Osteoporosis

Osteoporosis, a fall on an icy road, fractured hip, hospitalization, surgery, rehabilitation, nursing home……sounds tragic?

Yes. Falls among older adults, either at home or outside, have increased dramatically through out the world, says the British Medical Journal (BMJ). This is devastating to the patient and very expensive to our healthcare system.

In 1993, osteoporosis cost the Canadian health care system $465 million. This does not include the money spent on long term care ($563 million), and chronic care hospitals ($279 million).

The remodeling of bone (its formation and resorption) is a continuous process throughout life. When bone resorption exceeds bone formation, there is reduction in bone mass, density, and strength leading to osteoporosis.

In a review article in the Canadian Medical Association Journal, Dr. Brian Lentle says that a peak bone mass is achieved between the ages of 20 and 30 years. There after, men and women, lose bone at a rate of about 0.5 to 1 percent yearly. In fact, soon after menopause, a woman has 3 to 5 percent per year bone loss. The loss is less after the age of 65.

Can we prevent osteoporosis?

The Editorial in the BMJ says that regular exercise is probably the only method that may prevent osteoporotic fractures. Studies in animals and humans have shown that physical activity can increase bone mass, density, and strength.

The physical activity has to start early in life (before or at puberty) to have any beneficial effect in later life. The promotion of lifelong physical activity is essential, says the Editorial.

In one study, women aged 80 and over, strength and balance training reduced the rate of falling by more than 30 percent. Epidemiological studies have shown that both past and current physical activity does protect against hip fracture, reducing the risk by 50 percent.

Other studies have shown that estrogen deficiency plays a role in the loss of bone in post-menopausal women. Estrogen therapy reduces bone turnover. But many women are reluctant to go on this hormone because of side effects.

It has been shown that 50 percent of the women would prefer non-hormonal therapy (bisphosphonates). Some prefer to take Calcium, which helps sustain but not increase bone mass. Other medications used are: vitamin D and calcitonin.

How do you know you have osteoporosis?

There are number of methods, simple (x-rays and ultrasound) to sophisticated (dual energy x-ray absorptiometry) to measure bone density. Whether any of these methods should be used for screening or only for patients who are at risk of fracture remains controversial.

Osteoporosis continues to challenge the medical researchers. A literature search on the PUBMED revealed 17566 citations. This indicates that the last word is yet to come. If you think you have osteoporosis or are thinking of preventive measures then discuss this first with your family doctor. Do not consume large amount of Calcium or Vitamin D without medical advice. It can be hazardous to your health!

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