The bone, hard truth about osteoporisis and when women should start to think about it

Just a few years back, it was heresy to suggest that, when it comes to protecting bones, early treatment may not be the answer.

Part of the rite of passage through menopause a decade ago became bone-density screening. Around age 50, many women would position their skeletons under the X-ray eye of new machines that could calibrate the alarming rate at which their bones were being eaten away. On top of that, they began to hear commercials featuring women, often much younger than themselves, praising a pill for saving them from nursing homes, physical deterioration and crumbling spines.

It was no longer sufficient to get enough calcium and vitamin D and do weight-bearing exercise. A combination of new technology and clever marketing was pushing fear of fractures from geriatric reality to midlife worry. Meanwhile, women were hit with a new word, osteopenia. The pre-osteoporosis, non-disease condition, named by the World Health Organization in 1992, has a broad enough definition to include about half of all women older than 50.

"The average bone density for a 60-year-old Caucasian woman would put her in osteopenia," said Dennis Black, an epidemiologist at the University of California, San Francisco, who studies the effectiveness of osteoporosis treatments.

Confused about what the new label actually meant, young, healthy women suddenly seemed more worried about their bones than did their mothers and grandmothers — who really had something to worry about.

Dr. August Ritter III with Orthopedic Associates of Southeast Missouri said while younger women shouldn't worry, they should be wary.

"Women should begin preventing osteoporosis through diet and exercise in their early 20s," he said. "Osteoporosis is more common in women than men as testosterone has a protective effect."

More of a risk, but how much?

Newer studies have shown that most women will lose no more than 7 percent of their bone mass within the decade after menopause. Bisphosphonates have been shown to replace about 8 percent of bone within five years, so waiting will cost most women nothing. Counter to just about every other preventive health care message out there, when it comes to osteoporosis drugs, it's probably better to hold off.

"Wait until the risk gets high enough," said Dr. Bruce Ettinger, adjunct clinical investigator at Kaiser Permanente, Northern California.

Even the drug marketers seem to be getting more realistic.

"If you look at the TV ads, it's no longer the 45- or 50-year-old who's just finished her workout," Ettinger said. "It's a 65-year-old doing some stretching or gardening."

The current recommendation is that most healthy women get checked for bone loss with a bone-density test at age 65, not the minute they hit menopause, according to the U.S. Preventive Services Task Force. Those with risk factors — such as a family history of the disease, a fracture, smoking, heavy alcohol use or a history of taking corticosteroids — should get a bone-density test around age 60, the 2002 recommendation said. And men should be tested at 70.

This dramatic shift from early prevention to later prevention is an attempt to save healthy women from decades of pill popping to prevent a disease many will never have. Like all drugs, these have side effects that can include upper gastrointestinal irritation, ulcers of the esophagus, upset stomach, bone pain and skin rash. But what has many people concerned is that the long-term effects are unknown.