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In the News

Brittle Bones – Osteoporosis

By Jock Simon, M.D., Attending Physician at 75th St. & 126th St. Medical, Ocean Pines Medical & Doctors Weight Control & Wellness centers, Ocean City, MD.

An estimated 24 million Americans suffer from osteoporosis, the insidious loss of bone mass concurrent with the aging process. Known as the silent epidemic, because it often has no symptoms, the majority of people aren't aware of its presence. Anyone can get the disease, but women are much more likely to get it than men. Women develop less bone mass than men. Then, for several years after menopause, women also lose bone at an increased rate because their bodies are producing less estogen. Gradually, our bones become weaker until one day, we experience a fracture.

Sex, race, and size all influence how much bone a women will end up with and how great is her risk for the development of osteoporosis. Especially susceptible are thin Caucasian, Hispanic and Asian women; African-American women are at less risk because of their denser bone structure. Having a family history of the disease increases your risk, as does smoking, consuming large amounts of alcohol, not consuming enough calcium, and not exercising. Certain illnesses-- eating disorders, diabetes, and thyroid disease-- and medications for asthma, arthritis, and cancer are also contributing factors.

In order to insure adequate calcium intake, most experts recommend a minimum daily intake of 1,200 mg of elemental calcium daily if you're premenopausal, and 1,500 mg daily for postmenopausal women; since most people don't consume that much calcium, 400 to 800 mg of supplemental Vitamin D is also recommended to help the intestines absorb calcium and to encourage bone growth.

Regular weight-bearing exercise – walking, running, jumping rope, or lifting weights 20 to 30 minutes twice weekly – is one of the best things you can do to prevent the progression of osteoporosis by boosting bone density. And you're never too old to start exercising.

Bone-mineral density testing, the most accurate of which is the dual-energy X-ray absorptiometry or DXA scan, is the hallmark test for diagnosing osteoporosis. A small amount of radiation is passed though a selected bone and the bone density score is calculated. A bone density score of 1 or less is considered safe; a score between 1 and 2.5 can indicate a risk for the disease, but is not predictive; a score of 2.5 or above indicates bone loss of 25 percent or more, the definition of osteoporosis. Postmenopausal women with risk factors or who have suffered bone fractures and all women over the age of 65 should get the bone scan.

Several drugs have been shown to halt or reverse bone loss in women. Raloxifene , a selective estrogen receptor modulator, has been shown to slow the rate of bone loss and prevent fractures--without the inherent risk of cancer associated with standard estogen replacement therapy (ERT). ERT has long been the best therapy for prevention and treatment of osteoporosis, but is known to increase the risk of uterine and breast cancer and blood clotting if used for long periods of time. Fosomax, a nonhormonal treatment, may actually build bone, but has the troublesone side effect of gastrointestinal discomfort, which may be prevented by taking the medicine with an eight-ounce glass of water in the morning.

The best treatment, though, is prevention; therefore, drink your milk, take your calcium supplements, and exercise daily to maintain strong bones.

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