Bone mass reaches its peak in both men and women at the age of 30! Both sexes then begin to lose bone at a rate of 0.5% per year. When a woman reaches menopause, she experiences a precipitous drop in bone density of over 2% per year which lasts approximately 10 years.
In many affected people, bone loss is gradual and without symptoms or warning signs until the disease is advanced. Osteoporosis is a global problem which is increasing in significance as the population of the world both grows and ages. For these reasons, osteoporosis is often referred to as the "silent epidemic".
There are two types of osteoporosis, Type I and Type II.
Type I osteoporosis is six times more common in women than in men.
Its primary cause is ESTROGEN DEFICIENCY. This type of osteoporosis
manifests mainly as vertebral crush fractures leading to a hunched over
look or "Dowager's hump."
Type II osteoporosis is only twice as common in women as in men. This type
of osteoporosis is due to a long history of CALCIUM DEPLETION. It leads to
hip fractures and silent vertebral fractures.
Risk Factors for Osteoporosis:
1. Female gender
2. Age
3. Early onset of menopause
4. Increased alcohol and caffeine consumption
5. Cigarette smoking
6. Being Caucasian or Asian
7. Being underweight
8. Scoliosis
9. Physical inactivity - couch potato
10. Family history of osteoporosis
Detection
Osteoporosis can be diagnosed and followed up in one
of two ways:
1. Bone density study known as a DEXA scan. Do not be
fooled into thinking that one test which involves one
wrist or one heel is an appropriate screening test for
osteoporosis. A full body DEXA scan involves testing
the entire spine and hips. A T-score of < -2.5 is
considered osteoporosis. A T-score of > -2.5 but less
than -1 is considered osteopenia bordering on
osteoporosis. Both of these conditions require
treatment in order to prevent progression.
2. A urine N-telopeptide (NTX) measures the amount of
bone turnover by a bone marker found in the urine. This test is particularly useful for women on Fosamax
and Actonel.
Treatment
Calcium supplementation with calcium, magnesium and
vitamin D should be taken by all menopausal women
regardless of osteoporosis status. A good supplement
is Twin Lab brand Calcium 500mg. If a woman does not
take hormone replacement therapy, she should take at
least 1200mg per day, 600mg in the morning, and 600
mg. at night. All others taking hormone replacement
therapy should take a total of 1,000mg per day.
Alendronate known by the brand name Fosamax comes in
10mg and 70 mg pills. The 10 mg. pills are taken every
morning with 8 ounces of water standing up one half
hour prior to eating. The new 70mg pill need only be
taken once per week and has found to be just as
effective as daily dosing.
Calcitonin nasal spray (Miacalcin) is a good
alternative to Fosamax and Actonel if you suffer from
gastrointestinal problems such as an ulcer, gastritis,
reflux or a hiatal hernia.
Finally, raloxifene known by the brand name of Evista
has been shown to effectively prevent bone loss
without affecting the breast or uterus. The
pharmaceutical company who produces Evista is
currently seeking FDA approval to use this drug to
prevent breast cancer.
Dr. Tara Solomon
