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Osteoporosis
Consensus-Prevention
Osteoporosis
Consensus-Prevention
This article appeared in the first
issue of the Arthritis Insight Newsletter, April 5, 2000
NIH
Consensus Development Conference on Osteoporosis Prevention, Diagnosis,
and Therapy was held March 27-29 at the NIH in Bethesda, MD. The
conference brought together national and international experts to
present the latest research findings on osteoporosis and Dr. Susan Hoch
was there. She brought back
some important information for all of us.
As
defined by the consensus, osteoporosis is "a skeletal disorder
characterized by compromised bone strength predisposing to an increased
risk of fracture.
Bone
strength reflects the integration of two main features, bone density
and bone quality." Translated from doctorese, that means the bones
become weak and of poor quality, causing a higher chance of breaks.
Here
are some rather frightening statistics regarding osteoporosis and
fractures: The probability that a 50 year old will have a hip fracture
during his or her lifetime is 14% for a Caucasian female and 5-6% for a
Caucasian male. The risk for African Americans is much lower at 6% for
women and 3% for men. Nearly 28% of patients with hip fractures are
discharged to nursing homes within the year following a fracture.
One in 5 patients are no longer living 1 year after sustaining a
hip fracture. Spinal
fractures cause disabling pain, as well as deformity, loss of self
esteem, respiratory, gastrointestinal and other related problems.
It's
unavoidable right? We all get it as we age. Wrong! According to Dr.
Susan, "Osteoporosis is preventable. And that prevention starts in
childhood." Well then it is too late for me, you might say. Think
again. "It is never too late to build bone...bone can be built in
the osteoporotic patient," says Dr. Susan.
Some
of the risk factors are unavoidable, such as being a female, increased
age, estrogen deficiency, testosterone deficiency in men, of white race
and a family history of osteoporosis. But other risk factors are
avoidable, such as smoking, poor diet and lack of exercise.
Of
concern to many of us is the use of steroids. Steroid induced
osteoporosis is the most common form of drug related osteoporosis. In
one study, a group of patients treated with 10 mg prednisone for 20
weeks experienced an 8% loss of bone density in the spine.
Anyone taking more than 7.5 mg prednisone for two months or
longer and possibly anyone on more than 5 mg should be considered at
high risk for excessive bone loss.
So,
besides using the lowest possible dose of prednisone, if we must use it
all, we can we do about it?
Make
sure you get enough calcium. Most of us aren't. Calcium intake is low
for all ages. The RDA for children 3 to 8 is 800 mg/day. The RDA for
children and adolescents 9-17 is 1300 mg/d. Only 25% of boys and 10% of
girls meet these recommendations. Factors contributing to low calcium
intake are restriction of daily products, low intake of fruits and
vegetables and a high intake of low calcium beverages such as sodas. For
adults the RDA is 1000-1500 mg/day with 1500 mg/day for people with
osteoporosis and 1200 for people over 60.
Vitamin
D is important too. In ranges of 400 IU to 600 IU per day, vitamin D has
been shown to reduce fractures in elderly persons and to augment the
effect of estrogen on bone mineral density.
Exercise
and get those kids exercising. Exercise early in life contributes to
higher peak bone mass. Resistance and impact exercise is likely the most
beneficial.
Exercise
during the middle years of life is good for your health but there are
few studies on the effects of exercise on bone mineral density. In later
life, exercise along with adequate calcium and vitamin D appears to slow
bone loss. Exercise late in life in individuals beyond 90 years of age
can increase muscle mass and strength and reduce the risk of falls by
25%.
Osteoporosis
in not inevitable! It is preventable and treatable.
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