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November 2012: Facts about Osteoporosis

31 Oct 2012

Dr. Hema Azad is a board-certified internist at Weiss Memorial Hospital. Her areas of expertise include preventive medicine, women’s health and geriatric care. She has special interests in managing and treating osteoporosis, diabetes, obesity and hypertension.

Hema Azad, M.D.
Weiss Memorial Hospital
(630) 910-6200

According to the National Osteoporosis Foundation, osteoporosis affects 44 million Americans. Osteoporosis is a disease where bones become weak and brittle. This disease occurs when the body experiences excessive bone loss or makes too little bone, or both. In this first article of a two-part series, Dr. Azad discusses facts, symptoms, risk factors and diagnosis of osteoporosis. The second article, published in December, 2012, presents treatment options and steps for prevention.

Facts about osteoporosis

  • Osteoporosis is a condition of fragile bone with an increased susceptibility to fracture.
  • Bone mass (bone density) decreases after 35 years of age, and bone loss occurs more rapidly in women after menopause.
  • Osteopenia is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.
  • In the United States, 44 million people have low bone density (10 million have osteoporosis, and 34 million have osteopenia). This amounts to 55 percent of the U.S. population aged 50 years and older.
  • One in two Caucasian women will fracture a bone due to osteoporosis in her lifetime.
  • In the United States, direct health care costs from osteoporosis fractures amount to one billion dollars, without even taking into account the indirect costs, such as lost days at work and productivity.

What women need to know about osteoporosis
Females are at greater risk than males of developing osteoporosis and broken bones. 

  • Of the estimated 10 million Americans with osteoporosis, about 80 percent are women.
  • Approximately one in two women over age 50 will break a bone because of osteoporosis.
  • A woman's risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.

There are multiple reasons why women are more likely to get osteoporosis than men, including:

  • Women tend to have smaller, thinner bones than men.
  • When women reach menopause, estrogen, a hormone in women that protects bones, decreases sharply which can cause bone loss.

What are the symptoms of osteoporosis?
Unfortunately, there are no symptoms associated with early signs of osteoporosis. Symptoms occurring late in the disease include:

  • Fractures of the vertebrae, wrists or hips 
  • Lower back pain
  • Neck pain
  • Bone pain or tenderness
  • Loss of height over time
  • Stooped posture

What are the risk factors and causes of osteoporosis?
The following are factors that will increase the risk of developing osteoporosis:

  • Female gender
  • Caucasian or Asian race
  • Thin and small body frame
  • Family history of osteoporosis
  • Personal history of fracture as an adult
  • Cigarette smoking
  • Excessive alcohol consumption
  • Lack of exercise
  • Low calcium intake
  • Poor nutrition and poor general health
  • Malabsorption of nutrients (from such conditions as celiac disease)
  • Low estrogen levels in women (such as occur in menopause or with early surgical removal of both ovaries)
  • Hypogonadism (low testosterone levels in men)
  • Chemotherapy Amenorrhea (absence/loss of menstrual cycle)
  • Chronic inflammation (due to chronic diseases such as rheumatoid arthritis or liver diseases)
  • Immobility resulting from a stroke, or from any condition that interferes with walking
  • Hyperthyroidism (excessive production of thyroid hormones)
  • Hyperparathyroidism (excessive production of parathyroid hormones)
  • Vitamin D deficiency
  • Medications (long-term use of blood thinners such as heparin, anti-seizure medications such as phenytoin [Dilantin] and phenobarbital, and long-term use of oral corticosteroids such as prednisone.)

How is osteoporosis diagnosed?
A routine X-ray can reveal osteoporosis of the bone because the bones appear much thinner and lighter than normal bones. Unfortunately, by the time X-rays can detect osteoporosis, at least 30 percent of the bone has already been lost.

In addition to X-rays, the National Osteoporosis Foundation, the American Medical Association, and other major medical organizations recommend a dual-energy X-ray absorptiometry scan (DXA) to diagnose osteoporosis. DXA typically measures bone density in the hip, the spine and the forearm. The test is quite precise, takes only five to fifteen minutes to perform, and exposes patients to very little radiation (less than one-tenth to one-hundredth of the amount used on a standard chest X-ray).

The bone density of the patient is compared to the average peak bone density of young adults of the same sex and race to calculate the "T score," the measuring tool used to express the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass. 

  • Osteoporosis is defined as a bone density T score of -2.5 or below.
  • Osteopenia (between normal and osteoporosis) is defined as bone density T score between -1 and -2.5.

It is important to note that while osteopenia is considered a lesser concern than osteoporosis, it nevertheless can become a serious health issue and increase the chances for developing vertebral, hip and other fractures when combined with other risk factors, such as, smoking, cortisone steroid usage, rheumatoid arthritis, family history of osteoporosis, etc. In this setting, osteopenia may require medication as part of the treatment program.

Who should have bone density testing?
The National Osteoporosis Foundation guidelines recommend DXA testing for the following:

  • All postmenopausal women below age 65 who have risk factors for osteoporosis.
  • All women aged 65 and older.
  • Postmenopausal women with fractures.
  • Women with medical conditions associated with osteoporosis.
  • Women whose decision to begin treatment for osteoporosis might be aided by bone density testing to determine the presence or absence of osteoporosis or osteopenia.

How often is osteoporosis treatment covered?
Medicare Part B covers treatment for osteoporosis once every 24 months (more often if medically necessary).

For more information
If you would like more information about osteoporosis or would like to schedule an appointment, please call Dr. Azad’s office at (630) 910-6200. Her office is located at Weiss, Suite #4050, elevator A.