What Is Osteoporosis, Anyway?

Beautiful Bones without Hormones: The All-New Natural Diet and Exercise Program to Reduce the Risk of Osteoporosis and Keep Your Bones Healthy and Strong
by Leon Root, M.D.

(Page 2 of 4)

We are in the midst of a global eoporosis epidemic, and most of us don't even know it. For more than one half of the U.S. population over the age of fifty, osteoporosis and low bone mass are a major threat to health and longevity. The fact is that right now, 44 million of us are living with low bone mass (osteopenia, the bone-thinning condition that leads to osteoporosis) or with osteoporosis itself. I was shocked to learn that more than 200 million people worldwide are suffering from this condition, and as the global population continues to age the problem will get even worse. Just take a look at some of these startling statistics recently released by the National Osteoporosis Foundation (NOF): For the average American woman, the risk of developing osteoporosis is greater than her risk of developing breast cancer and endometrial cancer combined.

More women die from osteoporosis-related hip fractures each year than from uterine cancer and breast cancer combined. Most of these deaths can be prevented.

One out of two women will have an osteoporosis-related bone fracture in her lifetime.

One out of every eight men will have an osteoporosis-related bone fracture in his lifetime.

2002: Forty-four million men and women over fifty in the U.S. are currently suffering from low bone mass, 68% of whom are women.
    • Ten million of these people already have osteoporosis.

2010: Fifty-two million American men and women over fifty will have low bone mass.
    • Twelve million of these men and women will have osteoporosis.

2020: Sixty-one million Americans in this age group will have low bone mass.
    • Fourteen million of these people will have osteoporosis.

Seventeen billion dollars is spent in the U.S. each year on osteoporosis-related fractures.

Osteoporosis is responsible for more than 1.5 million fractures annually, including:

• 300,000 hip fractures
• 700,000 vertebral fractures
• 250,000 wrist fractures
• 300,000 fractures at other sites

Bone health must be considered a top priority for all Americans, as well as everyone over the age of fifty throughout the world.

What I find so disturbing in all this is that so many men and women know so very little about the dangers of osteoporosis. Let me tell you about a patient I have been treating for many years, named Mildred. When she first came to see me she was a feisty, funny, exceptionally bright and alert woman. She was a widow and surrounded herself with friends, most of whom shared her love of working for political causes. Ten years ago, when she was sixty-eight, she fell and broke her wrist. Fortunately, I was able to set the fracture and it healed without complications. Because of her age I suggested she get a bone density test, and much to her surprise, it revealed that she had significant osteoporosis. I urged her to stop smoking, take calcium supplements, and get more exercise. "Thanks," she said. "I appreciate your advice, but I'm just too old for all that." As you might imagine, things got worse. About two years after the wrist fracture, she fell and fractured her pelvis and lower spine. This time she was hospitalized for four weeks and had to spend three months after that at home, in terrible pain. Finally she was able to walk again, with a cane. This time I was able to get her to stop smoking. Then, about a year and a half later, Mildred slipped on a wet floor, landed on her back and fractured her sacrum and compressed four lumbar vertebrae. Again she was hospitalized for several weeks, and when she was finally allowed to go home, she was confined to bed rest and had to be on constant medication for pain. She was not even able to walk to the bathroom. It was six months before she could leave her home, and she was still in a great deal of pain. By this time she had lost two inches in height, was severely bent over, and could not walk without a walker, much less a cane. Mildred is no longer the lady I knew. She tries to be optimistic, but I can see that this is an enormous effort. She tires easily now, and though she still has a few close friends who help her out, she has had to give up all of her political activities. I mourn the loss of the woman I knew. Osteoporosis was the culprit here, and because she chose to do nothing to treat it, her life will never be the same.

Even more troubling is that most people in the highest risk group, namely postmenopausal women, are not getting adequate information about osteoporosis, nor are they getting advice on how to prevent and treat it. It is estimated that fewer than 30% of women with osteoporosis have been diagnosed with the disease, and of these women, fewer than 15% are receiving treatment. The tragedy is that osteoporosis is usually preventable and treatable, and the earlier you start taking steps to prevent or treat this crippling disease, the better. This is why I strongly recommend that you get a bone density test right now if you are in any of the high-risk groups for osteoporosis. What happened to Mildred need not happen to you. As the saying goes, an ounce of prevention is worth a pound of cure.

