By Dr. Mona Alqulali
Special to the Herald
January 21, 2009 09:46 am
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DEAR DR. MONA: My older sister has been recently told that she has severe osteoporosis in her spine causing her to become shorter. I am 45 and exercise regularly. How likely is it that I will have that same condition? Is there something I can do to prevent it? — Marcia
DEAR MARCIA: Many of us have recently heard that the age of 60 is the new 40! What a wonderful time we live in when many of the conditions and diseases of the past can be prevented or, at the very least, deferred. Osteoporosis can be one of those preventable conditions.
When you’re in your 40s or even much younger, keep in mind that what you do now can make a difference! Osteoporosis is a silent disease in which your bones weaken, become brittle and more likely to break. Most people don’t know they have it until they break a bone!
Although it is most common in women (80 percent of the cases), 25 percent of men over 50 will have an osteoporosis-related bone break at some point. Osteoporosis is usually the culprit in hip fractures as well as fractures of the spine and wrist, but any bone can be affected. Some fractures are permanently disabling causing severe back pain, shortened stature or a stooped posture (collapsed vertebrae). With osteoporosis, bones may spontaneously fracture, or fracture with a sudden step off a curb, minor bumps and falls, bending, lifting, or even coughing.
Let’s look at what bones are. They are living tissue consisting mainly of a framework of tough, elastic fibers of a protein called collagen and crystals of calcium phosphate mineral that harden and strengthen the framework. The combination of collagen and calcium phosphate makes bones strong yet flexible to hold up under stress. There are also living cells, including some that nourish the tissue and others that control the process known as bone remodeling which renews our bones throughout life.
When we are young, we add new bone faster than old bone is removed, allowing our bones to grow larger to support our larger body. We reach our peak bone mass in our early 20’s, influenced by genetic and environmental factors, including hormones, nutrition, and physical activity, allowing you some control over your peak bone mass.
To answer your question, this disease can strike at any age. Risk factors include aging, being small, thin and tall, having a family history of osteoporosis, taking medications (especially anticoagulants, anticonvulsants, glucocorticoid medications, chemotherapy drugs, methotrexate, lithium). Your diet from childhood on can make a difference — a diet low in calcium and vitamin D can increase your risk of osteoporosis and fractures. Excessive dieting or inadequate caloric intake can also be bad for bone health, as can alcoholism or heavy drinking. Those who seem to be in peak physical condition, such as female marathon runners, ballet dancers, and women who spend a great deal of time and energy working out at the gym may be at greater risk for osteoporosis due to caloric restriction.
In women, the reduction in estrogen production occurring in the menopausal years or with surgical removal of the ovaries causes more rapid bone loss. Women lose bone rapidly shortly after the onset of menopause and by age 65, men and women tend to lose bone tissue at the same rate gradually continuing throughout life.
So, what can you do to prevent bone loss?
Diagnosing osteoporosis involves a good physical exam and medical history, blood and urine tests, and a bone mineral density assessment. If you have back pain or have experienced a loss in height or a change in posture, your doctor may request an x ray of your spine to look for spinal fractures or malformations due to osteoporosis. However, x rays cannot necessarily detect osteoporosis.
Once osteoporosis is diagnosed there are drugs that can be prescribed such as Evista (having actions similar to estrogen and with the same side effects), Actonel, Boniva, and Fosamax (also available as generic). One of the newest and perhaps most effective medications is Reclast, given once annually as a 15 minute infusion in the office. This drug improves bone strength and reduces fractures. Forteo is another new medication used for men and women at high risk for fracture.
However, Marcia, the best thing you can do now is to assure good nutrition, adequate caloric intake and plenty of calcium. Calcium supplements (calcium citrate and calcium gluconate) with vitamin D to help in absorption are also recommended. The National Institutes of Health encourages women who are still menstruating, or who are postmenopausal but taking hormone replacement therapy, to get 1,000 mg of calcium each day. This jumps to 1,200 to 1,500 mg per day for pregnant or breastfeeding women. Postmenopausal women not on hormone replacement therapy should get 1,500 mg/day.
Good luck, Marcia, and keep your bones strong!
Dr. Mona Alqulali is a board certified OB-GYN.
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