Osteoporosis affects nearly eight million women and two million men in the United States, and its incidence is only increasing as the population ages. It is a metabolic bone disorder in which a progressive decrease in the density of bones weakens them and makes fractures more likely. Instability and loss of strength in the aging process causes falls which, combined with weakened bones, can cause fractures, resulting immobility, and sharp increases in both morbidity and mortality.
Most people reach a bone mass and strength peak between the ages of 25 and 30. From this point forward bone resorption and remodeling causes changes in the actual bone structure. The body draws calcium from the bones in ongoing ways to support such essential body functions as heart contraction, muscle strength, blood clotting, nerve responses and countless other necessary metabolic functions. Calcium is absorbed when needed and then replaced in the bones when the level in the body is too high by means of a constant feedback system through various hormones that are either stimulated or suppressed depending on body requirements. These changes happen every minute of every day and react to body needs.
After awhile, more bone is broken down than is remodeled, as the process of aging proceeds. The density of bones decreases slowly, and if the body is unable to maintain an adequate amount of bone formation, the bones lose density and become increasingly fragile. This process leads to osteoporosis. Peak bone mass is determined by many factors which include gender (females are more affected than males), genetics, exercise and nutrition. While men lose bone in a linear fashion as they age, females suffer a rapid loss right after menopause, when the sudden loss of estrogen (which is bone protective) is lost. That loss, along with a more haphazard process of bone remodeling, increases susceptibility to osteoporosis at this time in life going forward.
Osteoporosis is defined by measured bone mass. Measured bone density within one standard deviation of average is considered normal. Osteopenia is a condition in which bone mineral density is between 1 and 2.5 standard deviations below the reference value of normal.
Osteoporosis is defined as 2.5 or greater standard deviations below normal, and severe osteoporosis is diagnosed by fragility fractures (meaning those from mechanical forces that would not usually cause damage).
To this point we’ve defined primary osteoporosis. Secondary osteoporosis results not only from normal aging but secondary to other systemic diseases. These include chronic kidney failure, endocrine disorders such as diabetes, thyroid and parathyroid disorders, and those where body nutrition is compromised. Medications such as corticosteroids or anti-epileptic drugs, when administered chronically, likewise increase the risk of osteoporosis.
Most X-rays don’t show bone loss until at least 40 percent of bone mass has been lost. Bone mineral density is better and more accurately measured with a scan called a DEXA scan, which uses double energy X-ray absorptiometry. The National Osteoporosis Foundation recommends testing for all men over 70 and females over the age of 65 at least once, although earlier testing may be done in those with chronic disease or medication administration which facilitates osteoporosis or a history of fracture at an earlier age not commensurate with the trauma that caused it. Females with surgically induced menopause (when uterus and ovaries are removed) have a sudden drop in hormone levels and are candidates for earlier testing as well.
As it is a silent disease without symptoms in earlier phases, osteoporosis is underdiagnosed, underreported and undertreated. Those at higher risk of osteoporosis or with apparent bone density loss diagnosed by X-ray or DEXA scan should supplement their diet with 1,000-1,200 mg calcium and 800 IU vitamin D daily. Other medications are reserved for more severe cases. Increased physical activity, especially weight-bearing activities, smoking cessation, and limited alcohol consumption are also helpful. Osteoporosis is generally a condition that doesn’t require an insurance rating unless there are repeated fractures or incomplete recovery from same, or a marked decrease in stability and everyday function. Osteoporosis, particularly progressive and untreated, contributes to impaired mobility and is a leading cause of mortality in older ages.
