Osteoporosis

Dr. Spence:
Please tell me all about Osteoporosis.
Thanks,
Imma Bender

Osteoporosis I – Definitions and Evaluation
Osteoporosis remains a significant health risk in this country. Estimates suggest that nearly eight million women and two million men in the United States have osteoporosis and another 34 million may have osteopenia, considered a precursor to osteoporosis. It is characterized by low bone mass and structural deterioration of bone strength resulting in an inherent increased risk of fracture. Shockingly, about 1 in 2 white females will suffer an osteoporotic fracture in her lifetime. Should you fracture your hip, mortality increases 10-20% at one year. Twenty five percent of patients with hip fractures will require long-term nursing home care.
It is suggested that all women greater than 65 years of age and all men greater than 70 should be screened for osteoporosis. Other patients that should be screened are those adults who have had a previous fracture or have certain clinical factors that place them at increased risk. These factors include low body weight, history of falls, excessive alcohol use or use of certain medications (i.e. steroids like prednisone, or anti-seizure medications like dilantin).
Screening is traditionally done by bone mineral density testing (DEXA scan) which measures bone strength at the hip and lower spine. Heel testing, as done in some offices, is reasonable, but follow-up on abnormal screens is recommended. A so-called "T-score" is generated that arbitrarily compares your bone strength with that of a 30 year old female. Any T score less than -2.5 meets the definition of osteoporosis whereas scores of -1.0 to -2.5 represents osteopenia.
There are various secondary causes of osteoporosis that should be note. Though most elderly patients have pure osteoporosis as a result of age and loss of estrogen production, there are secondary issues that may require different treatments. For example, reversal of a patient’s vitamin D deficiency may improve bone mineral density and may be all that is required for formal therapy. Other common conditions that may cause osteoporosis include hyperthyroidism, diabetes, emphysema, kidney failure and rheumatoid arthritis. Again, many prescribed drugs may ultimately result in loss of bone mass.
Treatment should generally be initiated for any patient with a calculated bone mineral density of less than -2.5 or any patient who has suffered a hip or vertebral fracture. Guidelines further suggest treatment for those with osteopenia. My experience has shown, however, that insurance companies are less to apt to cover the costs of therapy in cases of osteopenia. Given that treatment may very well prevent progression to overt osteoporosis, it seems ludicrous that insurance companies would block access to potentially valuable medication, but this is typical of our spiraling healthcare system. This is a topic for a whole separate discussion!

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at scripna@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.