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Disease & Conditions >>> Osteoporosis Articles & News

Winning The Battle Of The Bones

By: Edward L. Schneider, MD (Dean, Leonard Davis School of Gerontology, University of Southern California)

A bold new approach to fighting osteoporosis was described in a recent issue of the New England Journal of Medicine. Osteoporosis is a deadly epidemic affecting millions that does not appear frequently in the news. The visible part of the epidemic are the bone fractures that result in disability, dependency and death. The good news is that this epidemic is not only preventable but can be effectively treated. In this article, I will summarize the preventive strategies and discuss the latest advance in the treatment of osteoporosis, parathyroid hormone injections, which were recently shown to actually build bone in osteoporotic individuals.

Loss of bone occurs in all of us as we age. The diagnosis of osteoporosis can be made with a painless and relatively inexpensive test called dual beam photometry when it reveals bone loss that is 2 standard deviations below your age matched peers. Individuals with osteoporosis are at greatly increased risk of hip, forearm and spinal fractures. In the United States, there are 300,000 hip fractures and 2,000,000 spinal fractures a year, mostly in older women. It is a deadly disease since 25 to 35% of those who experience hip fractures die within the following 12 months. Furthermore, it is a major cause of disability since another 25 to 30% of those with hip fractures require assistance to walk for the remainder of their lives. Hip fractures are a frequent cause of admission to assisted living facilities and nursing homes.

My mother and my grandmother had similar lifestyles, dietary habits and body builds. My mother had 4 hip fractures before her 89th birthday and lives today in a nursing home while my grandmother lived to be 89 without any fractures and lived in her home independently until her death. What was the difference? My grandmother never learned to drive and walked everywhere. She lived in apartments where she had to climb stairs daily carrying heavy bags of groceries. By contrast, my mother drove everywhere and used the elevator to get to her apartment.

My grandmother knew how to prevent hip fractures: exercise and weight training. My grandmother never joined an aerobics group or weight-lifting gym, but she was physically fit her whole life. Fortunately, it is never too late to arrest the loss of bone with both of these effective approaches. Studies have shown that even in the 60's and 70's, starting an aerobic exercise or weight training program can slow down the loss of bone.

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Women are at increased risk for osteoporosis, which accelerates in the years after menopause. Hormone Replacement Therapy (HRT) can prevent this accelerated bone loss and protect women from hip and other fractures. It is not clear whether replacement of testosterone in men who have decreased levels of this hormone (not all men do) will be equally protective for men.

It is also critical that bones be kept strong by ingesting adequate calcium, either in your diet or through supplements. In another article I will address ways to insure that you get enough calcium.

Diagnosis of osteoporosis is critical since it enables physicians to formulate ways to prevent further bone loss. Despite the availability of excellent diagnostic techniques, only a minority of women with osteoporosis ever learn they have the disease until they have a fracture. Therapies for osteoporosis focus on slowing bone loss and include exercise, weight training, HRT, Fosamax and other etidrionates, and calcitonin.

We have known for decades that parathyroid hormone actually increases bone mass. But recently, in a clinical study, parathyroid hormone was administered to osteoporotic patients and their bone mass increased. This is very exciting since it offers a possible cure to this terrible condition where previous treatments were, at best, strategies to delay the progression of the disease. Since osteoporosis is usually diagnosed after the first hip, wrist or spinal fracture, don't stop weight lifting or walking briskly or your HRT since prevention can help you avoid that first fracture.

The use of hormone replacement therapy must be reconsidered in the light of recent findings from the Women's Health Initiative Study. The potential risk of breast cancer and other side effects has been determined fairly conclusively - see "Hormone Replacement Therapy (HRT) - Now What to Do?" (Robert Griffith, editor)

Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis RM. Neer, CD. Arnaud, JR. Zanchetta, et al., N Engl J Med, 2001, vol. 344, pp. 1434--1441

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