Definition
Osteoporosis, or porous bone, is a disease characterized by low bone mass
and structural deterioration of bone tissue, leading to bone fragility and
an increased susceptibility to fractures, especially of the hip, spine and
wrist, although any bone can be affected.
In simpler terms, osteoporosis is a condition in which the bones become weak
and can break from a minor fall or, in serious cases, from a simple action
such as a sneeze.
Prevention
About 85-90% of adult bone mass is acquired by age 18 in girls and 20 in
boys. Building strong bones during childhood and adolescence can help to
prevent
osteoporosis later in life.
There are five steps, which together can optimize bone health and help
prevent osteoporosis. They are:
1. Get the daily recommended amounts of calcium and vitamin D
2. Engage in regular weight-bearing and muscle-strengthening exercise
3. Avoid smoking and excessive alcohol
4. Talk to your healthcare provider about bone health
5. Have a bone density test and take medication when appropriate
A study of disease management in a rural healthcare population demonstrated
that a preventive program was able to reduce hip fractures and save money.
Prevalence Osteoporosis is a major public health threat for an estimated 44
million Americans, or 55 percent of the people 50 years of age and older.
In the U.S. today, 10 million individuals are estimated to already have the
disease and almost 34 million more are estimated to have low bone mass,
placing them at increased risk for osteoporosis.
While osteoporosis is often thought of as an older person's disease, it can
strike at any age.
Osteoporosis Prevalence: Gender
Of the 10 million Americans estimated to have osteoporosis, eight million
are women and two million are men.
Eighty percent of those affected by osteoporosis are women.
Twenty percent of those affected by osteoporosis are men.
Osteoporosis Prevalence: Race/Ethnicity
Significant risk has been reported in people of all ethnic backgrounds.
Twenty percent of non-Hispanic Caucasian and Asian women aged 50 and older
are estimated to have osteoporosis, and 52 percent are estimated to have low
bone mass.
Seven percent of non-Hispanic Caucasian and Asian men aged 50 and older are
estimated to have osteoporosis, and 35 percent are estimated to have low
bone mass.
Five percent of non-Hispanic black women over age 50 are estimated to have
osteoporosis; an estimated additional 35 percent have low bone mass that
puts them at risk of developing osteoporosis.
Four percent of non-Hispanic black men aged 50 and older are estimated to
have osteoporosis, and 19 percent are estimated to have low bone mass.
Osteoporosis is under recognized and under-treated not only in Caucasian
women, but in African-American women as well.
Ten percent of Hispanic women aged 50 and older are estimated to have
osteoporosis, and 49 percent are estimated to have low bone mass.
Three percent of Hispanic men aged 50 and older are estimated to have
osteoporosis, and 23 percent are estimated to have low bone mass.
When compared with other ethnic/racial groups, risk is increasing most
rapidly among Hispanic women.
Experts predict that costs related to osteoporotic fractures among Hispanics
will increase from an estimated $754 million in 2005 to $2 billion per year
in 2025.
Cost In 2005, osteoporosis-related fractures were responsible for an
estimated $19 billion in costs.
By 2025, experts predict that these costs will rise to approximately $25.3
billion. Symptoms
People cannot feel their bones getting weaker. They may not know that they
have osteoporosis until they break a bone. A person with osteoporosis can
break a bone from a minor fall, or in serious cases, from a simple action
such as a sneeze.
Vertebral (spinal) fractures may initially be felt or seen in the form of
severe back pain, loss of height, or spinal deformities such as kyphosis or
stooped posture. In many cases, a vertebral fracture can even occur with no
pain.
Risk Factors
Certain people are more likely to develop osteoporosis than others. Factors
that increase the likelihood of developing osteoporosis and broken bones are
called "risk factors." Many of these risk factors include:
Being female
Older age
Family history of osteoporosis or broken bones
Being small and thin
Certain race/ethnicities such as Caucasian, Asian, or Hispanic/Latino
although African Americans are also at risk
History of broken bones
Low sex hormones
Low estrogen levels in women, including menopause
Missing periods (amenorrhea)
Low levels of testosterone and estrogen in men
Diet
Low calcium intake
Low vitamin D intake
Excessive intake of protein, sodium and caffeine
Inactive lifestyle
Smoking
Alcohol abuse
Certain medications such as steroid medications, some anticonvulsants and
others
Certain diseases and conditions such as anorexia nervosa, asthma and others
Loss of height (which may indicate a spinal fracture)
Women can lose up to 20 percent of their bone mass in the five to seven
years after
menopause, making them more susceptible to osteoporosis.
Fractures One in two women and one in four men over age 50 will have an
osteoporosis-related fracture in their remaining lifetime.
Fractures due to osteoporosis are most likely in the hip, spine and wrist,
but any bone can be affected.
