OSTEOPOROSIS - OSTEOPOROSIS OVERVIEW

According to the National Osteoporosis Foundation, 10 million Americans have osteoporosis, 80 percent of whom are women. But men are not immune to this condition. Every year about 2 million men are diagnosed with osteoporosis. Estimates show that an additional 34 million Americans have low bone mass, placing them at high risk of developing osteoporosis. Although osteoporosis can strike at virtually any age, it is a major health threat for people 50 years old or older. In fact, 55 percent of people 50 or older are at risk of developing the condition at some point in their lifetimes.

The human suffering and financial healthcare implications created by this condition are devastating. Hip and vertebral fractures are common among people with osteoporosis. These fractures are painful and can cause disability, deformity, dependence, and substantially reduced quality of life. Conservative estimates show that the financial cost of osteoporosis in the United States each year is $10 billion. Prevention and early detec-tion are critical. Understanding the causes and risk factors can help with prevention and early detection.

Causes And Risk Factors

Our bones naturally become thinner as we age, so getting older auto-matically puts us at risk of developing osteoporosis. Reduced hormone production in both older men and women can cause bone cells to be reabsorbed faster than the body can make new bone cells. Fortunately, there are things we can do as we age to offset this risk factor (more on that in Chapters 3 and 4). Following is a list of some of the other causes and risk factors associated with osteoporosis: Eating disorders cause metabolic problems, reduced mineral intake, and hormonal imbalance.

•  Medications such as chemotherapy for cancer, steroids (Prednisone), anticonvulsant seizure drugs or aluminum-containing antacids can encourage bone loss.
•  Exposure to radiation can weaken bones.
•  A family history can pre-dispose an individual to osteoporosis.
•  Smoking and drinking alcohol in excess can reduce bone mass.
•  Being Caucasian, and to a lesser extent Asian, as well as having a thin frame and low bodyweight.
•  Being inactive for a long period of time.
•  A poor diet, specifically a high acidic diet (more on that in Chapter 4).

In addition to these causes and risk factors, there are several diseases that can contribute to bone loss including:

•  Celiac disease (individuals allergic to gluten)
•  Inflammatory bowel disease
•  Rheumatoid arthritis
•  Anorexia
•  Depression
•  Hyper- or hypothyroidism
•  Hormone dependent cancers such as breast and prostate

If you have any of the previously listed risk factors or illnesses, you will need to be especially diligent about protecting and strengthening your bones. While there are no overt signs of osteoporosis, there are just a few things that can indicate your bones are getting weaker:

•  Back pain
•  Loss of height over time with a stooped posture
•  Fractures of the vertebrae, hip or wrists

Unfortunately, as bones become thin, symptoms can be very subtle if they are even noticed at all. In most people, diagnosis of the disease occurs following a fracture or several consecutive fractures. Individuals with osteo-porosis may break a bone by doing simple everyday tasks such as bending over to pick something up, reaching for something on a high shelf or even coughing. Early diagnosis, long before such fractures occur, is critical.

It's very important to understand the risk factors for the development of osteoporosis and monitor your bone health accordingly. Discuss any concerns with your doctor as soon as possible.

Screening And Diagnosis

Loss of bone mass can be detected using a variety of screening tests, however the most common test used is dual energy X-ray absorptiom-etry (DEXA). This test is considered to be economical, quick, simple, and accurate. It can detect as little as two percent bone loss. The DEXA test allows for less radiation and measures the density of the bones in the spine, hip, and wrist, which are the area's most commonly affected by osteoporosis. The patient lies on the DEXA examination table as X-ray beams are aimed at the key sites. Other tests to determine the thickness of bone include a computed tomography (CT) scan or ultrasound.

The results of the DEXA test will reveal two numbers: T score and Z score. The T score shows the amount of bone you have compared to a young adult of the same gender who has peak bone mass. Here are the T score categories:

•  above -1 = normal
•  between -1 and -2.5 = osteopenia (low bone mass)
•  below -2.5 = osteoporosis

The Z score compares the amount of bone you have to other people in your same age and gender group. Because bone thins as we age, the Z score may be more valid than the T score because it compares your density to that of people the same age.

Remember, the DEXA test only measures how dense your bones are, not the actual strength of your bones. The fact is there are many people who have thin bones but never experience a fracture. "More than half of the people with thin osteoporotic bone never fracture," explains bone health expert and author Susan Brown, PhD. "Here in the United States, by the time women reach the age of 80 most have osteoporotic hip bone density, yet only a small percentage ever fracture any bones."

Some healthcare professionals believe the NTx test is a better tool to use because it measures the rate of bone breakdown or resorption. This test measures N-telopeptide levels in the urine or blood. This molecule is released during the bone breakdown process. If NTx levels are elevated, bone is breaking down faster than it can be replaced, which is a key risk factor for osteoporosis. An NTx test result is not meant to diagnose osteo-porosis, rather it provides valuable information regarding the complete picture of bone health. Many healthcare professionals will use this test to determine if lifestyle changes, dietary supplements or medications are working to restore bone health.

Top 10 Osteoporosis Risk Factors

• Age
• Family history
• Body composition (thin, small frame)
• History of broken bones
• Poor diet
• Inactivity
• Smoking
• Alcohol abuse
• Certain medications and/or certain illnesses
• Being a woman (especially a menopausal woman)

Is Screening For You?

