Sticks and stones...

Why is it that one elderly person will have a mild fall resulting in a fracture of the wrist or even hip while another gets up and walks away? Such an unexpected broken bone is often a warning sign of the condition called osteoporosis, which can have severe health consequences down the road if not taken seriously or detected.

Osteoporosis is caused either by failure to form new bone or too much reabsorption of existing bone. By the time a fracture happens the problem is far advanced therefore effective treatment depends on early detection.

It is estimated that one out of five American women over age 50 has osteoporosis and half of them will have a fracture of the hip, wrist, spine or pelvis. This condition actually starts after age 30 and slowly reduces the strength of the skeleton; in women there can be a very rapid and severe loss of calcium and weakened bone density within five years after menopause. Men are also affected but later in life.

Besides the normal aging process, lack of calcium in the diet is a key factor and as many as half of all individuals may be low in levels of vitamin D. Other factors include family history of brittle bones, smoking, insufficient weight-bearing exercise, low body weight, diabetes or more than two alcohol drinks per day. Reducing levels of testosterone in males and estrogen in females seem to play a role. Other hormonal conditions such as diabetes or thyroid disease can be a factor. These fractures can be prevented by risk factor modification and/or medication thereby avoiding possible future chronic pain and loss of independence.

Since there are no symptoms in the early stages I watch my patients for loss of height, bone pain particularly in the spine or a history of breaking a bone too easily. When I suspect osteoporosis in my male patients over 65 and women over 50, I order a test called DEXA scan which measures the strength of bones specifically in the hip and lower spine. The lower the measured bone density the higher the future fracture risk. When the test shows osteoporosis, further deterioration can be prevented with appropriate medication given to actually strengthen the bones over time and avoid future fractures. Repeat testing one or two years later can determine if treatment with medication to strengthen the bones has been effective.

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