• Health Reference Library
• Publications Library
• Managing Osteoporosis

More than 10 million Americans over the age of 50 currently have osteoporosis and more than 33 million have low bone mass (osteopenia). By 2020, approximately 14 million Americans will have osteoporosis and more than 47 million will have low bone mass. Although persons of any race can develop osteoporosis, whites and Asians generally have lower bone mass than do blacks or Hispanics and are at greater risk of developing osteoporosis. Each year in the United States, there are more than 1.5 million osteoporotic fractures including 700,000 spine, 300,000 hip, 250,000 wrist and 300,000 other types of fractures. One in two women and one in every eight men will experience an osteoporotic fracture during their lifetime. This association between osteoporosis and fractures is a significant health concern-these fractures lead to chronic pain and disability, increased nursing home placement and increased mortality, particularly with hip and spine fractures.

What is is Osteoporosis?

Osteoporosis, the most common bone disorder affecting adults, results in decreased bone strength and increased risk of fracture. Bone strength is determined by bone mineral density (BMD) and bone quality. BMD is the gold standard by which the diagnosis of osteoporosis is made. Further, BMD is a measure of bone strength that is easily and accurately used to assess fracture risk. The majority of bone mass is accumulated during the first 20 years of life. In fact, during adolescence, we gain up to 60 percent of our total bone mass, with further increases until we reach the age of 30 - 35 years. Thereafter, bone loss increases with aging and is accelerated as the sex hormones estrogen and testosterone decline. Osteoporosis can result from either bone loss or bone quality deterioration or from impaired bone growth during childhood and adolescence. Thus, experts recommend that the prevention and treatment of osteoporosis focus on identifying risk factors for osteoporosis in conjunction with BMD testing.

What Are The Risk Factors

Knowing the risk factors and BMD for osteoporosis is the foundation for making one's decision regarding prevention and treatment; this allows the patient and the physician to prevent first fractures in at-risk patients and subsequent fractures in patients who have already fractured.

Risk Factors for Osteoporosis and Related Fractures include:

Most important:

• Advancing age (> 60 years old)
• Personal history of fracture in adulthood
• Low body weight (< 127 lbs.)
• Family history of fractures

• Early loss of estrogen or testosterone
• Low lifetime intake of calcium
• Recent falls, impaired vision
• Low level of physical activity
• Smoking
• Excess alcohol

When is BMD Testing Indicated?

Given the risk factors listed above, BMD testing is indicated for:

• Women aged 65 and older
• Postmenopausal women under age 65 with risk factors
• Postmenopausal women discontinuing estrogen therapy, especially with known risk factors as outlined previously
• Men aged 70 and older
• Men and women with a fracture after age 45
• Men and women with a disease or condition associated with low bone density or bone loss
• Men and women taking med- ications associated with low bone density or bone loss
• Anyone being considered for treatment with steroid therapy (cortisone, prednisone or other steroids)
• Anyone being considered for treatment for osteoporosis or being treated to monitor treatment effect

What are Current Options to Treat Osteoporosis?

Available treatment to reduce fracture risk includes several bone-active agents that act by inhibiting bone loss. Estrogens, selective estrogen receptor modulators (SERMs) such as Evista, bisphosphonates such as Fosamax and Actonel, calcitonin (Miacalcin nasal spray), calcium with Vitamin D all have bone-sparing properties by different mechanisms and to some extent by varying degrees. The benefit of these therapies occurs rapidly and is evident within 6-12 months of initiating therapy. The effectiveness of these therapies is sustained over time and they are generally well tolerated. Finally, a number of new agents that increase bone formation (anabolic therapies) are available for the treatment of osteoporosis and prevention of fractures. One agent, Forteo, has been approved for the treatment of women and men with osteoporosis at high risk for fracture. Other strategies to improve bone health such as exercise and fall-prevention techniques or hip protectors should be incorporated into a fracture-prevention program.

The primary goal of treatment is to prevent fractures. Careful consideration of the risks and benefits of each of these treatments will serve as a guide in choosing the best therapy for the individual patient. Early detection and treatment can make a difference.