There are several types of bone mineral density (BMD) tests available. The tests are simple, painless, and the cost is usually covered by medical insurance. I'll tell you all about who is at risk and why, and describe the types of Bone Mineral Density (BMD) tests in Chapter 2. The sooner you know what your risk factors are, the sooner you and your doctor will be able to decide on the best course of action. In the meantime, the safest and most effective thing that you can do for bone health is to make sure that you're getting lots of calcium in your diet every day. Most people don't get nearly the amount of calcium their bones need each day to stay healthy. I'll tell you how to do it in the following chapters. For now though, if you are over fifty, try to make sure you are getting 1,500 milligrams of calcium in your diet daily. This little step, along with a simple and gentle exercise regimen, will go a long way toward restoring your beautiful bones to optimal health.

What exactly is osteoporosis? It is "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture," according to the new definition that the National Institutes of Health came up with in March 2000. It affects our entire skeletal system, and it is characterized by compromised bone strength, which means your bones are less dense than they should be in order to do their three primary jobs: 1) support your body; 2) protect your delicate internal organs, and 3) serve as a storeroom for calcium and other essential minerals you need to stay healthy.

Bone is a living, self-regenerating tissue. It is made up in large part of collagen, a protein giving bone a soft framework, and calcium phosphate, a mineral that makes this framework hard and gives it strength. It is the combination of this protein and mineral that makes bone strong, yet flexible enough to withstand stress. Our body achieves its peak bone mass (maximum bone density and strength) by the time we are between twenty-five and thirty, and it does a pretty good job of keeping bone mass at its peak by working out a precise balance between resorption, the removal of old bone, and formation, the addition of new bone. When we are children and teenagers, bone is being added faster than it is being removed, but sometime between the age of twenty-five and forty the process starts to reverse, and resorption (removal) slowly begins to exceed bone formation. In other words, our body begins to lose more bone mass than it can replace. Usually, the rate of loss at the beginning of this process is from 0.5 to 1% a year. When resorption occurs too quickly, or formation occurs too slowly, low bone mass starts to occur and, over time, if this imbalance persists, will lead to full-blown, debilitating osteoporosis. Osteoporosis is more likely to develop in people who did not reach optimal bone mass during their bone-building years. Therefore, the prevention of osteoporosis should start as early as in your late teens. Men and women are both affected by this loss, but when a woman reaches the age of menopause her bone loss accelerates from about 3% up to 7% a year.

Think of it this way: If you have been diagnosed with low bone mass or density, this means that your bones have less mineral per square inch than they should, when measured against the typical bone mass of a healthy, thirty-year-old Caucasian person. If your diagnosis shows that your bones are only somewhat less dense than normal, you probably have a condition called osteopenia, meaning that on your bone density test, your T-score was between - 1 and - 2.5 standard deviations below what your normal bone density was when you were about thirty. On the other hand, if your T-score is below - 2.5 you have full-blown osteoporosis. Both of these conditions indicate that the structure of your bone tissue has begun to deteriorate, making your bones more fragile and susceptible to fractures. Osteoporosis is a progressive disease, and as I've said, the scary thing is that there are usually no symptoms until a fracture occurs. Often, for example, I'll be treating a woman for a broken wrist and she'll say to me, "I just can't believe it. I had no idea anything was wrong. Why didn't I have any warning that this could happen? I thought I was perfectly fine." This is why osteoporosis is often referred to as the "silent thief." It just sneaks up on you like a thief in the night and steals from your precious bones.

Copyright © 2005 Dr. Leon Root

About the Author

Dr. Leon Root is an orthopedic surgeon at the Hospital for Special Surgery in New York, where he also serves as the Director of Rehabilitation Medicine and Director of the Back School Program. A Professor of Clinical Orthopedics at the Weill College of Medicine, Cornell University and a frequent guest on national media, he lives in New York City.