By Michael J. Wolpmann, M.D., FACOG, FACS
a skeletal disorder characterized by progressive loss of bone and bone
mass resulting in a weakening of the bone architecture. This weakening
can result in fractures of the bone, most commonly of the hip, spine, or
wrist. Osteoporosis is now recognized as a largely ‘silent disease’ until
it is complicated by fragility fractures and even death. The purpose of
this article is to discuss osteoporosis and the significant implications
of this disease for women.
It is estimated that almost 44 million men and women, or approximately 55%
of the population age 50 years and older in the United States, have
osteoporosis or low bone mass. Postmenopausal women account for nearly
three quarters or 75% of these individuals and are at especially high risk
for osteoporosis and osteoporotic fractures. Many other factors can
further increase the risk of osteoporosis in women including family
history of osteoporosis, smoking, slender build, low calcium diet,
sedentary lifestyle, chronic diseases such as diabetes or arthritis, and
medications such as prednisone or coumadin.
Studies predict that one of every two Caucasian women alive today will
experience an osteoporotic fracture. In fact, after age 65, the incidence
of hip fracture in white women is greater than the incidence of stroke,
diabetes, or breast cancer. Over her lifetime, a woman’s risk of hip
fracture is greater than her risk of breast, endometrial and ovarian
If a hip fracture occurs, the risk of death in the first year after
fracture is calculated to be approximately 20%. A full one third of
hip-fracture patients will break the opposite hip, and only 40% will ever
regain their previous level of mobility. For survivors and their
families, the loss of independence and diminished quality of life can be
devastating and not surprisingly, can lead to psychological depression in
Vertebral or spine osteoporotic fractures are another consequence of
chronic bone loss or osteoporosis. These can lead to back pain, loss of
height, twisting of the spine and even death. Like hip fractures from
osteoporosis, once a spine fracture occurs, the risk of sustaining another
fracture increases dramatically. For example, 1 in 5 postmenopausal women
with a vertebral fracture will experience another vertebral fracture
within one year, even while receiving calcium and vitamin D supplements.
Women that experience a vertebral fracture have an 8-fold higher risk of
dying within 3 years compared to women without a fracture.
The economic burden of osteoporosis is no less daunting. In 1995,
osteoporotic fractures were the cause of 180,000 nursing home admissions,
more than 430,000 hospital admissions, and approximately 2.5 million
doctor visits. Each year, osteoporotic fractures cost the US economy
approximately $17 billion in health care or about $40,000 per hip
fracture. Osteoporosis affects people of all ages and races, but is most
prevalent among postmenopausal white and Asian women. However, even
African-American and Hispanic women face significant risk.
The facts above describe the devastating problem that comprises
osteoporosis and the potentially severe consequences to the average
women’s health. But what can be done?
TESTING: All women 65 years of age or older or 40 years and older that
have had a fracture or other risk factor, should see their doctor about
having a bone mineral density measurement test to accurately identify
whether they suffer from osteoporosis. A DXA scan or bone densitometry
study is currently the most accurate test available for diagnosing
osteoporosis of the spine and hip. Other modalities may also be
appropriate, including ultrasound and urinary markers of bone loss.
Testing alone cannot fully assess risk and a visit to your doctor is
recommended for an individualized evaluation of your risk factors.
TREATMENT: Recent years have brought many medical advances in the
treatment of osteoporosis. The effects of osteoporosis and chronic bone
loss can be decreased, stopped, or many times reversed with appropriate
therapy. Modern treatment and/or prevention of osteoporosis includes many
newer drugs such as the biphosphonates and raloxifen, as well as older
agents such as estrogen and calcitonin. Weight bearing exercise and
calcium with vitamin D supplementation are also recommended for the
majority of postmenopausal women at risk. However, individual assessment
by your doctor is necessary and may include other treatment.
In summary, osteoporosis or chronic bone loss is a skeletal disorder that
primarily affects postmenopausal women. Osteoporosis is a disease that
can result in disability or even death if not identified and treated.
Modern advances in testing and treatment can prevent and even reverse the
course of this debilitating disease.