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Osteoporosis: Prevention and Screening
John J. LaFerla, M.D.
Osteoporosis is a condition of the bones characterized by an increased tendency for bones to fracture. It is most often seen in the elderly and more in women than men, but often begins at younger ages and can affect men. A common example of osteoporosis is a post-menopausal woman who has become several inches shorter and now has a sharply curved spine and chronic back pain. Fortunately, this scenario is preventable.
The first step in preventing osteoporosis is to realize one must take continued action over many years beginning as early as the 20s or 30s when there is maximum bone mass. Making changes at later ages can slow the progression of the condition but it is difficult to reverse bone loss that has occurred over many years.
A cornerstone of prevention is to consume sufficient calcium. The recommended daily intake is about 1,200 - 1,300 milligrams. The most common food source is low-fat milk, which contains about 300 milligrams of calcium per eight-ounce glass. Other foods rich in calcium include cheese, yogurt, sardines and broccoli. Many foods, such as bread or orange juice, can contain added calcium. Many people find it difficult to get enough calcium from regular foods so they take supplements such as calcium tablets or Tums® (calcium carbonate).
Equally important is physical activity. Bone is a living part of the body and responds to stressors by getting stronger. Weight-bearing activities such as walking or lifting are most effective. Even small amounts of walking can be beneficial compared to inactivity.
A third important component in preventing osteoporosis for post-menopausal women is taking estrogen. There are pros and cons of hormonal replacement therapy but estrogen does play a critical role in maintaining bone mass.
Other medical treatments for osteoporosis include several categories such as bisphosphonates, calcitonin, selective estrogen receptor modulators and fluoride. These drugs may be prescribed by your health care provider.
Several screening methods are available that indicate if a person is at risk for osteoporosis. The most accurate method of measuring bone density, or bone mass, is a technique called dual photon absorptiometry or a DEXA scan. This method measures the degree of osteopenia (loss of bone) in the hip and spine; however, it is time consuming, requires highly trained technicians and is expensive. Quicker, easier and less expensive methods have been developed to estimate bone density; these methods are slightly less accurate than DEXA but because of their simplicity may be optimal for initial screenings. One method utilizes an ultrasound of the heel bone. Another uses a low-dose x-ray of the hand. Both methods are fast, painless and easily performed in an office setting.
Not everyone needs to be screened for osteoporosis. A healthy woman who is getting ample dietary calcium, is physically active and is still menstruating or taking estrogen, may benefit little from testing. On the other hand, if you are concerned because of family history or if you are taking steroids, thyroid medication or do not fit the picture of a healthy lifestyle, then a screening for osteoporosis may enable you to make proactive changes to avoid long-term problems.
Additional information is available from the National Osteoporosis Foundation at (877) 228-6635 or at www.nof.org. Chestertown Orthopedics offers DEXA scans locally with a referral from your physician. Chester River Physicians performs hand x-rays screenings. Inexpensive heel bone screenings are available at the Women’s Health Care office in the Kent & Queen Anne’s Hospital Medical Services Building; no referral is needed. Call (410) 778-9152 for an appointment.
Osteoporosis is largely preventable by making choices for healthier bones throughout life.