According to the National Osteoporosis Foundation, unless you have risk factors for developing osteoporosis, you don't need to have your bone density tested until you are age 65. If you are under age 65, you may want to consider having your bone density tested if:

•  you are postmenopausal with at least one of the risk factors mentioned previously (also refer to the side bar "Top 10 Risk Factors" on page 11);
•  you have an abnormality with your spine or a history of fractures;
•  you use medications such as prednisone, proton pump inhibitors, or have been on chemotherapy;
•  you have a history of breast or prostate cancer;
•  you have other illnesses such as type 1 diabetes, severe depression or liver, kidney or thyroid disease; or
•  you have a family history of osteoporosis.

If you are under age 65 and concerned about your bone health, talk to your doctor about your risk factors and the possibility of being tested. Although testing before age 65 is not often covered by insurance, it's an effective way to get a baseline picture of bone health that can later be referred to if there is a problem. Doctors don't typically recommend test-ing for men, but men should also be aware of risk factors and the poten-tial need for testing.

The goal of conventional treatment is to slow bone loss. There are sev-eral categories of drugs presently being used.

Conventional Treatment

While there are many drugs available to treat osteoporosis, many of them have serious side effects. Careful consideration, and weighing of the pros and cons, must be done before taking any of the osteoporosis drugs on the market today.

The Failure of Fosamax?

The bisphosphonate drug Fosamax was developed to help prevent bone loss. New research, however, indicates that Fosamax (and most likely all bisphosphonates) can increase the chance of developing a fracture. Accord-ing to Carolyn Dean, MD, ND, author of The Magnesium Miracle, "X-rays of bones under the influence of Fosamax may look like they have more calcium but without the remodeling capacity, the bones' internal structure is in disarray and bones are more brittle and may actually break more easily." If you are on a prescription bisphosphonate or considering taking one, discuss this issue carefully with your doctor. Never discontinue tak-ing a prescription medication without your doctor's knowledge.

Hormone replacement therapy (HRT). HRT such as Premarin, Prempro, and others were previously thought to be the gold standard of osteoporosis prevention among menopausal women. Based on the widely-publicized Women's Health Initiative (WHI) study, the widespread use of HRT has fortunately declined. The WHI and several other long-term studies have clearly demonstrated long-term use of HRT (more than five years) increases the risk of congestive heart failure, stroke, breast and ovar-ian cancer, gallbladder inflammation, and increased blood clots which can contribute to heart attack. Women with a family history of hormone-dependent cancers are advised to avoid HRT.

Bisphosphonates. These drugs (Fosamax, Boniva, Actonel, Reclast) destroy osteoclasts, cells important in the bone remodeling process, in an effort to prevent bone breakdown. Unfortunately, the side effects of these medications are severe and can include nausea, abdominal pain, and an inflamed esophagus or esophageal ulcers. Although a few studies show a significant reduction of spine and hip fracture, far more studies show that bisphosphonates can actually increase a person's risk of develop-ing a thigh fracture. It is believed that long-term use of these drugs cause an over-suppression of bone turnover resulting in brittle bones despite improved density. Common side effects of bisphosphonates can include joint and muscle pain, fever, high blood pressure, headaches, and flu-like symptoms. In addition, some bisphosphonates can cause osteonecrosis of the jaw, which is when the bone loses its blood supply, eventually dies and collapses causing severe pain and arthritis in the affected area. For more information, refer to the side bar above.

Calcitonin. Calcitonin is a hormone produced in the thyroid that reduces bone resorption and may slow bone loss. This drug is typically given as a nasal spray and can therefore cause nasal irritation. It can also be administered via an IV. Other side effects can include diarrhea, nausea, metallic taste in the mouth, loss of appetite, difficulty breathing, and other allergic reactions.

Raloxifene. Sold under the trade name Evista, this medication is a part of a group of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogens effects on bone density in postmenopausal women. It is a hormone therapy drug also given to postmenopausal women to reduce their risk of developing breast cancer. Side effects of raloxifene can include hot flashes, flu-like syndrome, joint pain, infertility, and symptoms of the common cold. Although more rare, some women taking raloxifene develop blood clots.

Tamoxifen. This is a synthetic hormone prescribed to reduce the risk of breast cancer in high-risk women or to reduce the risk of breast cancer recurrence in women who have had breast cancer. Some studies indicate that tamoxifen can also reduce the risk of fractures especially in women over age 50. Side effects can include hot flashes, vaginal discharge, fluid retention (especially in the hands, ankles and feet), and loss of libido. In some cases, tamoxifen can cause nausea, weight loss, and mood changes (specifically anxiety and/or depression).

Teriparatide. This new class of drugs (most commonly sold under the trade name Forteo) is a synthetic parathyroid hormone and is the only drug that has been shown to actually stimulate new bone growth. Unfortunately, long-term effects are still being studied and there are numerous side effects including dizziness, leg cramps, chest pain, nausea, muscle weakness, rash, and swelling. Preliminary animal studies show that there is an increased risk of bone cancer in individuals taking this drug. This drug is given as a once-a-day injection under the skin of the thigh or abdomen.

As you can see, there are several choices regarding the conventional treatment of osteoporosis, however all of these choices are not without risk. Most doctors will choose the route of least toxicity when trying to prevent osteoporosis or prevent further bone loss. A thorough discussion of dietary supplements, diet, and lifestyle factors designed to strengthen bone health is prudent. Please note: Never discontinue taking a prescription medication without first talking to your doctor and always tell your doctor about the dietary supplements you are taking.

There is no cure for osteoporosis; however, as they say in the world of sports, "the best offense is a strong defense." Defending against further bone loss through a comprehensive approach will give you the best chance at also increasing bone density. The next several chapters will describe how a combination of dietary supplements, diet, and lifestyle choices can help you do just that.