Osteoporosis is the most common bone disease in humans. It is a disease characterized by low bone mass and structural deterioration leading to bone fragility and increased risk for fracture of the spine, wrist, hip, and other bones.  Currently 1.5 million Americans experience an osteoporotic fracture each year which represents 700,000 vertebral (spine) fractures, 300,000 hip fractures, and 250,000 wrist fractures. The number of people with osteoporosis and the resulting fractures are expected to increase significantly in the next 20 years. Every year the healthcare costs related to osteoporosis increase. In 2000 in North Carolina alone the healthcare costs for osteoporotic fractures was $455 million; the projected amount for 2025 is almost $800 million.

The consequences of osteoporotic fractures are serious. Approximately 20% of those who suffer a hip fracture will die within the first year post-fracture. Half of those who experience a hip fracture will never be able to return to their previous level of physical function. Vertebral fractures result in chronic pain, respiratory and digestive problems, changes in body image and physical function, and difficulty fitting into usual clothing.  An osteoporotic fracture is a significant risk factor for another fracture within a year.

One of the major risk factors for osteoporosis for both men and women is age; women are more affected by this disorder than men once they go through menopause and lose the hormone, estrogen. One in two postmenopausal women will experience an osteoporotic fracture in her lifetime. Ethnicity plays a role also as those of Caucasian and Asian descent are at greater risk than those of darker skin races who have heavier skeletal structure. Genetics influence individual skeletal development; therefore, family history of osteoporosis and non-traumatic fracture are risks. Other risks for osteoporosis include: low body weight, inadequate calcium and Vitamin D intake, inadequate physical activity, excessive alcohol intake, smoking,  long-term use of steroid medications, and the presence of certain medical conditions.

The skeleton is living tissue that is being continuously “remodeled” through a process of cells which destroy old bone and other cells that build new bone. This process is balanced in the young adult; however, beginning in the third decade bone begins to be slowly lost. This process accelerates with certain conditions, such as loss of estrogen in women, certain medical conditions, use of some medications, and nutritional factors. The “bone building” cells can no longer keep up with the amount of bone that is being removed.

Osteoporosis is diagnosed by DEXA which stands for “dual-energy x-ray absorptiometry”, a quick, painless, minimal radiation test which evaluates the density of the mineral in the bone. The results of the test help predict fracture risk by demonstrating whether the bone mineral is normal, low, or in the osteoporosis range. Another tool to help predict fracture risk is called FRAX which utilizes data about certain known risk factors to generate the 10 year probability of fracture.

Adequate nutritional intake of calcium and vitamin D is critical to bone health; studies show that intake of both of these nutrients is inadequate in most American diets. It has been recognized that most people are vitamin D deficient; vitamin D is essential for the absorption of calcium and is critical to other body functions. Supplementation of both calcium and vitamin D can compensate for daily dietary deficiencies.

Exercise, particularly weight-bearing or resistance exercises, such as strength training with weights or machines, is important for bone and muscle strength. It has a positive effect on bone growth and improves balance and muscle strength which improves balance and decreases fall risk.

If nutrition and exercise fail to maintain bone health, pharmacologic therapy is available and proven to improve bone density and decrease fracture risk. One category of medications is the bisphosphonates which include Fosamax, Actonel, Boniva, and Reclast. These medications help to slow bone loss. For women, hormone therapy with estrogen may be used for osteoporosis prevention if she also needs estrogen for menopausal symptoms. Evista is a medication called a SERM (selective estrogen receptor modulator) which acts in a similar way to estrogen on bone but is not an estrogen. Forteo is a unique medication that actually helps to build new bone very rapidly and is indicated for people with severe osteoporosis or prior fracture.

Once osteoporosis is present, early diagnosis is critical followed by any needed changes in nutrition and exercise. A healthcare provider can recommend the appropriate regimen of pharmacologic therapy.  Fortunately osteoporosis is a preventable disorder!! By practicing proper nutrition and participating in exercise that promotes bone health, bone loss may be prevented. When low bone mass is detected early, lifestyle changes and pharmacologic therapy can prevent progression to osteoporosis and significantly reduce risk of fracture.  Osteoporosis does not have to be an inevitable outcome of post-menopausal status in women and aging for both genders.

The North Carolina Osteoporosis Foundation (NCOF) is a non-profit organization whose mission is to raise awareness of osteoporosis through education with a particular emphasis on prevention. In 2008 the NCOF funded six educational projects for consumers around the state. In addition to funding organizations to provide education about osteoporosis, NCOF also has a Speakers Bureau of knowledgeable individuals who can participate in community events.

Rebecca Yates, CNM, MN is in private practice in Albemarle, NC and is a member and the secretary of the Board of Directors of the North Carolina Osteoporosis Foundation.