting smoking.

Adequate calcium and vitamin D intake are important in bone metabolism.

Recommended Calcium requirements

  • Premenopausal women: 1,000 mg
  • Postmenopausal women <65 using estrogen: 1,000 mg
  • Postmenopausal women not using estrogen: 1,500 mg
  • All women older than 65 years: 1,500 mg
Calcium is better absorbed when taken after meals and in divided doses.

Recent evidence suggests that many women are vitamin D deficient and the recommended daily amounts in the past (400 iu/day) have been too low. Supplementation with 1,000 -2,000 iu/day is probably needed to maintain normal vitamin D levels. Measurement of Vitamin D levels may be appropriate. Vitamin D deficient women may require larger (prescription) doses.

Medications are in general indicated in women with osteoporosis (T score less than -2.5), whether to treat women with a higher bone density (osteopenia) depends on additional risk factors. Options include:

  • Estrogen
  • Bisophosphonates (alendronate, risedronate, ibandronate)
  • Selective estrogen receptor modulators (SERMs) (raloxifene)
  • Parathyroid Hormone

More information is available at the following sites:
www.nof.org
www.nlm.nih.gov/medlineplus/osteoporosis.html
www.sciam.com/article.cfm?id=cell-defenses-and-the-sunshine-vitamin


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