Osteoporosis: Silent and Often Unexpected

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Author: Aron Adkins, MD

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Osteoporosis is a common condition but, often silent. It affects 9 million Americans today and according to the National Osteoporosis Foundation it is estimated that 48 million Americans have low bone mass. Current estimates are that 60% of men and women over the age of 50 years are at risk for fracturing a bone.

Osteoporosis is detected by a special kind of dual x-ray that differentiates fat from bone tissue. Some of the x-rays pass through soft tissue like muscle and fat, and others bounce back from bone tissue. In this way, the relative content of the calcium content of bone can be determined. When calcium content is very low, it is referred to as osteoporosis.

The term "osteoporosis" originally was used to describe a certain low calcium content in bone in postmenopausal women that would increase the risk of fracture and was primarily used in clinical studies. Now, osteoporosis is often a universal term which describes any patient, man or women, who is at risk of fracture because of low calcium content of their bones, or other conditions that weaken the bone. Sometimes, patients can have osteoporosis and have relatively mild losses of calcium in the bone.

Osteoporosis is important, as fracturing of a bone can have serious health implications. Fracturing the spine for example, can result in disabling pain, abnormal curvature of the spine and changes in internal organ function related to this change in body shape. It is a known fact that when a person has a fracture of the spine because of fragile bones, their risk of developing another fracture within a 1-2 year time period is estimated at 20-30%.

Hip fractures also can pose a serious health risk. A hip fracture can result in severe permanent disability, the need for major surgery and the potential complications that can surround a major operation. Hip fractures in elderly patients substantially increase their risk of dying, and certainly can limit their independent functioning.

Bone can be thought of as a sponge-like structure that has many cross beams and supports that give the bone strength. Not only does the actual calcium make bone strong, but the cross beam structure allows for the
ability of bone to support weight and stress.

You can think of osteoporosis like a building. A strong building has both bricks and mortar, but underlying this, there is a strong scaffolding of support beams and other structures that give it strength. The same is true for bone. The bone can be weakened if its calcium (bricks and mortar) is diminished. Bone can also be weakened if the beams or support structure are damaged, even if the bricks and mortar are intact.

We often think of osteoporosis as a condition of aging. This is certainly true in women who go through menopause. They are at significant risk of developing osteoporosis. The decrease in estrogen plays a major role in the loss of bone from the skeleton and the breaking of these very important support structures of bone. In the same way, men who age have lower testosterone levels which also has a very similar impact on
the weakening of bone and increased risk of fractures.

Aging and loss of testosterone and estrogen are not the only reasons for osteoporosis however. We often do not think of younger people developing osteoporosis, but this disease can affect the young and old alike.

Other, often under-represented causes of osteoporosis can be many. Steroid exposure can weaken bones. Usually this occurs from taking several months of higher dose oral steroids, but impact on bone, can occasionally be seen when there is significant exposure to higher dose inhaled steroids or frequent steroid injections into muscle or joints.

Celiac Sprue, an intolerance to gluten, can be often under-diagnosed and has been associated with osteoporosis. Chronic diseases that cause inflammation like rheumatoid arthritis, place a patient at much higher risk of fracturing bones. Certain medications, like long term use of proton pump inhibitors, can be associated with increased risk of bone fracture. A relatively common condition that affects women and men in their 60's and 70's called hyperparathyroidism, an abnormal production of parathyroid hormone, is also associated with the development of weakened bones. Smoking, excessive alcohol intake and high levels of soda intake are associated with loss of bone.

It is important to consider the possibility of osteoporosis, as often it is a very silent disease and not obvious until there is a major fracture. It is important to seek regular physicals from your health care provider and identify the risk factors that you may have for osteoporosis and consider osteoporosis screening with bone density scanning.