Osteoporosis Wake Up Call

"This is a silent disease with fracture as the primary presentation," said Elwyn Grimes, MD, from the John H. Stroger Jr. Hospital of Cook County in Chicago, IL. "It is a condition that is silent and has mortality as an important outcome. It has the potential to have a significant impact across the nation."

Dr. Grimes used the Morton and Diane Stenchever Lecture to deliver a wake up and a call to action to obstetricians and gynecologists. Unless practitioners act now to stem the tide of osteoporosis, the country can look forward to 14 million patients by the year 2020 and another 47 million individuals with low bone mass at risk for the disease. That is up from the current rate of about 1.5 million osteoporosis-related fractures annually.

"Osteoporosis is typically viewed by individuals to be something that is a significant problem for Caucasian women and less of a problem for African-American and Asia women and never a problem for men," Dr. Grimes explained. "In reality, it affects all ethnic groups, males and females. Neither health-care providers nor the general public places the proper emphasis on this condition."

Many practitioners are surprised to learn that osteoporosis is not a new disease. It has been diagnosed in Bronze Age skeletons from Jordan, 4,000 year-old Egyptian skeletons, and in fossilized Neanderthal remains.

The incidence of osteoporosis is skewed toward older women, Dr. Grimes said, because women typically suffer bone loss 10 to 15 years earlier than men due to hormonal changes. But as both genders live longer, the incidence will increase in the population as a whole.

The specter of widespread osteoporosis prompted the Surgeon General to issue a report in 2004, Dr. Grimes explained. The report, Bone Health and Osteoporosis, is the opening salvo in a public health campaign on the same scale as earlier programs to reduce the incidence of smoking and increase the use of automobile seat belts. The problem, he said, is translating clinical knowledge into positive behavioral changes.

"Males tend to believe this is a woman's disease," he said. "African-Americans tend to think it is a Caucasian disease. But 80% to 90% of fractures in African-American women over the age of 64 are due to osteoporosis. And African-Americans who fracture are more likely to die than Caucasians."

Many people, including physicians, believe that osteoporosis is an inevitable consequence of aging, said Barbara Soltes, MD, from Rush-Presbyterian St. Luke's Medical Center in Chicago. The reality is that the bone loss leading first to osteopenia, then to osteoporosis, can be minimized with changes in diet, exercise and environment.

A diet low in calcium, high in caffeine, high in red meat, high in acidifying foods, high in salt, and high in alcohol reduces bone mineral density, Dr. Soltes said. So does physical inactivity and smoking.

Chronic renal failure, gastric or intestinal bypass surgery and other medical conditions are contributing factors regardless of age or gender. So are anticonvulsants, thyroid extracts, antacids high in aluminum, and other medications.

Genetics and family history play a crucial role in osteoporosis, she continued. So does family history.

"Nutrition, exercise, and environment play vital roles, especially during the adolescent years," Dr. Soltes explained. "Something as simple as walking 30 minutes, three times a week, can really help women of all ages."

Prevention of osteoporosis is as simple as diet and exercise, but it requires a lifetime of both. In addition to at least 90 minutes of weight-bearing exercise each week, women between the ages of 16 and 45 should take 1,000 mg of calcium daily. Postmenopausal women should take 1,500 mg of calcium daily. Women over the age of 65 should take 1,500 mg of calcium plus 400 IU of vitamin D daily.

"We need to close the gap between clinical knowledge and its application," Dr. Grimes concluded. "This is essentially a condition that is preventable and treatable. We need to educate health-care providers, the public, policymakers, and insurers. We have to ensure that everyone receives accurate information on screening and prevention and that they act on that information."