Throughout our lives, bones are undergo a continuous turn-over. While during childhood and youth bones usually grow in size and thickness, bone mass starts to reduce once we reach our forties. An annual decline in bone density by 1-2% is considered normal. In patients with osteoporosis, bone substance is degraded at a considerably faster pace. Bones begin to lose stability and strength, and become »porous«. Already minor accidents can result in severe fractures.
How does Osteoporosis develop?
Since female sex hormones are the very effective in promoting bone density, osteoporosis usually occurs during menopause. This has to do with the gradual decline in estrogen production in the female ovaries that occurs usually around the age of 50. Although all women – if they grow old enough – undergo menopause, not all suffer from osteoporosis alike. While in some women bone density remains stable throughout their lives, others suffer extensive bone loss already at a young age. We are still unable to predict which women will eventually suffer from osteoporosis, but we now know some of the risk factors:
· Age
· Sedentary lifestyle
· Low body weight (BMI < 20)
· Weight loss of more than 10 kg
· Long-term use of Corticosteroids and Heparin
· First-degree relatives with known osteoporosis
A diet that lacks sufficient amounts of calcium, smoking and shortage of sunlight are further risk factors for osteoporosis.
Osteoporosis is usually only diagnosed after a bone fracture has already occurred. It is therefore highly recommended that women with one or more of the above mentioned risk factors commence active osteoporosis prophylaxis. Even if you have already heard it many times: the value of adequate exercise and a balanced diet cannot be over-emphasized. Whether you hike, ride a bike, swim or run, exercise stimulates bone development. And only bone tissue that is constantly challenged can maintain its stability. And if you exercise outdoors, the sun will further enhance calcium incorporation through Vitamin D. Obviously, it is a good idea to feed your body sufficient calcium. Milk and milk products contain lots of calcium, but fizzy calcium tablets will do just about as well. You should, however, try to refrain from convenience food: they prevent the intake of potassium and are indeed »calcium thieves«. High alcohol intake and smoking have also been shown to reduce bone density and are therefore particularly adverse in women who already suffer from osteoporosis.
How to Diagnose Osteoporosis
Unfortunately, osteoporosis is usually only detected after multiple small bone fractures have bent the spinal column or after a hip fracture that occurred after a simple fall. There are, however, methods that allow for an early detection and diagnosis of this potentially lethal disease. Bone density measurement (also often termed »osteodensitometry«) is one of the most reliable methods to diagnose osteoporosis. It is now mainly done through the DXA (»Dual-X-Ray-Absorptiometry«) method. Computer-aided tomography (»CAT scan«) is another method to determine bone density, although it is associated with increased radioactivity. The so called »quantitative ultrasound« measurement (abbreviated: »QUS«) is another commonly used technology. While it is not associated with exposure to X-rays, the accuracy of this method is often poor and QUS is currently not recommended as substitute for DXA. Finally, the measurement of certain metabolites in a blood sample can also give some indication on bone health. These blood markers however, are currently not suitable for the diagnosis of osteoporosis
Osteoporosis Treatment
For many years osteoporosis prevention was simple: Combinations of estrogens and progestins were used in order to maintain bone density and to reduce the risk of bone fractures. However, since the protective effect of hormones is limited to the years during which hormones are actually used, this would require a life-long estrogen intake. We now know that in most women the risks of hormone replacement outweigh its benefits and especially estrogen / progesterone combinations should not be used for the prevention of osteoporosis. Among the hazards that are associated with hormone intake are breast cancer, deep-vein thrombosis (»DVT«), and cardiovascular insult especially in women who smoke.
There is now a number of other drugs that can effectively counteract osteoporosis: Bisphosphonates inhibit cells that are involved in bone resorbtion. In combination with calcium and Vitamin D they are protective against bone loss. The hormone calcitonin is another anti-resorbtive drug. It has also been shown to alleviate bone pain and can be applied via a nasal spray. The influence of Selective Estrogen Receptor Modulators (»SERMs«) is currently investigated in large clinical trials. SERMs are drugs which resemble estrogens in their effect on bone health, but which – in contrast to estrogens – do not increase the breast cancer risk. Despite their widespread use, comparatively little is known about the effects and the safety of phytoestrogens. Phytoestrogens are naturally occurring estrogens that are commonly used for the treatment of menopausal symptoms, but their effect on bone density and fracture risk remains unproven.
What is my Osteoporosis Risk?
Together with the renowned Harvard University, Breast & Health offers a test that allows to calculate your individual osteoporosis risk. Following this risk assessment, we develop a prevention strategy that is custom-tailored to your needs and that will help you to effectively lower your osteoporosis risk.