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<< Previous   of   Next >>   ADVERTISEMENT   CONTACT THE HERALD Melanie Munk, Features Editor munk@heraldnet.com   Published: Tuesday, April 1, 2008 Understand, and assess risk for, osteoporosis By Dr. Elizabeth Smoots Debilitating broken bones are a concern for many Americans as they age. How worried should you be? I've summarized the facts about osteoporosis causes and screening, including comments from Dr. Fred Heidrich, a professor of family medicine at the University of Washington in Seattle, Heidrich has a special interest in the bone-weakening disease. Here are some things to consider: Causes of osteoporosis Your bones are constantly repairing themselves. Osteoporosis develops when bone breakdown by bone cells called osteoclasts exceeds bone formation by competing cells, which are called osteoblasts. "It's sort of like putting money in the bank," Heidrich says. "If you end up taking more money out than you're putting in, your balance goes down. Similarly, if you have osteoclasts working faster than your osteoblasts, your bone density goes down." Low bone-mineral density increases the risk for fractures. Broken bones that occur in the hip or spine can result in shrinking stature, disabling pain, difficulty standing or walking, and loss of independence, especially in older people. Fracture risk It's important when sizing up osteoporosis to think about your risk factors. Some factors you can't do anything about and others you can. Nonmodifiable risk factors: The rate of osteoporosis goes up with age. Half of Americans older than 50 will have a high fracture-risk from brittle bones by the year 2020, according to a report from the U.S. Surgeon General. Likewise the rate of hip fractures is two to three times higher in women than men. Race can play a role: "In general, white women have roughly double the fractures of black and Asian women," Heidrich says. "White men have higher fracture rates than black and Asian men. But you can always find exceptions." Other factors that are difficult to change include having a family history of osteoporosis, a prior fracture as an adult, a chronic ailment or generally poor health. Modifiable risk factors: A weight of less than 127 pounds increases your risk for osteoporosis. So does low calcium and vitamin D intake, inactivity, smoking and excess drinking. Eating large amounts of protein, phosphorus (common in soft drinks), sugar and salt may promote bone loss. Another culprit is consuming vitamin A in excess of 2,000 milligrams a day, according to a study in the Journal of the American Medical Association. Some medications have side effects that may damage your bones. Examples include cortisone, drugs for thyroid or seizures, proton pump inhibitors and antacids containing aluminum. So it's wise to have your doctor review all your medications. Osteoporosis tests The U.S. Preventive Task Force recommends bone-mineral density screening for women beginning at 65 years of age, or 60 in women with risk factors for osteoporosis. However, low bone-mineral density is only one of many risk factors for hip fracture. Your doctor can estimate your chance of developing a hip fracture over the next several years by looking at all of your risk factors. If you are at increased risk for osteoporosis Heidrich says that getting a bone density test plus an assessment of your risk factors is the best way to predict fractures and decide about therapy. Even if you're not at high risk, now's an excellent time to take care of your bones. Make sure you're getting enough calcium and vitamin D from your diet, Heidrich advises. Perform weight-bearing activities to strengthen your leg bones and upper-body exercises to fortify your arm bones. "Even people in a wheelchair have benefit for their bones by doing exercises," Heidrich says. More info: National Osteoporosis Foundation, www.nof.org. Contact Dr. Elizabeth Smoots, a board-certified family physician and fellow of the American Academy of Family Physicians, at doctor@practicalprevention.com. Her columns are not intended as a substitute for medical advice or treatment. Before adhering to any recommendations in this column consult your health care provider. © 2008 Elizabeth S. Smoots

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