Osteoporosis, or thinning of the bones, (literally, porous bone) is the most common of all bone diseases. In the United States today, 10 million individuals already have osteoporosis and 18 million more have low bone density, placing them at increased risk for the disease.
Out of every five people with osteoporosis, one is a man. That's 2 million men with osteoporosis, most of who probably thought it was only a women's disease!
Fractures are the most common and serious complication of osteoporosis, typically of the hip or vertebra. In the elderly however, a fracture does not just mean a broken bone. Becoming bed ridden as a result of a fracture can lead to severe complications and often death.
Achieving and maintaining optimum bone health is not difficult if you follow a few simple steps, all of which have overall health benefits as well.
As with everything else in life, good bone health is a matter of balance. There must be a balance between the cells that form new bone and the cells that break down and remove old bone. To maintain healthy bones we must take in enough of the right bone building nutrients and avoid taking in too many bone robbing substances. And we must balance the non-active parts of our lives with activities that encourage strong bones.
Calcium and phosphorus (phosphate) are the main minerals essential to normal bone formation. The majority of calcium in our bodies, 99 percent of it in fact, is found in our bones and teeth. The other 1 percent is made available for some pretty important things like muscle contraction, nerve transmission, the secretion of hormones, enzyme production, blood clotting and wound healing and many other functions in the body.
The bones act as a storehouse for calcium and when there is not enough calcium in the blood to satisfy the body's need it is pulled from the bones. When there is more calcium than required, the excess (to a point) goes back into the bones. This dance is carefully orchestrated by the parathyroid glands, a set of four little glands that sit on the thyroid gland located in your neck. Under the influence of the parathyroid's hormones, calcium, phosphorous and vitamin D interact to maintain the integrity of our skeletal system.
Risk Factors for Osteoporosis
There are some risk factors for osteoporosis that you have no control over and many that you do.
Risk factors for osteoporosis that you have no control over:
Gender -- Five times as many women as men have osteoporosis (and women are twice as likely to break a bone as a result of osteoporosis than men).
Age -- The risk of osteoporosis increases with age.
Race -- Caucasians and Asians have higher rates of osteoporosis than other races.
Size -- Small-framed men and women, as well as those who are very thin, have a higher risk of osteoporosis.
Family history -- Having a parent or sibling with osteoporosis puts you at increased risk.
Medical history -- Diseases such as Crohn's and celiac disease and surgical procedures involving the stomach can affect your body's ability to absorb calcium. Other diseases involving glands such as the thyroid, parathyroid and adrenal glands can lead to bone loss due to excess production of their respective hormones.
Risk factors for osteoporosis that you can control:
Diet -- Ensure an adequate amount and proper balance of nutrients that support healthy bone formation. Everyone talks about getting enough calcium and although calcium is of major importance it is just one part of the equation. (More on this in Part 2.)
Exercise -- People who live sedentary lives are at higher risk of osteoporosis then those who lead more active lives. (More on this in Part 2.)
Alcohol -- Avoid excessive alcohol consumption. More than two drinks a day increases your risk of osteoporosis because it interferes with your ability to absorb calcium.
Drugs -- Corticosteroid drugs: Long-term use of corticosteroid drugs such as cortisone, prednisone and dexamethasone, which are prescribed to treat conditions like asthma, lupus and rheumatoid arthritis; antidepressants of the SSRI type (Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft); aromatase inhibitors (Arimidex, Aromasin, Femara) used in the treatment of certain breast cancers; and proton pump inhibitors (Prilosec, Prevacid, Nexium, Aciphex) used to treat esophageal reflux are all associated with an increased risk of osteoporosis. Depo-Provera, a commonly prescribed contraceptive, is also known to decrease bone density. It is used by more than 2 million women including 400,000 teens.
Tests for Osteoporosis:
Bone Density Test: When your doctor orders a bone density test, what you will typically be getting is a DEXA scan. This Dual Energy X-ray Absorptiometry scan is the standard test for measuring bone mineral density, typically at the hips and lower spine. The results are reported as a T-score which is a statistical analysis comparing your result with that of a healthy individual's bone mass when it is at its peak level. Normal is when your T-score is less than -1.0. Osteopenia, the term used to describe a decrease in bone mass but not enough loss to be considered osteoporosis, is when your T-score falls between -1.0 and -2.5. You are considered to have osteoporosis with a T-score of -2.5 and beyond.
Blood tests: Blood tests that are important screening tools for bone health are serum calcium and phosphorus and vitamin D. Most standard blood chemistry panels measure calcium but rarely phosphorus. I find this vitally important because it is the ratio of calcium to phosphorus which will tell us if there is a need for additional calcium in the diet or too little phosphorus for the amount of calcium already there. Vitamin D is best measured by the level of one of its main metabolites, 25-hydroxy-vitamin D.
Urine test: There is also a simple and inexpensive urine test that measures the break down by-products of bone being excreted by your body. The bone density scan shows us the actual bone mass at that moment in time. What it doesn't show us is if you are actively loosing bone or not. Done at the same time as a bone density test it allows us to know how aggressive we need to be with treatment. If there is no indication of bone loss on either test, you're doing great. If the scan is not yet showing any loss of bone but the urine test shows that bone is actively being broken down, or if the scan is showing that there is already some bone loss even though the urine test indicates no current bone break down, it's time to get going on a bone strengthening program. And if the scan shows a loss of bone mass and the urine test shows that you are actively losing bone, a more aggressive program is needed.
In the next installment I will discuss the different treatments for osteoporosis and how you can keep you bones healthy and strong.
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