Bone loss is inevitable with aging, but osteoporosis doesn’t have to be

Build strong foundation before age 30

Osteoporosis, or porous bone, is not a natural part of the aging process, as so many Americans believe. It is a preventable and highly treatable disease.

"As you get older, it is normal to lose some bone, but the severe bone loss associated with osteoporosis is not a normal condition," says Lynn Chard-Petrinjak, senior communications coordinator for the National Osteoporosis Foundation in Washington, DC.

Bone mass is built until approximately age 30, and then as part of the natural aging process, bones begin to break down faster than new bone is formed. Therefore, a healthy lifestyle that builds strong bones before age 30 and keeps bones strong later in life is the best method for preventing osteoporosis. The foundation recommends an across-the-life span approach to health that includes a well-balanced diet with at least 1,200 mg of calcium and vitamin D, weight-bearing exercise, and avoiding tobacco and excessive alcohol.

Education about nutrition, activity, and lifestyle choices should target girls as young as 10 years old, says Felicia Cosman, MD, clinical director for the National Osteoporosis Foundation. Cosman also is an osteoporosis specialist at Helen Hayes Hospital in West Haverstraw, NY, and associate professor of medicine at Columbia University in New York City. While adult women need to know these same preventive measures, they also need to understand the risk factors and who should be tested. If they have the disease, they need to be taught the treatment options, says Cosman.

Who is at risk? Women are more at risk than men. In fact, 80% of those diagnosed with osteoporosis are women. In America, about 8 million women and 2 million men have osteoporosis, according the National Osteoporosis Foundation. Other risk factors include a thin or small frame, advanced age, a family history of osteoporosis, being postmenopausal, abnormal absence of menstrual periods, anorexia or bulimia, an inactive lifestyle, cigarette smoking, a diet low in calcium, use of certain medications such as steroids, and excessive alcohol use.

The only way to determine whether a person has osteoporosis is by administering a bone mineral density (BMD) test. There are several machines used for testing, but the two main types are central machines, which measure bone density in the hip, spine, and total body; and peripheral machines, which measure bone density in the finger, wrist, kneecap, shin bone, and heel. "Osteoporosis screening is exceedingly important. You can’t tell that you have the disease in its early stages unless you get a bone density test," says Cosman.

Don’t wait until symptoms appear

Women between the ages of 50 and 65 should get a BMD test if they have any of the known clinical risk factors for osteoporosis, and all women at age 65 and older should be tested. Those treated for osteoporosis should be retested every one to two years, and those in the normal range should consult their physician about when they should be retested, according to the National Osteoporo-sis Foundation. "It is important to uncover osteoporosis in the early stages of the disease because there are no warning signs until someone breaks a bone. If it is diagnosed and treated early, a person may never break a bone," says Chard-Petrinjak.

Bone fractures can be debilitating and the two major fractures for people with osteoporosis are of the hip and spine. Only 10%-20% of seniors older than 65 who break their hip are able to resume their former lifestyle once the fracture has healed, says Cosman.

With spine fractures, the bone tends to compress in on itself, and people not only lose height, but the shape of the spine and torso change, explains Cosman. People end up with their head pointing downward, which makes it difficult to walk and they fall more often. Frequently, they have back pain, chronic neck pain, abdominal discomfort, and are at greater risk for dying of pulmonary illnesses such as pneumonia. The spine fractures occur spontaneously just by walking around, reaching for a dish, or turning in bed. "The fractures have a big impact on the quality of life and also life span," says Cosman.

While Cosman advocates testing, she generally is not in favor of public screenings at health fairs. Usually, peripheral machines are used to do the BMD tests, and these are not as accurate as the central machines that measure bone density in the hip, she says. "There is no other test that is as good as the central DXA [Dual Energy X-ray Absorptiometry] test, and I think that sometimes people may be misled by the peripheral test. It is a good test if you don’t have access to the central test," explains Cosman.

Another problem Cosman sees with community osteoporosis screenings is that younger women are being tested, which is inappropriate because there are no medications that are available for that young age group. The foundation recommends that postmenopausal women older than 65 are screened, and women older than 50 who have one or more risk factors in addition to being post-menopausal. Sometimes, these young women are traumatized to find out they have very low bone density even though it is within the normal scale, because the bell curve includes people with very low bone density and some with very high. Osteoporosis-related fracture in the young age group is small, says Cosman.

