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Definition of Osteoporosis

Osteoporosis is defined by the National Institutes of Health Consensus Development Panel onOsteoporosis as “a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture”. This definition takes into consideration that there are other factors that influence bone quality, beyond simply bone density.

From the bone density diagnosis standpoint, the WHO defined osteoporosis as bone density T-score lower than 2.5 and osteopenia as T-scores between –1.0 and –2.5. T-score is determined by comparing an individual’s bone density to that of young normal adults (aged 20-29, age at which peak bone mass is attained). T-score is useful in the diagnosis of osteoporosis and is predictive of fracture risk.

Prevention and management of osteoporosis is not simply treating the bone density number. Identifying correctable causes bone loss is vital. Unfortunately, bone loss can occur with no obvious symptoms. Some experience symptoms without realizing that they’re associated with osteoporosis – eg. loss of height or severe back pain, and these are usually signs that fractures have already happened in the spine.

Statistics

10 million individuals have osteoporosis
34 million individuals have low bone mass, who are at risk for fracture
1.5 million fractures occur every year due to osteoporosis.
1 out of 8 men and 1 out of 2 women will suffer an osteoporosis-related fracture within their lifetime
Most typical sites of osteoporosis-related fractures are the hip, spine, wrist and ribs
Women are 2-3 times more likely to have a hip fracture, but men more twice as likely to die from them
In general, 24% of people with hip fractures die within 1 year, 50% loses mobility and 25% end up in nursing homes
Vertebral fractures are under-diagnosed and osteoporosis under-treated in general – only about 1/3 come to clinical attention – more than 20% of them will have another fracture within 1 year and the mortality rate is approximately 25% within 5 years
Fractures are significant because of their associated consequences, including pneumonia, blood clots, pain, disability, and death

Risk Factors for Fractures

Age, ethnicity
Poor vision / risk for falls
Personal history of fracture as an adult
History of fracture in first-degree relative
Low body weight
Low calcium intake
Cigarette smoking
Alcohol intake – more than 2 drinks several times a week (1 drink is 4 oz of wine)
History of rheumatoid arthritis
Long-term glucocorticoid (steroid) therapy (>3months)

Correctable Causes (Secondary Causes) of Osteoporosis

Women: Estrogen deficiency at an early age (<45 years)
Men: Testosterone deficiency
Hyperparathyroidism
Hypercalciuria (losing too much calcium in the urine)
Eating disorder (eg. Anorexia Nervosa)
Celiac’s disease
Rheumatoid arthritis, lupus
Multiple myeloma
Medications such as steroids, anticonvulsants, immunosuppressives, proton pump inhibitors, lupron, antidepressants, depo-Provera, etc.

This list is not exhaustive. There are still other conditions that contribute to bone loss.

Medical Workup

For a patient with osteoporosis, a full workup would include:

History and physical
Laboratory testing: blood testing including electrolytes, blood counts, thyroid & hormonal testing, vitamin D, parathyroid hormone levels, and 24-hour urine calcium testing; additional testing for other secondary causes of osteoporosis as appropriate.
Bone density scan & other imaging, as needed

Treatment

When considering a treatment, keep in mind that the goal is fracture prevention. The degree of bone density improvement does not really correlate with the fracture reduction efficacy of osteoporosismedications. According to the International Osteoporosis Foundation, the only pharmacological agents (available in the US) that protect against both vertebral and hip fractures are: Actonel, Fosamax, Forteo and estrogen replacement therapy.

Key Takeaway Facts

The purpose of osteoporosis prevention and treatment is to reduce fractures and consequences including pain, disability and mortality.

We do not simply look at a person’s bone density and treat the numbers! We at the Center for Optimal Health evaluate the individual’s risk factors and work up thoroughly for correctable causes of bone loss and then come up with a comprehensive treatment plan involving nutrition, exercise, vitamins and appropriate medications.

Articles

Calcium supplements increase heart attack risk?! Making Sense of the Confusing Data…
    By Jannet Huang, MD, FRCPC, FACE, ABIHM, CCD, NCMP. August 2010
"Missing the Mark for Preventive Health" - Institute of Medicine New Recommendations on Calcium and Vitamin D Intake Fall Short
    By Jannet Huang, MD, FRCPC, FACE, ABIHM, CCD, NCMP. December 2010

Resources

American Association of Clinical Endocrinologists
National Women’s Health Network
North American Menopause Society
National Osteoporosis Foundation
International Osteoporosis Foundation
International Society for Clinical Densitometry
National Institutes of Health - Osteoporosis and Related Bone Diseases - National Resource Center