Bone Up on Osteoporosis

Osteoporosis. The term glares out at us from newsstands, advertisements, and brochures in doctors’ offices. But just what does it mean and why is it important that we understand it? Following are a few facts.

What is osteoporosis?

Osteoporosis—or, literally, porous bones—is a common disorder characterized by thinning or decreased mass of the bones. It is most frequently manifest in increased susceptibility to broken bones. All the bones in the body may be affected; however, spine, wrist, and hip fractures are most common. These breaks often come after a fall, but they may also occur as the result of a simple twist, lifting motion, or cough.

What causes the condition?

The exact causes of osteoporosis are not fully understood. Bone is a living tissue that changes constantly throughout a person’s life. It consists of a framework of protein supported by minerals—largely calcium and phosphorus.

The growth and maintenance of bone tissue are complex processes that are influenced by a number of hormonal and chemical factors in the body. Such things as diet, digestive tract function, and kidney performance all have a role in these processes.

For these and other reasons, bone mass varies significantly between individuals and also in the same person at different stages of life. For most people, bone mass reaches its peak in one’s twenties and thirties, then it slowly decreases over the rest of one’s life. Women generally have less bone mass than men; they also have an increasing loss of bone mass for three to seven years after menopause. Bone loss can also be quickened by a variety of diseases, such as rheumatoid arthritis.

Who is affected?

Osteoporosis affects close to twenty million people in the United States alone. It is a condition that is more common in women than in men, in caucasians than in blacks. It is especially prominent in older women who have hormone deficiencies, who don’t have enough calcium in their diets, or who are confined to bed or immobilized for long periods. Current evidence suggests that women who have early menopause, who are markedly underweight, who smoke cigarettes, who consume alcohol regularly, or who have a family history of osteoporosis are also frequently affected.

Can osteoporosis be treated?

While it is possible to predict those who are at greatest risk for osteoporosis, there are no easy or inexpensive tests to identify the process in its earliest stages. For most people, the first manifestation of osteoporosis is a fracture. By that time, the bones may have already lost a large amount of mass. Unfortunately, once bone density has been lost, it cannot be replaced significantly. Thus, prevention is much more important than treatment.

How can it be prevented?

Though there is no clear cure in sight for the disease, osteoporosis and its attendant fractures can be in large part prevented or at least delayed. But when taking preventative measures, you must remember that every person is different. The recommendations that follow are only generalizations and should be carefully matched with advice from a physician who knows your situation well.

Calcium. The usual daily intake of calcium in the United States and much of the rest of the world is approximately half of what is ideal. While the exact amount of calcium required by an individual varies, doctors currently recommend that about 1,000 to 1,500 milligrams a day is optimal. An eight-ounce glass of milk contains 275 to 300 milligrams of calcium, so to get enough calcium, your intake must be considerable and regular.

For those who don’t get enough calcium in their diets, doctors generally advise calcium supplements. But as with any other treatment, excessive doses of calcium can be harmful. Check with your physician before beginning your own calcium therapy.

One of the problems with very large doses of calcium is that it can be properly absorbed into the system only if sufficient levels of vitamin D also enter the system. People who do not receive adequate daily exposure to sunlight are at special risk for vitamin D deficiency and may need to have supplemental doses. But as with calcium, excessive dosages of vitamin D can have dangerous side effects. Let your doctor guide you.

Estrogen. Cyclic estrogen therapy is usually recommended for women who have had their ovaries removed before age fifty. Women who have had a natural menopause may also be considered for estrogen therapy if they understand the risks and are able to have regular medical examinations. As with any treatment, however, there are potential side effects, and these must be weighed against possible benefits on an individual basis.

Life-style. Because inactivity leads to bone loss, modest weight-bearing exercise, such as walking, is usually recommended. For those with physical disabilities or circumstances that prevent walking, alternate programs can be followed.

Making sure that one’s diet is well-balanced and avoiding alcohol, tobacco, and possibly even caffeine are also wise preventative measures encouraged by experts.

Although several agents and forms of treatment for osteoporosis are currently under investigation, their effectiveness and safety have not yet been established. Proper living to avoid undue risks—the kind of life-style encouraged by the Word of Wisdom for more than a century and a half—is still the best approach.—Cecil O. Samuelson, M.D., Salt Lake City