"We shouldn’t routinely test pre-menopausal women. Some pre-menopausal women with certain underlying diseases or those taking specific drugs that can adversely affect the skeleton should be tested, but in general we do not advocate testing in that young age group," says Cosman.

There is also the quality control issue. Often at public screenings, people are handed a piece of paper and they have no idea what to do with it. There isn’t good follow-up, says Cosman. Yet, she does concede that some health fairs are well run.

Opportunity to get the word out

While people who are not always appropriate candidates due to their age or risk factors take advantage of the screenings at health fairs, their presence provides great opportunities for education, says Brenda Covert, RNC, women’s services coordinator at Sacred Heart Medical Center in Spokane, WA. "We really want to increase awareness in younger women that osteoporosis is something that you think about now," she says. It is especially important because many young women do not eat well and some have eating disorders. They also tend to drink a lot of soda that has phosphorus, which pulls calcium out of the bone, says Covert.

However, it is important to emphasize that the screenings are a service rather than a diagnostic procedure and are meant to identify people that may be at risk for osteoporosis, says Covert.

The vital part of a community outreach screening is the education and 10-15 minutes spent with each individual for this purpose during the osteoporosis screenings conducted at the University of Missouri Health Care’s health information center located in Columbia Mall. "Registered nurses go over the medical history for each individual and their risk factors as well as current methods of prevention and treatment. We work with the state Osteoporosis Education Program and provide lots of handouts," says Janet Hale, RN, manager of the health information center in Columbia. People at risk are referred to their physician for follow-up and are given the computer printout from the DXA heel scan.

Education during the osteoporosis screenings conducted by women’s services at Sacred Heart Medical Center is both verbal and written, says Covert. Many pharmaceutical companies produce pamphlets on osteoporosis, and these are distributed as well as materials produced by the health care facility in conjunction with its orthopedic department and physicians within the community. These materials cover risk factors and ways to prevent osteoporosis focusing on diet and lifestyle. There is some mention of medications that build bone or prevent bone loss, but for this information, people are told to talk to their pharmacist or health care provider.

If it is a large event and 200 people are being screened each day, there’s little time for individual education, says Covert. Written materials are always given, and the results of the screening are explained and people are told if they need to follow-up with their physician, says Covert. How-ever, at most screenings, participants are asked to fill out a brief history that includes questions about their diet, lifestyle, medications they are taking that might put them at risk for osteoporosis such as steroids, and whether they have a physician. The information helps with education and follow-up. Those who don’t have a physician are given a list of clinics they can go to.

Women’s services at Sacred Heart Medical Center conducts the screenings wherever needed, which include senior wellness conferences, retirement facilities, schools, and corporate health fairs. They also carry the DXA scan machine on the coach they use for medical outreach so osteoporosis screenings can be done at other times.

When screenings are offered at the health information center in Columbia Mall, the promotions recommend that women entering menopause and men over 65 be screened, but anyone can participate. The first time the screenings were offered, 400 people took advantage of them. Now they are offered at the center every three months.

If a person is diagnosed with osteoporosis, the education at the physician’s office should include a review of all the available medications, says Cosman. The education process should help the patient make an informed decision by determining what is appropriate based on the individual’s personal history, family history, other medical conditions, and personal preferences, she says.

While there are pros and cons to community outreach osteoporosis screening, it does provide an opportunity to draw attention to a disease that is often misunderstood, says Hale. "One pro is that we have people’s attention to discuss prevention of osteoporosis and promote healthy lifestyles. The screening brings in people who may not just come in for health teaching," she says.

For more information about osteoporosis screening, prevention, and treatment, contact:

Lynn Chard-Petrinjak, Senior Communications Coordinator, and Felicia Cosman, MD, Clinical Director, National Osteoporosis Foundation, 1232 22nd St. N.W., Washington, DC 20037. Telephone: (202) 223-2226. Web site: www.nof.org.

Brenda Covert, RNC, Women’s Services Coordinator, Sacred Heart Medical Center, W. 101 Eighth Ave., Box 2555, Spokane, WA 99220. Telephone: (509) 474-2058. E-mail: covertb@shmc.org.

Janet Hale, RN, Manager, Health Information Center, University of Missouri Health Care, Columbia Mall, 2300 Bernadette Drive, Columbia, MO 65203. Telephone: (573) 882-4743. E-mail: halej@health.missouri.edu.