MEDICAL SURFARI: OSTEOPOROSIS ISN'T INEVITABLE

Ever heard of or seen a "dowager's hump", and wonder what it is? It is the hump that some elderly women develop on their back and is often associated with the "little old lady" stereotype. This is actually caused by multiple vertebral compression fractures (broken back bones), that results in a "hump," bend, or angulation of the spine. These broken vertebrae are often the result of osteoporosis.

What is osteoporosis?

This disease is marked by porous, brittle bones that lose their ability to withstand normal stresses and they break or collapse. Osteoporosis develops from a gradual loss of bone mineral over many years and the process may begin as early as 30 to 35 years of age.

Bones. Two hundred and six of them!

Contrary to what many believe, bone is not a stony, dead mineral within our bodies that our soft parts cling to. It is a dynamic living tissue. Think about it, everyone knows that broken bones usually heal! Bone continuously remodels its own architecture, to bear the daily stresses imposed upon it by exercise, work, injury and even our own body weight.

Your bone mass (total body bone) is like a savings account -- it depends upon how much you deposit. The critical years for depositing are from teens to about age 30 and some experts believe that bone mass can be increased by as much as 20 percent during these years thereby becoming a critical factor to prevent osteoporosis.

In bone, as in other aspects of life, there are givers and takers. Two armies of cells with opposite functions live within the lacey caverns of bone normally remodeling our skeleton through a balanced system of bone formation and resorption (bone loss). If more resorption than formation occurs there will be a decrease in bone mass. As part of the natural aging process bone mass is lost, resorption occurs faster than new bone can be formed -- the takers outpace the givers. In women, bone loss often accelerates after menopause when the ovaries stop making estrogen, a hormone that reduces bone loss.

Who is at risk ?

Two of the most commonly prevailing myths about osteoporosis are that it is an inevitable part of aging and that it only affects women. One out of every two women and 1 out of every 8 men have a risk of suffering an osteoporotic fracture sometime during their life. Yes, although much less common, it can affect men too!

Women with a small, slight body frame, especially white women and women of Asian descent have a higher risk for osteoporosis.

Risk Factors For Osteoporosis:

-- Age: risk increases with age.

-- Gender: women have 4 times the risk of men.

-- Race: Caucasian and Asian women have the highest risk but African American and Hispanic women also have significant risk.

-- Bone Structure and Body Weight: Normal or early menopause brought on naturally or because of surgery increases risk of osteoporosis. Non-menstruating women are at higher risk.

-- Lifestyle: Smoking tobacco, drinking too much alcohol, inadequate consumption of calcium and little or no weight-bearing exercise increase risk.

-- Medications: Certain medications, especially steroids, as well as some medical conditions that reduce ones ability to exercise, may increase risk.

-- Family History: Young women whose mothers have a history of osteoporosis seem to have reduced bone mass and may be at increased risk.

Prevention and Treatment of Osteoporosis:

A dowager's hump and osteoporosis can be prevented. Once you develop osteoporosis there is no cure, but it can be treated. Successful prevention of this disease requires raising physician and public awareness about lifestyle and dietary effects upon the age-related process within bone.

The St. Louis District Dairy Council on osteoporosis created an educational video entitled Build Better Bone Now, that has been distributed to over 800 schools, which targets the teen audience to instruct them about their need now for a diet rich in calcium and exercise to reduce their risk of osteoporosis in later years. Experts at the National Institutes of Health believe that this could be the generation that sees the end of osteoporosis.

Hormone replacement therapy approved by the Food and Drug Administration (FDA) at or after menopause is regarded by some as an essential treatment to prevent accelerated bone loss in high-risk women. There are risks as well as benefits associated with estrogen use. Uterine cancer risk can be offset by adding another hormone, progesterone, to the estrogen therapy. Others are concerned about the long-term use of estrogen and the possible increase risk of developing breast cancer.

There are other medications, bisphosphonates and calcitonin (inhibit bone loss) and selective estrogen hormone modulators, for women who can not or who choose not to take conventional estrogen hormone replacement therapy. These selective estrogen modulators are designed to allow estrogen to act upon some parts of the body but not the breast tissue. Research with these "designer estrogens" looks promising especially for early menopausal women. The risks and benefits of these and other therapies as well as nutritional supplements must be discussed with your treating physician.

Are my bones healthy?

A proper medical interview and physical examination by your doctor will determine whether you should have a bone mass measurement. This is not necessary in everyone but it is a sure way to get an accurate measure of your bone density. Although some health care providers question the usefulness of bone density testing , others feel that it personalizes the issues and encourages people to be more interested in their health.

World Wide Web Information Resources:

National Osteoporosis Foundation

http://www.nof.org/Osteoporosis.html

This is a friendly, well-organized site with a full information menu. The content is medically sound, up-to-date information for patients, families and professional about prevention, detection and treatment of osteoporosis.

Missouri Osteoporosis Foundation:

http://www.moof.org/

Headquartered in St. Louis, this not-for-profit foundation was established in 1988 to increase public awareness of osteoporosis, promote physician education and provide support to osteoporosis sufferers, as well as fund research of osteoporosis. This site is a provides a good source of information about the various bone mineral density tests as well a calendar of upcoming events and a list of support groups.

Dr. Gibbs is a neurosurgeon and the Editor-in-Chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo. 63701.