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Bone is living tissue that is constantly renewed throughout life, as old bone gets replaced with new. Osteoporosis occurs when too much bone is lost, too little new bone is produced, or both.
Children and teens make more bone than they lose, with peak bone mass usually reached in the early 20s. The denser the bones are at their peak mass, the less likely it is that osteoporosis will develop later in life. After bone mass peaks, bone production slows down but continues to about age 30. After that, bone mass shrinks about 1% annually. Certain factors can accelerate the loss. The rate at which bone density declines depends on a number of factors, such as age, gender, bone structure family history and lifestyle.
About 52 million Americans have low bone mass, which makes them at risk for osteoporosis – the most common type of bone disease. According to the National Osteoporosis Foundation, approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.
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- Gender – Both men and women can develop osteoporosis, but women are four times more likely to have it.
- Age – Osteoporosis can develop at any age, but risk increases with age. Women over 50 are the most susceptible to bone loss and fractures.
- Race – Osteoporosis is most common among people who are white or of Asian descent.
- Family history – A person whose parent or sibling had a hip fracture or spinal collapse fracture is at a higher risk for osteoporosis.
- Personal history – A person who has had a broken bone is at greater risk for another fracture.
- Bone structure & body weight – Petite and thin women have less bone mass to begin with. Weight loss after age 50 seems to increase women’s risk of hip fractures, while weight gain decreases the risk. Small-boned, thin men are at greater risk than large men.
- Hormones (female) –Reduction of estrogen associated with menopause or absence of menstruation (amenorrhea) for long periods contributes to loss of bone density.
- Hormones (male) – A drop in testosterone decreases bone density.
- Lack of physical exercise is detrimental to bones.
- Eating disorders (anorexia or bulimia) or gastrointestinal surgery can lead to inadequate nutritional absorption and hormonal imbalances. Also, eating disorders cause a “starved” body to produce excessive amounts of the adrenal hormone cortisol, which is known to trigger bone loss.
- Low calcium and Vitamin D intake results in loss of bone.
- Smoking – Studies show that current or former smokers have lower bone densities. Women smokers have lower levels of estrogen, which is necessary for healthy bones. Women smokers often go through menopause at a younger age, as well.
- Alcohol – excessive consumption is detrimental to bone density
- Medications – Bone density can be negatively affected by current or former long-term use of corticosteroid medications (e.g., prednisone, cortisone), thyroid drugs, anticonvulsants, antacids, or medications used to combat or prevent cancer, depression, or transplant rejection.
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Menopause and Osteoporosis
At menopause, women experience a drastic decline in the hormone estrogen. The drop in estrogen levels slows the replacement of old bone with new, resulting in a faster rate of bone loss. About ten years after the onset of menopause, the rapid bone loss subsides and the rate of loss returns to pre-menopausal levels. Even though the loss slows down, however, the formation of new bone does not increase. That is why postmenopausal women have a greater chance of a fracture.
Women who have early menopause (before age 40) have even greater risk of osteoporosis and fractures.
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There are no symptoms in the early stages of osteoporosis. Bone loss occurs over a period of many years and sometimes the first evidence of it comes when a fracture occurs – most commonly in the hip, spine or wrist. If a bone fracture occurs more easily than one would expect, it may be a sign of osteoporosis.
Other possible indications are loss in height or stooped posture.
There may be pain in the spine caused by compression fractures. The pain may occur suddenly or over a period of time.
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Medical evaluation to diagnose osteoporosis may include one or more of the following:
• Medical and personal history: Age, gender, menopause, previous fractures, smoking and drinking habits, diet (including intake of calcium and Vitamin D), physical activity/exercise, current or previous eating disorder, medications taken currently or previously.
• Physical exam: A look at the spine and measurement of height. A loss in height may indicate osteoporosis. After age 50, it is recommended that height be measured annually, without shoes.
• Laboratory tests: Measurement of blood calcium levels, thyroid function, parathyroid hormone levels, testosterone levels in men, 25-hydroxyvitamin D, 24-hour urine calcium and biochemical marker tests (NTX, which bone resorption in urine, and CTX, which measures bone resorption in the blood).
• FRAX® tool: A method of evaluating a patient’s fracture risk over the next 10 years based on bone mineral density results from a DEXA scan at the femoral neck and assessment of the following risk factors: age, sex, weight, height, previous fracture, parent had a fractured hip, current smoking, alcohol use, use of glucocorticoids, if diagnosed with rheumatoid arthritis, if diagnosed with an illness strongly associated with osteoporosis such as diabetes or hyperthyroidism. The FRAX® tool is useful for postmenopausal women or men age 50 or older, people who have low bone density and those who have not taken osteoporosis medication.
• Bone density test (DEXA scan): The only test that can diagnose osteoporosis, the DEXA scan is a low-level X-ray that measures the proportion of mineral contained in the bones. The results are used to estimate the density of the bones and the probability that a bone will break. Usually the hip and spine are checked. The National Osteoporosis Foundation recommends bone density scans for women age 65 or older and men age 70 or older, or earlier if there are other risk factors.
