Osteoporosis: Update

This is an update on Osteoporosis (OP) and Fragility Fractures (FFs), conditions initially introduced in our October and December 2010 columns.  I recommend a review of those earlier columns. A brief summary is as follows:     

• OP is defined as “thin bones “and is due to inadequate calcification of the skeleton
• FFs are fractures through these weakened bones and occur following minor trauma
• Bisphosphonates (BPs) are a class of drugs proven to reduce the risk of FFs and improve skeletal calcification
• Postmenopausal women are at high risk for developing OP

OP and its sequelae, FFs, are increasing at an alarming rate in the United States. There are more FFs each year than heart attacks, strokes and new cases of breast cancer combined.

A program of exercise, adequate calcium/Vitamin D intake (especially during the prime growth years of 8-18) and, when indicated, BPs, has been proven to reduce significantly the risk of OP and its complications. Despite this evidence, misconceptions and distrust abound, keeping compliance and participation low.

Let us review some fears, facts, and current thinking on OP.

Fear: “Bisphosphonates cause femur (thigh bone) fractures rather than prevent them.”

Fact:  BPs can cause femur fractures, but it’s rare. Actually, BPs prevent as many as 100 femur fractures to every one they may cause.  This rare event, moreover, seems to occur in persons taking BPs for longer than 5 years, the point at which many patients can safely stop the drug as their bone mass may well have stabilized.

Fear:  “Calcium supplements can cause heart attacks”

Fact:  This causal relationship, though implied in recent studies, has not been proven.  Because of this possible connection, however, the recommendation is to obtain most of one’s daily calcium requirement through dietary means.  Dietary calcium has not been linked to heart attacks.

Fear:  “OP is the accepted cost of aging and FFs are relatively uncommon, especially if one is careful”

Fact:  Fifty per cent of women over age 50 will have a FF in their lifetime. This serious complication of OP is largely a preventable condition if prophylactic recommendations are followed.  Being careful is not enough.

Here are the current OP recommendations for all adults over 40:

1. All post-menopausal women need to be screened for OP
2. Everyone with a FF, regardless of age or sex, needs to be evaluated and treated for OP; without treatment, the chance of a second FF is very high
3.  Take 1000-1200mg of Calcium (dietary preferred) and 400-800 IU of Vitamin D supplements each day
4. Engage in daily weight bearing exercises using the upper extremities as well as the lowers
5. Do not smoke
6. Limit alcohol to no more than two drinks a day
7. Take BPs if prescribed; while taking BPs, be cognizant of any persistent thigh pain and report it to your doctor. After 5 years of continuous use of BPs, discuss possible cessation with your doctor; do not stop them on your own

OP, like Hypertension, is a silent disease, slowly progressing without causing symptoms.  In both conditions proactive treatment will avert serious complications.