Osteoporosis: Underrecognized & Undertreated

portrait of senior black womanBone is living tissue, and that tissue responds to weight-bearing exercise, physiological conditions within the body, and dietary intake of minerals that contribute to bone growth and development.

Osteoporosis is a disease of the bones that can lead to painful and occasionally deadly fractures. Literally meaning “porous bones”, this condition results in reduced bone density that occurs gradually over a period of years.

The Causes of Osteoporosis

The main cause of osteoporosis is a decrease in estrogen levels in women (usually at the onset of menopause) and a decrease in testosterone levels in men, although the risk for men is significantly less than for women.

Calcium and phosphate are the two minerals that are most crucial for bone health. In older individuals, calcium and phosphate are reabsorbed back into the body from the bones if dietary intake is insufficient, and this leads to bone loss. Thus, brittle and fragile bones lead to an increased risk of fracture. And according to some sources, nearly 50% of all women over 50 years of age experience a fracture of the hip, wrist or spine at some point in their later lives.

Other potential causes of osteoporosis are kidney disease, eating disorders such as bulimia and anorexia nervosa, rheumatoid arthritis, confinement to bed, or taking corticosteroid drugs such as prednisone.

Confinement to bed and immobility contribute to bone loss and the development of osteoporosis, due to the fact that bone responds to physical exercise and weight bearing by becoming stronger and denser. Astronauts living in weightless conditions, individuals confined to bed, and those who are immobile are all unable to bear weight – thus, their bones begin to leach their calcium and phosphate into the bloodstream, resulting in decreased bone density.

Other Risk Factors

White women of European descent and Asian women are generally at greater risk for osteoporosis than others, as well as any individual with a family history of the disease. Other risk factors include:

• Prolonged cessation of menstruation
• Excessive intake of alcohol
• Hormone treatment for breast cancer or prostate cancer
• Cigarette smoking
• Abnormally low body weight
• Low dietary calcium intake

Osteoporosis and African American Women

Although a great deal of the literature on osteoporosis states that African American and Hispanic women are at a lower risk of the disease than White and Asian women, information on the website of the National Institutes of Health (http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Background/default.asp) states very clearly that osteoporosis in African American women is both “underrecognized and undertreated.”

According to the NIH website, the risk of a hip fracture doubles every seven years as African American women age, and Black women are more likely to die from a hip fracture than their White peers.

Additionally, sickle cell anemia and lupus, two diseases more prevalent in African American women, significantly increase the risk of developing osteoporosis. The NIH website also points out that African American women tend to consume less than the recommended daily allowance of calcium, and a prevalence of lactose intolerance among African American women also contributes to low dietary intake of calcium.

Symptoms

The symptoms of osteoporosis can include bone pain, fractures caused by minor trauma, loss of height over time, neck and back pain due to tiny fractures, and kyphosis, a stooped condition also known as “dowager’s hump”.

Prevention

A lifetime practice of weight-bearing exercise (such as walking, running, weight-lifting, skiing, hiking, and dancing) is crucial to the development and maintenance of healthy bones. Balance exercises such as yoga and Tai Chi are also excellent non-impact forms of exercise that prevent the loss of bone tissue.

Most sources also recommend 1,200 milligrams per day of dietary calcium and 800-1,000 international units (IUs) of Vitamin D3. Vitamin D3 assists the body in the absorption of calcium.

Not smoking, as well as decreasing alcohol intake, are additional healthy lifestyle practices to embrace when it comes to osteoporosis prevention.

Treatment

The treatment of osteoporosis includes medications to increase bone density, slow the rate of bone loss, and reduce pain. Weight-bearing and balancing exercises, increased dietary intake of calcium and vitamin D, as well as smoking cessation and decreased alcohol intake are also prescribed. Fall prevention and safety are paramount, since brittle bones with decreased density are at greater risk of fracture.

Lower Risk Does Not Translate To Disregaring Your Health

Osteoporosis is a serious health concern for all women as they age, and African American women should not lose sight of that fact despite the somewhat lower risk that they enjoy when compared to other racial and ethnic groups. Bone loss and the resulting fractures that it causes can be painful, debilitating, and occasionally deadly, and both ageing women and men should be aware of their risk factors for bone loss over time.

Exercise, good dietary habits, not smoking and moderate alcohol intake are all important factors in preventing osteoporosis, as well as a lifelong practice of being more aware of this significant health issue.

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Protect Yourself From Bone Loss

senior man doing a push up(BlackDoctor.org) — Many people do not fully understand what osteopenia is. To explain, it is a mild form of bone loss—meaning that bone loss has not progressed to a point where breaks are likely to occur. Regardless of your bone density measurements, if you have osteopenia and then break a bone, your doctor will immediately bump up the status of your condition to osteoporosis. To prevent osteopenia and osteoporosis from developing, it’s important to take bone health seriously.

Having osteopenia rather than its more severe related condition, osteoporosis, doesn’t mean you’re not at risk for a fracture—it just means you haven’t had one yet.

Women sustain the majority of osteoporosis-related fractures that are actually in the range of osteopenia, which is why it’s important to be aware of the condition. If you wait to be concerned with bone loss until you’re at the point where it’s so severe that you’ve broken a bone, you’re missing the opportunity to reduce the risk of fracture.

Treating Osteopenia

Treatments are the same for osteopenia and osteoporosis, but your doctor will recommend options based on your individual case. Monitoring for additional bone loss is part of the treatment plan for osteopenia, along with making adjustments to diet and exercise in order to help strengthen bones. Not everyone with osteopenia or osteoporosis needs medication; however, people who are experiencing bone loss because of a family history of osteoporosis normally are started on prescription medication to help prevent the progression from osteopenia to osteoporosis.

The primary goal when treating osteopenia is to prevent or slow bone loss and the associated risk of fractures. Finding the treatment method that’s right for you will depend on several factors, including whether you’re postmenopausal.

In starting osteopenia treatment, your doctor must first determine what’s “normal” and what’s actually the result of bone loss in your specific case. This is why regular bone density screenings are so important. If routine screenings indicate that bone loss has occurred, then you should be treated for osteopenia.

Treatment options for osteopenia vary greatly from person to person, but the following are some methods that have been successful:

• Weight-bearing exercise through activities like dancing, walking, jogging, and lifting weights

• Improve balance with exercises like yoga and tai chi

• Supplement your diet with calcium and vitamin D

• Take bisphosphonates, a class of drugs that help prevent bone loss to decrease your risk of fractures

• Take hormone medication (such as estrogen replacement therapy) or selective estrogen receptor modulators (SERM bone-building medication), which play a role in the maintenance of bone mass

• Use calcitonin (Miacalcin, Fortical), a nasal spray that can help decrease bone loss

• Get regular bone density scans

• Remove home hazards that can increase your risk of falls and fractures

• Quit or avoiding smoking, which can also contribute to bone loss

Strong Bones Mean Healthy Bodies

It’s never too late to treat bone loss and even slow it down with lifestyle changes and medication, when appropriate. Even though some medications can be very helpful in preventing broken bones, none of them are 100 percent effective.

You may be able to prevent osteoporosis and slow down bone loss even after you’ve been diagnosed with osteopenia or low bone density. If you’ve received an osteopenia diagnosis, now is the time to take preventive measures that can build up your bone health before a condition like osteoporosis robs you of bone density. There are many options to treat osteopenia, and you and your doctor should work together to figure out the best way to keep bone loss to a minimum so you can stay  as healthy and strong as possible.