If the bone density test shows early signs of bone loss it is called osteopenia. When bone loss becomes more severe, it is osteoporosis.
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While osteoporosis is common as one ages, getting older doesn’t mean osteoporosis will develop.
Throughout life, eating a balanced diet and getting adequate amounts of calcium and Vitamin D from food and/or supplements helps to keep bones strong.
• Calcium: In addition to milk, cheese and yogurt, good sources of calcium are canned sardines and salmon (with bones), and dark green vegetables such as kale and broccoli. Calcium-fortified foods, such as some types of bread and juices, are also available. Experts recommend 1,000 milligrams of calcium each day for premenopausal women and 1,200 milligrams for postmenopausal women. For men age 70 and younger, the recommended total daily intake of elemental calcium is 1,000 milligrams and men age 71 and over should consume 1,200 milligrams daily.
Supplements are only advised when the recommended amount of daily calcium cannot be obtained through diet. If your diet does not provide enough calcium, ask your doctor if calcium supplements are right for you.
• Vitamin D: In order for the body to absorb calcium, Vitamin D is needed. Twenty minutes of exposure to the sun each day helps ensure that the body produces Vitamin D, but not everyone can get sun exposure – especially in the winter. Dietary sources of Vitamin D include eggs, fatty fish like salmon, fortified milk and cereal and Vitamin D supplements. To optimize bone health, the The National Osteoporosis Foundation recommends both men and women under the age 50 take 400–800 international units (IU) of Vitamin D daily. Men and women aged 50 and over are recommended to take 800-1000 IU daily.
Limit caffeine and alcohol: Coffee, tea and soft drinks with caffeine can decrease calcium absorption. Excess alcohol consumption has also been shown to have an adverse effect on bone health.
Exercise: Regular exercise makes bones and muscles stronger and helps to prevent bone loss. Both weight-bearing and muscle-strengthening exercises can help prevent osteoporosis and promote the ability to stay active.
Weight-bearing exercise, which should be done at least three or four times a week, includes such activities as walking, jogging/running, dancing, high-impact aerobics, playing tennis, jumping rope, hiking and stair-climbing. Lower impact exercises can also help keep bones strong and are a safe alternative for people who cannot do high-impact exercises. Some examples of low-impact weight-bearing exercises are elliptical training machines, low-impact aerobics, stair-step machines and fast walking.
Muscle-strengthening exercises, such as lifting weights or using elastic exercise bands, cause skeletal muscle to pull against the bone, which results in the bone rebuilding and becoming denser. Muscle-strengthening exercises should be done two to three days per week.
Tai Chi can help improve balance and prevent falls; and posture exercises are good for reducing rounded shoulders, which decreases the chance of breaking a bone. Yoga and Pilates may be beneficial for some people – but before beginning either, a physical therapist should be consulted .
Note that too much exercise can be detrimental for women, however, because it can cause a drop in estrogen, which is needed for bone health.
The most common medications to prevent and treat osteoporosis are medicines that slow the loss of bone called antiresorptive medicines. These include bisphosphonates (Fosamax, Boniva, Actonel), calcitonin, estrogen, estrogen agonists/antagonists (SERM) and RANK ligand inhibitor (Prolia).
It is also recommended that the preventative measures listed above be adopted to preserve bone density as much as possible.
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The Phelps Osteoporosis Center
Phelps established the Osteoporosis Center to provide comprehensive diagnosis, treatment and support for patients with osteopenia and osteoporosis. It is a multi-disciplinary program under the medical direction of endocrinologist James Hellerman, MD.
Each patient is given a thorough medical examination and is interviewed to determine possible risk factors. Lab tests and a DEXA bone density scan may be recommended. Results are assessed, and an individual treatment plan is developed for each patient.
The treatment plan for patients who are diagnosed with osteopenia or osteoporosis may include any of the following:
- Physical Medicine Evaluation – A physiatrist will work on posture with patients who have structural problems, such as sloping upper back.
- Nutrition Counseling
- Pain Management – Referral to the Phelps Pain Center for patients who have back pain caused by compression fractures
- Group Programs
- Group Exercise Programs
- A physical therapist helps participants increase strength, reduce back pain, and improve posture and balance to prevent falls.
- An occupational therapist teaches ways to perform activities of daily living that are less likely to result in falls or fractures.
- Nutrition Information Session
- Education Sessions
- Group Exercise Programs
- Support Group led by a social worker
Monthly education, nutrition and exercise programs take place at Phelps Memorial Hospital Center, 701 North Broadway, Sleepy Hollow, in the Board Room on the second Thursday of the month from 11 am – 12:30 pm, beginning on February 13, 2014.
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Phelps Osteoporosis Center
James Hellerman, MD, Medical Director
200 South Broadway
Tarrytown, NY 10591
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