Osteoporosis is a common disorder that involves the entire bony skeleton. It is characterized by low bone mass and deterioration of bone tissue resulting in increased bone fragility. We now understand that low bone mass IS NOT a normal part of aging, but, rather, a systemic skeletal disease that can begin early in life and that increases the risk for fracture, making early recognition essential for preventing progression.

Osteoporosis currently affects more than 26 million Americans, of which more than 20 million are women. Women have less bone mass than do men. The lifetime risk of sustaining any fracture for a Caucasian woman is 40%, which is equivalent to the risk of breast, ovarian and endometrial cancers combined. The lifetime risk of a hip fracture for all women is 15%. Men, too, can suffer from osteoporosis, a disease that is rarely considered unless they have fractured a hip. Morbidity and mortality from injuries related to osteoporosis are extremely high. For example, among patients who have sustained a hip fracture, 20% die within one year, 50% can no longer walk without assistance, and 25% are institutionalized in a long tern care nursing facility after the event.

In addition to hip fractures, osteoporosis is a generalized, persistent and disabling disease that can influence every facet of a person's life. This chronic, debilitating disease has been described as a primary factor contributing to a deterioration of quality of life for older women. Osteoporosis can cause acute and chronic pain, impairments in functional status, and a perception of poor health. These issues may precipitate a reduction in quality of life.

Age related bone loss occurs in both men and women beginning around the age of 40 years; however, in women the rate of bone loss is accelerated during menopause. This is because the decrease in estrogen production permits increased bone turnover and increases the rate of bone tissues deterioration.
There are many risk factors of the development of osteoporosis. The major factors include female sex, a family history of osteoporosis, and advancing age. The use of certain drugs-thyroid medication, anticonvulsants, diuretics, aluminum containing antacids, heparin and corticosteriods-may also promote the development of osteoporosis. Lifestyle choices such as cigarette smoking, excessive alcohol intake, a sedentary lifestyle and an inadequate intake of dietary calcium may lead to the development of osteoporosis as well as certain genetic traits such as a family history of osteoporosis, fair skin and slender body build.

The key to osteoporosis therapy begins with prevention. Lifestyle changes such as smoking cessation, decreased alcohol consumption, increase physical exercise and increased intake of dietary calcium should be encouraged. Calcium is also important later on in life to prevent bone loss and to help restore bone that might have been lost due to osteoporosis. Postmenopausal women who are not taking estrogen should receive 1500 mg of calcium per day, and those on hormone replacement therapy (HRT) should receive 1000 mg of calcium per day.

There is strong data that estrogen replacement therapy (ERT) is effective in the prevention and treatment of osteoporosis. By conserving bone mass, estrogen therapy results in an approximately 40% to 75% reduction of vertebral fractures and 25% decrease in nonvertebral fractures with five years of use. However, another study concluded that among women 75 years of age or older who had taken ERT for 7-9 years, bone density was only 3.2 % higher than in women who had never taken estrogen., Therefore, ERT may have little residual effect on bone density among women 75 years of age and older, who have the highest risk of fracture. Additionally, many women avoid ERT because they are concerned about increasing their risk of breast or uterine cancer. IF they have begun ERT, they will often discontinue therapy because of side effects, including uterine bleeding and breast pain and bloating. These side effects are especially unwelcome by the woman over age 70.

Several pharmocologic agents have recently been developed for the prevention and treatment of osteoporosis. Among these new agents is alendronic acid (alendronate) (tradename: Fosamax) which is an aminobiphosphate that specifically inhibits bone resorption. Also, alendronic acid has not been associated with an increased risk of cancer nor does it affect the menstrual cycle. Gastrointestinal adverse effects are the most common treatment related complaints and alendronic acid appears to have the potential to cause esophageal ulceration. Its occurrence has generally been attributed to noncompliance with the manufacture's administration guidelines.

Calcitonin nasal spray may represent an acceptable alternative therapy for osteoporosis for the elderly patient. In addition to its effects on bone mass, intranasal calcitonin has also been shown to provide an analgesic benefit for women with acute vertebral compression fractures. Calcitonin is safe and generally well tolerated, as demonstrated in more than 7 years of intranasal use. Additionally, it can be given in combination with food or other medication and therefore is easily incorporated into a complex medical regimen. Because of the qualities listed above, calcitonin nasal spray is often the preferred therapy for osteoporosis with the elderly patient.

Recently, the Food and Drug Administration (FDA) approved raloxifene, one of a new class of selective estrogen receptor modulators (SERMs) as a treatment for osteoporosis. SERMs mimic the effects of estrogens on bone and blood lipid levels without producing the undesirable stimulatory effects on the breast or uterus caused by estrogen.

Osteoporosis is sometimes called the "silent epidemic" because there are no symptoms until a fracture occurs. Therefore, early detection so that treatment can begin is essential. Since bone mass is a major determinant of bone strength, measurement of bone mineral density can provide information that aids in the diagnosis of osteoporosis.

Osteoporosis is a preventable condition. It is realistic to anticipate that in the next century, we will regard osteoporosis in a historical context, much as rickets and vitamin D deficiency are regarded today. Achievement of this goal will, however, depend on tow factors; (1) Educating the community about the importance of developing maximal bone mass before menopause, and (2) Introducing into the health care system easily accessible and reimbursable means of identifying women and men at risk for osteoporosis.

Barbara Darlington
Director
Gateway Care Center
139 Grant Avenue
Eatontown, NJ 07724
Phone: 732-542-4700
Email: gateway139@aol.com