In this part . . .
Chapter 1
Boning Up on Osteoporosis
In This Chapter
Figuring out what osteoporosis really is
Getting an early diagnosis
Doing your best to avoid osteoporosis
Building up your (and your children and grandchildrenâs) bone density
Dealing with osteoporosis
Understanding the difference between osteoporosis and other diseases
Years ago, when your authors first started taking care of patients, doctors had no way to diagnosis early osteoporosis. By the time osteoporosis was apparent on a regular X-ray or a fracture had occurred, significant bone loss had already affected the individual. Nor did doctors have any effective drugs to treat or prevent osteoporosis. Weâve come a long way, baby, in the early detection, prevention, and treatment of osteoporosis.
In this chapter, we introduce you to the problems of osteoporosis and explain why itâs an issue affecting everyone. Even if youâre not at risk for developing osteoporosis, you undoubtedly have a younger loved one who is in the process of building bone. We want to help you understand what you can do to make your bones, and those of your loved ones, the best they can be, even if youâve never had a glass of milk in your adult life.
Defining Osteoporosis
What exactly is osteoporosis? The standard World Health organization (WHO) definition is that osteoporosis is âa skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture,â which is certainly a mouthful, if not a particularly enlightening one. Osteoporosis is the most common bone disease by far, but itâs a disease many people donât understand.
Most people think of osteoporosis only in terms of bone fractures or loss of height, but osteoporosis is far more complicated. Youâd probably understand osteoporosis most clearly if you could see a bone specimen affected by osteoporosis under the microscope, but youâre not likely to ever be privy to a bone biopsy. Doctors donât usually perform bone biopsies in their patients to diagnosis osteoporosis, although pathological examination of bone is still the gold standard in diagnosing osteoporosis. Normal bone has a network of strong plates and bands. In osteoporosis the bands become thinner and weakened, and worse yet there are tiny breaks in the plates and bands.
Another way to define osteoporosis is that osteoporosis is present if bone mineral testing value is more than 2.5 standard deviations below the average adult, even if thereâs no history of fractures. (See Chapter 9 for more on bone mineral density tests.)
The word âosteoporosisâ actually means porous bones. If something is porous, it has holes in it. Although all bone has cavities filled with cells and blood (see Chapter 2 for more information on bone biology), in osteoporosis, the normal bony cavities enlarge. When the âholesâ become larger, bone becomes more fragile and more susceptible to breaking. Minimal trauma can cause a fracture when you have osteoporosis. Osteoporosis is a systemic disorder that affects the entire skeleton.
Bone is in a constant state of remodeling; old bone is broken down and replaced with new bone (see Chapter 2 for more on how bone is built). Osteoporosis can occur when you lose more bone than you rebuild, or when more bone than normal is broken down. (See Chapter 3 for risk factors that are responsible for changes in your bone density.)
Bone mass decreases between 1 and 5 percent per year after age 40 in women, and less than 1 percent in men. Women are more likely to develop osteoporosis because they generally have less bone mass to start with than men do. The sudden loss of estrogen, a sex hormone that is instrumental in building healthy bone, in menopause also contributes to womenâs increased risk of osteoporosis.
Who, Me? How Osteoporosis May Affect You
If youâre reading this book, you may already be proactive about your bone health. Maybe you already know that you need to change your diet, exercise more, and take that extra calcium supplement. This book can help those of you who want to prevent osteoporosis. If you already have osteoporosis, this book can explain the ways to treat it and to prevent it from worsening.
To emphasize just how common the problem of osteoporosis is, a recent report from the Surgeon Generalâs office stated that by the year 2020, half of all Americans older than age 50 will be at risk for fractures from osteoporosis. Of women now age 50 or older, 40 percent will suffer a fracture of the hip, wrist, or spine at some point in their lives.
Your co-author Sharon works with a population of patients who are older than 60 years of age. Part of her job includes weighing and measuring each patient. Invariably, nearly every person laments that they used to be taller than they are now. (Thinner too, but thatâs another issue!)
Losing height used to be considered an inevitable part of aging, similar to wrinkles and age spots. Most people donât realize that one cause of height loss is related to fractures in the spinal column called vertebral compression fractures. Between 60 and 70 percent of women older than age 65 have at least one of these fractures.
Even worse, studies show that 20 percent of people with a vertebral fracture will sustain another fracture within a year. And people with compression fractures have a relative risk of death that is nine times higher than their healthy counterparts.
If youâre one of the 28 million Am...
