It’s known as the silent disease. Often, the first symptom is a broken hip or fractured wrist from a minor fall. Like wood ravaged by termites, over time osteoporosis causes bones to lose mass, become brittle and break. The disease is a major public health threat for more than 28 million Americans, 80 percent of whom are women.
“In the United States, 10 million individuals already have the disease and 18 million more have low bone mass, which puts them at risk for osteoporosis,” said Lynn Chard-Petronjal, a spokeswoman with the National Osteoporosis Foundation in Washington.
Hip fractures are the most serious consequence of osteoporosis. Some 24 percent of those older than 50 who suffer hip fractures associated with osteoporosis will die from complications of the injury within one year, according to Chard-Petronjal.
“There is much more emphasis on osteoporosis than 10 years ago,” said Dr. Jesse Weinger, a Peoria, Ill., orthopedic surgeon. “The reason for the attention is that we now have drugs that can effectively treat the disease. And the technology also exists to measure bone density.”
Weinger, a spinal specialist with Midwest Orthopedic Center, added a bone densitometer to his office. The machine uses small amounts of X-ray to determine how much bone mineral is present. Before getting the machine, the surgeon ordered bone density tests through Methodist Medical Center.
“The test compares your bone density to that of a healthy young adult and also to people of your same age,” Weinger said. “I probably order five to 10 bone density scans a week. …It’s only within the past five years that this has become a common practice.”
The machine measures bone density in the spine, hip and wrists, three areas most susceptible to osteoporotic fractures.
“The test takes about 10 minutes,” Weinger said. “And the amount of X-ray absorbed by the patient is very small. It’s only about one-10th of that received by a chest X-ray.”
A bone scan can not predict a bone fracture, but it can determine if a person is at greater risk of having one. After the bone scan is complete, the doctor receives a patient’s results, called a T-score, the difference between the patient’s results and that of a healthy young adult.
A T-score that is above negative 1 is considered normal; one between negative 1 and negative 2.5 shows low bone density; and a score below negative 2.5 indicates osteoporosis. Bone density can vary from one part of the body to another. Minutes after a bone density scan on an 81-year-old woman, Weinger was studying the results.
“With the scanner we can determine the need for treatment,” the surgeon said. “The measurements allow us to detect the disease very early in its development and begin treatment before it gets to the point of a fracture. The scanner also allows us to measure the patient’s progress so we can tell if our treatment is working.”
There is a wide variety of treatments for osteoporosis. Two of the most promising medications are bisphosphonates called Fosamax and Actonel. The drugs are relatively new, Weinger said, having been around for just two or three years.
“But they have emerged as the most effective drugs to treat a patient with osteoporosis,” he said. “They substantially reduce fracture risk and studies show that they increase bone density.”
Even more effective drugs are being developed. A study released in the New England Journal of Medicine found that a natural bone-building hormone appears to be the most effective treatment ever for osteoporosis, The Associated Press reported.
The manufacturer hopes the medicine, called Forteo (for-TAY-oh), will be available by prescription by the end of the year. If so, it is likely to be recommended for victims of moderate to severe osteoporosis. The drug is based on the parathyroid hormone, which is ordinarily secreted by tiny glands in the neck. When given to volunteers with osteoporosis, it doubles their normal rate of bone formation.
The study shows that it dramatically reduces the risk of broken bones. The risk of spinal fractures, a hallmark of osteoporosis, fell by two-thirds in women getting the medicine.
“It’s the first demonstration of the concept that stimulating bone formation is going to be an effective way to treat osteoporosis in humans,” said Dr. Robert M. Neer, the study’s director.
Medication and bone density testing are only part of treatment in preventing the disease. Proper diet with foods rich in calcium and vitamin D, changing unhealthy habits such as smoking and excessive alcohol consumption, and regular weight-bearing exercises can all help prevent brittle bones.
The National Osteoporosis Foundation advises that all adults older than age 50 take 1,200 milligrams of calcium a day. The NOF also advises adults to get at least 10 minutes of sunlight a day, or take at least 400 International Units of vitamin D daily. Weight-bearing exercises such as walking or stair-climbing as well as strength-training exercises using weights, machines or resistance devices help build up bone. Exercise and proper diet are most important in preventing osteoporosis, according to Chard-Petronjal.
“You can start losing bone mass as early as 30 if you don’t exercise or have a good diet,” she said.
Osteoporosis is responsible for more than 1.5 million fractures annually.
“Many people consider osteoporosis a fact of life that results with old age,” Chard-Petronjal said. “Too many people have resigned themselves to living with the disease. We need to change that perception. While there is yet no cure, we can take steps to prevent it and even treat the disease.”