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.