Osteoporosis is a disease that weakens bones and makes them susceptible to fracture. Literally translated, osteoporosis means "bone that is porous" (osteo= bone and porosis= porous). This disease affects both men and women; however, 80% of those affected are women. This may be because women generally have smaller bones than men, and because at menopause women lose their estrogen protection, which is a major contributor to bone strength.
Fractures due to osteoporosis of the spine usually affect women after the age of 50, while fractures of the hip start later, usually in the 70's. Hip fractures occur later in life and fractures of the spine earlier, because the hip is surrounded by a tough outer bone called cortical bone. The spine is made up of soft trabecular bone, without the tough outer cortical bone covering. This makes the spine more susceptible to fractures. If one looks inside a vertebra of the spine, it will look somewhat like Swiss cheese. As osteoporosis develops, the supporting structures within the vertebra break down and the "Swiss cheese" holes become larger, leading to weaker bone and fractures.
Osteoporosis itself is painless. However, the resulting fractures of osteoporosis are painful. Not only can these fractures be associated with pain, but also with limitation in movement. The decrease in mobility that can occur leads to further deconditioning, which in turn further weakens muscles and bones. In addition, the constant pain and reduced mobility caused by these fractures can lead to clinical depression.
Many patients are not aware that they have osteoporosis until they develop pain. Unfortunately, with many patients, their first clue that they have osteoporosis occurs when they develop a painful fracture.
Aging itself is associated with bone loss, which explains why most non-traumatic fractures occur in the elderly. Bone growth usually occurs until around age 35, after which a slow decline begins. Various other disease states, such as rheumatoid arthritis, can also be associated with bone loss leading to osteoporosis. Medications, especially long term usage of corticosteroids, can lead to bone loss.
The following risk factors may predispose one to osteoporosis:
- Low levels of testosterone in men
- Having a small frame (delicate bone structure)
- A family history of osteoporosis
- A history of a bone fracture due to trauma
- A history of Inflammatory arthritis such as rheumatoid arthritis
- A low level of calcium intake
- Drinking more than 2 alcoholic beverages a day
The long term use of the following medications may predispose one to osteoporosis (these are medications which can possibly reduce bone strength):
- Phenytoin (Dilantin)
- Thyroid replacements
- Long term heparin therapy
The goal is to diagnosis osteoporosis before a fracture develops. Your physician will want to obtain a good history to determine if you have risk factors, and perform a physical examination. Blood tests may be ordered to rule out other diseases that can weaken bones. A bone density test can be obtained which provides a numerical value for bone loss. It compares the density of your bone to others of your age and sex, thus providing a risk estimate of your having osteoporsis. A dual-energy absorptiometry is currently the "gold standard" for measuring bone density. This test is painless, quick, and readily available.
Good bone health depends upon good nutrition, with adequate protein and calcium. In addition, exercise is important to keep the muscles and bones strong. Ideally, one would like to build up as much bone mass as possible prior to age of 35 when bone loss generally begins. Calcium is vitally important for bone strength. Most adults need about 1000 mg of calcium a day, while post-menopausal and pregnant women may need up to 1500mg a day. If you are not a milk drinker, calcium can be obtained from other dairy sources such as yogurt and cheese. An eight ounce glass of milk contains about 300 mg of calcium. Other foods that contain calcium include dark leafy green vegetables, Brazil nuts, calcium fortified juices, and bread. Your diet may also be supplemented with calcium tablets or chewables.
Exercises that are suited to your age and physical health can help to strengthen bones and the muscles that attach to the bones. This will help to reduce the chance of fractures from occurring. We have found that the best exercises for this condition include walking, swimming or water exercises, working in the garden, and stationary bicycles. However, before embarking on any exercise program, you need to discuss it with your family doctor.
Medications are often used with calcium to either treat osteoporosis or to increase bone density and reduce the risk of fractures. There are currently five classes of drugs that are used either for prevention or treatment of osteoporosis. The five classes are listed below, along with the names of one or two popular medications included in that class:
- Estrogen and Estrogen/Progesterone combinations (Premarin and Prempro)
- Selective Estrogen Receptor Modulators (Evista)
- Bisphosphonates (Fosamax and Actonel)
- Parathyroid Hormone (Forteo)
- Calcitonins ( Miacalcin)
Additional Measures That May Help Reduce Osteoporosis Related Fractures: In addition to a healthy diet and exercise program, good common sense is essential. Lifting should be done with the knees while keeping the back straight. Sleeping with a cervical pillow can help protect the neck muscles and cervical vertebrae. We have found the Walpilo to be very effective. Your home should be made safer to help reduce the risk of falling. In my practice I recommend:
- The installation of sturdy handrails in the bathrooms and on stairs
- Eliminate slippery throw rugs
- Use good lighting through out your home
Patients with persistent back discomfort from osteoporosis may benefit from the use of back supports or braces that provide lower abdominal and back support. This type of support can be helpful in reducing stress on the back, and promoting the proper curvature of the back. I recommend the use of either the Impacto Air Temp Advantage Back Brace or the Rolyan Positive Support Lumbo Sacral Orthosis.
When sitting, it is very important to use a chair with good lumbar back support. Lumbar supports such as the Contour Freedom Back Cushion can be used in most chairs to reduce spinal pressure, provide support, and to give comfort to ailing backs.