According to estimated figures, osteoporosis was responsible for more than 2
million fractures in 2005, including approximately:
297,000 hip fractures
547,000 vertebral fractures
397,000 wrist fractures
135,000 pelvic fractures
675,000 fractures at other sites
The total number of fractures due to osteoporosis is expected to rise to
more than 3 million by 2025.
Women with a hip fracture are at a four-fold greater risk of a second one.
Fractures due to osteoporosis lower a patient’s quality of life.
The rate of hip fractures is two to three times higher in women than men;
however, the one year mortality following a hip fracture is nearly twice as
high for men as for women.
A woman's risk of hip fracture is equal to her combined risk of breast,
uterine and ovarian cancer.
In 2005, about 293,000 Americans age 45 and over were admitted to hospitals
with a fracture of the femoral neck, a common type of hip fracture.
Osteoporosis was the underlying cause of most of these injuries.
An average of 24 percent of hip fracture patients aged 50 and over die in
the year following their fracture.
One in five of those who were ambulatory before their hip fracture requires
long-term care afterward.
At six months after a hip fracture, only 15 percent of hip fracture patients
can walk across a room unaided.
In addition to hip fractures, vertebral fractures are also linked to an
increased risk of death.
Caucasian women aged 65 or older have twice the incidence of fractures as
African- American women.
Diagnosis Specialized tests called bone mineral density (BMD) tests can
measure bone density in various sites of the body. Experts recommend a type
of BMD test using a central DXA (which stands for dual energy x-ray
absorptiometry).
A BMD test performed by a central DXA can:
Tell if a person has low bone density before a fracture occurs
Tell if a person’s bones are losing bone density or staying the same when
the test is repeated at intervals of one year or more
Predict the chances that a person will have a fracture in the future
Help a person and their healthcare provider decide if treatment is needed
A new methodology called absolute fracture risk takes into account a
person’s BMD and other risk factors to estimate the likelihood of breaking a
bone due to low bone mass or osteoporosis over a period of 10 years. This
new tool helps healthcare providers and patients make better treatment
decisions and assure that people with the highest fracture risk get treated.
Medicare reimburses for BMD testing every two years.
An increase in BMD testing and osteoporosis treatment was associated with a
decrease in hip fracture incidence.
BMD is an important determinant of fracture risk even in nursing home
patients.
There has been a five-fold increase in office visits for osteoporosis (from
1.3 to 6.3 million) in the past 10 years. Medications
Although there is no cure for osteoporosis, it can be treated. The following
medications are approved by the FDA to prevent and/or treat osteoporosis:
Antiresorptive Medications – Bisphosphonates
Alendronate and alendronate plus vitamin D3 (brand names Fosamax® and
Fosamax plus D™).Alendronate is approved for the prevention and treatment of
osteoporosis in post-menopausal women and for the treatment of osteoporosis
in men. It also is approved for the treatment of glucocorticoid-induced
osteoporosis in men and women as a result of long-term use of steroid
medications.
Ibandronate (brand name Boniva®). Ibandronate is approved for the prevention
and treatment of osteoporosis in postmenopausal women.
Risedronate and risedronate with calcium (brand names Actonel® and Actonel®
with Calcium). Risedronate is approved for the prevention and treatment of
osteoporosis in postmenopausal women and for the treatment of osteoporosis
in men. It also is approved for the prevention and treatment of
glucocorticoid-induced osteoporosis in men and women as a result of
long-term use of steroid medications.
Zoledronic Acid (brand name Reclast®). Zoledronic acid is approved for the
treatment of osteoporosis in postmenopausal women.
Other Antiresorptive Medications
Calcitonin (brand names Fortical® and Miacalcin®). Calcitonin is approved
for the treatment of osteoporosis in postmenopausal women who are at least
five years beyond menopause.
Estrogen (multiple brand names available) Estrogen therapy (ET) and estrogen
with progesterone hormone therapy (HT) are approved for the prevention of
osteoporosis in postmenopausal women. According to the FDA, postmenopausal
women should consider other medications before taking ET or HT to prevent
osteoporosis due to risks associated with these medications. They should
also be used in the lowest possible dose for the shortest period of time to
meet treatment goals.
Estrogen Agonists/Antagonists also known as Selective Estrogen Receptor
Modulators (SERMs) –Raloxifene (brand name Evista®). Raloxifene is approved
for the prevention and treatment of osteoporosis in postmenopausal women.
Bone Forming (Anabolic) Medications
Parathyroid Hormone –Teriparatide (brand name - Forteo®). Teriparatide, a
type of parathyroid hormone, is approved for the treatment of osteoporosis
in postmenopausal women and in men who have very low BMD or are at high risk
for a fracture. Teriparatide can only be taken for two years.
Medical experts agree that osteoporosis is highly preventable. However, if
the toll of osteoporosis is to be reduced, the commitment to osteoporosis
research must be significantly increased. It is reasonable to project that
with increased research, the future for definitive treatment and prevention
of osteoporosis is very bright.
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