May is National Osteoporosis Awareness Month.
Osteoporosis is a poorly understood concept amongst the general public, and perhaps the best way to explain it is the presence of an insufficient quantity of bone – the bone that is present, however, is normal (or properly mineralized). This can be contrasted with osteomalacia (or rickets, in children), where the pathology centers around undermineralized bone.
For most, bone density will peak before age 30, after which we experience a net loss of 0.3% each year (bone, however, is always being degraded and rebuilt – osteoporosis results from a loss of balance between these processes). Unfortunately, women experience a greater loss (3-5% yearly) in the 5-7 years following menopause before returning to a normal rate, which is why they are at a greater risk of developing osteoporosis.
Yearly, Americans suffer from approximately 1.5 million osteoporosis-related fractures (at a national cost of $14B) – the lifetime risk is about 1 in 2 for women, and 1 in 4 for men. Obviously, the risk is greater amongst the elderly, but sustaining a fracture at an advanced age can have serious, even life-threatening consequences. Some risk factors are out of our hands, but others can be modified through simple lifestyle changes.
Osteoporosis risk factors:
- Sex (female > male)
- Age (especially >65 years)
- Race (Asian or Caucasian)
- History of previous fracture (#1 risk factor)
- Cigarette smoking
- Excessive alcohol consumption
- Low body weight (<125lbs)
- Long-term corticosteroid or heparin use
- Immobilization/inactivity
- Some medical conditions (e.g. Crohn’s disease, renal insufficiency, eating disorders)
- Obesity
In case you didn’t take note above, both low and high BMI can contribute to osteoporosis – as with just about every health concern, maintaining a healthy body weight can be protective.
Kill two birds with one stone by incorporating weight-bearing exercises into your routine – resistance training is not only superior to cardio in most aspects, it has been shown to improve bone density (if you’ve been inactive for an extended period, consider beginning with a daily walk). Be sure to examine your diet for the recommended amounts of calcium and vitamin D – consider supplementation after discussing it with your doctor. Finally, there are medications available to reduce your risk of an osteoporosis-related fracture; your doctor will know if they are right for you.
In short, some of the best things you can do to prevent osteoporosis are avoiding smoking, keeping a healthy weight, engaging in regular exercise, and maintaining sufficient calcium intake before age 30. If you are over 65, have risk factors, or are taking medications known to increase your risk, talk to your doctor about getting a DEXA scan, which is still the best way to diagnose osteoporosis (normal lab values on your blood work does not exempt you).
James Haddad is a medical student who blogs at Abnormal Facies.
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