By MARY JEAN PORTER
THE PUEBLO CHIEFTAIN
It’s no longer a totally silent disease.
Osteoporosis, the bone thief, still surprises many older women and men when their bones suddenly fracture, but some others have become aware of it through their primary-care physicians, magazine and newspaper articles, and drug advertisements on television.
“There’s increased awareness,” said Pueblo rheumatologist Dr. Patrick Timms. “It’s become a regular part of proactive health care. Ten years ago, we didn’t have very good ways to diagnosis osteoporosis or medicines to treat it. In the last five years, there’s been a renaissance. There’s a more proactive approach to bone-density issues. Hormone-replacement therapy is not so much in favor anymore.”
Timms said it took several years after the drug Fosamax came out before specialists like himself were getting many referrals from primary-care physicians, even though the diagnostic DEXA (dual energy X-ray absorptiometry) scan was available. “Now women are asking about it, asking if they should have a bone-density test or be taking one of these drugs they see on TV.”
Actress Sally Field has drawn additional attention to the disease by joining a national bone-health campaign sponsored by the makers of Boniva, a once-a-month osteoporosis drug. Field appears in ads for the drug, appealing to baby boomers, many of whom are postmenopausal and at risk for osteoporosis.
Timms said all of the extra awareness means professionals now are better able to help women improve their health. But he also said the most important thing for postmenopausal women to know is that osteoporosis is a “silent disease. Until a bone fractures, you don’t know you have it. You can have lost up to 30 percent of your bone mass without a fracture occurring.”
He said a baseline bone-density scan at age 50 is a good idea, in addition to other routine diagnostic tests recommended for older women.
The most important thing for younger women to know, he said, is that they should be getting enough calcium and doing weight-bearing exercises.
“Strength training is excellent. You don’t have to go to a gym or be all bulked-out to receive the benefits.”
Vitamin D also is important for younger women – and becomes more important as women age. Vitamin D is needed by the body to get calcium from the digestive tract into the bloodstream, and calcium is the most important mineral for bone health.
Younger women also should be aware if they have a history of osteoporosis or fractures in close family members. If they have rheumatoid arthritis or lupus or are taking steroids for another disease, that’s a red flag, Timms said, “though the only real way to tell is to measure bone density.”
Men get osteoporosis, too, though in far fewer numbers than women; the ratio is 4 to 1. Men produce small amounts of estrogen in addition to testosterone, but they don’t undergo the drastic reduction in bone-protecting estrogen that women do when they go through menopause. And most men have larger skeletons and more bone mass to start with, which is the main reason for the disparity, Timms said. By age 80, osteoporosis is equally common in men and women, he said.
The first 10 years after menopause are the most critical in terms of bone loss, he said, and some women lose more bone than others for a variety of reasons, including genetics, race (thin, white women seem to be most affected), family history, medications like steroids, and endocrine disorders such as hyperparathyroidism.
Timms said osteoporosis and osteoarthritis aren’t linked. Osteoarthritis affects the joints and cartilage that cushions bones, while osteoporosis affects the bones themselves, thinning the outer layer and making the interior more porous. The word osteoporosis means “porous bone.”
The most common fractures due to osteoporosis are of the vertebrae and hip because they support weight; wrist fractures also are common. Visible signs of osteoporosis – loss of height and the stooped posture once called “dowager’s hump” – are due to compression fractures of the vertebrae which can result from actions as harmless as coughing or hugging another person.
Timms said there now are a lot of different medicines prescribed for osteoporosis. Ones such as Fosamax, Actonel and the newer Boniva work by slowing down the rate of bone loss. The recently FDA-approved Reclast can be given once a year by injection and may be a good choice for people with stomach problems who can’t tolerate the other drugs. Forteo, which is taken in daily injections, is man-made parathyroid hormone that has been shown to increase bone density and strength.
Hormone-replacement therapy has some benefits for women’s bones, he said, but after the Women’s Health Initiative 15-year study revealed a higher incidence of breast cancer, and heart attack, stroke or blood clots in women taking estrogen plus progestin, Timms sees few prescriptions for it. The study of postmenopausal women also showed that women taking the hormones had fewer hip and other fractures.
To take the hormones or not is something a woman needs to decide with her primary care physician, Timms said.
He sees mainly older women in his practice – ages 60 to 65 – but of the women who are ages 50 to 55, at least 30 percent show some evidence of bone loss.
“I think it’s sort of important that at 50, women know what their bone mass is and where they stand in terms of getting a bone fracture.”
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