Osteoporosis: The Silent Threat

By Michael J. Wolpmann, M.D., FACOG, FACS

Osteoporosis is a skeletal disorder characterized by progressive loss of bone and bone mass resulting in a weakening of the bone architecture.  This weakening can result in fractures of the bone, most commonly of the hip, spine, or wrist.  Osteoporosis is now recognized as a largely ‘silent disease’ until it is complicated by fragility fractures and even death.  The purpose of this article is to discuss osteoporosis and the significant implications of this disease for women.

It is estimated that almost 44 million men and women, or approximately 55% of the population age 50 years and older in the United States, have osteoporosis or low bone mass.  Postmenopausal women account for nearly three quarters or 75% of these individuals and are at especially high risk for osteoporosis and osteoporotic fractures.  Many other factors can further increase the risk of osteoporosis in women including family history of osteoporosis, smoking, slender build, low calcium diet, sedentary lifestyle, chronic diseases such as diabetes or arthritis, and medications such as prednisone or coumadin.

Studies predict that one of every two Caucasian women alive today will experience an osteoporotic fracture.  In fact, after age 65, the incidence of hip fracture in white women is greater than the incidence of stroke, diabetes, or breast cancer.  Over her lifetime, a woman’s risk of hip fracture is greater than her risk of breast, endometrial and ovarian cancer combined.  

If a hip fracture occurs, the risk of death in the first year after fracture is calculated to be approximately 20%.  A full one third of hip-fracture patients will break the opposite hip, and only 40% will ever regain their previous level of mobility.  For survivors and their families, the loss of independence and diminished quality of life can be devastating and not surprisingly, can lead to psychological depression in many patients.

Vertebral or spine osteoporotic fractures are another consequence of chronic bone loss or osteoporosis.  These can lead to back pain, loss of height, twisting of the spine and even death.  Like hip fractures from osteoporosis, once a spine fracture occurs, the risk of sustaining another fracture increases dramatically.  For example, 1 in 5 postmenopausal women with a vertebral fracture will experience another vertebral fracture within one year, even while receiving calcium and vitamin D supplements.  Women that experience a vertebral fracture have an 8-fold higher risk of dying within 3 years compared to women without a fracture.

The economic burden of osteoporosis is no less daunting.  In 1995, osteoporotic fractures were the cause of 180,000 nursing home admissions, more than 430,000 hospital admissions, and approximately 2.5 million doctor visits.  Each year, osteoporotic fractures cost the US economy approximately $17 billion in health care or about $40,000 per hip fracture.  Osteoporosis affects people of all ages and races, but is most prevalent among postmenopausal white and Asian women.  However, even African-American and Hispanic women face significant risk.   

The facts above describe the devastating problem that comprises osteoporosis and the potentially severe consequences to the average women’s health.  But what can be done?  

TESTING

All women 65 years of age or older or 40 years and older that have had a fracture or other risk factor, should see their doctor about having a bone mineral density measurement test to accurately identify whether they suffer from osteoporosis.  A DXA scan or bone densitometry study is currently the most accurate test available for diagnosing osteoporosis of the spine and hip.  Other modalities may also be appropriate, including ultrasound and urinary markers of bone loss.  Testing alone cannot fully assess risk and a visit to your doctor is recommended for an individualized evaluation of your risk factors.


TREATMENT

Recent years have brought many medical advances in the treatment of osteoporosis.  The effects of osteoporosis and chronic bone loss can be decreased, stopped, or many times reversed with appropriate therapy.  Modern treatment and/or prevention of osteoporosis includes many newer drugs such as the biphosphonates and raloxifen, as well as older agents such as estrogen and calcitonin.  Weight bearing exercise and calcium with vitamin D supplementation are also recommended for the majority of postmenopausal women at risk.  However, individual assessment by your doctor is necessary and may include other treatment.