Monday, December 17, 2001

Osteoporosis Answers

Osteoporosis Answers
New York Resident
By Pamela Appea

Everyone knows a friend, a neighbor or a loved one who has broken a hip due to osteoporosis, declined rapidly and perhaps even died. A chronic and degenerative disease, osteoporosis is a public health crisis in the U.S. that received some much needed attention by the American Medical Association last week in Manhattan. More than 28 million Americans are either at risk for osteoporosis or have the disease. Some 80 percent of sufferers are women.

Middle-aged people and senior citizens clock in 600,000 fracture-related emergency room visits annually. An additional 35,000 mature adults experience painful hip fractures and emergency room visits each year.

At the AMA conference, Dr. Sheryl Sherman, director of Maryland’s National Institute on Aging’s Clinical Endocrinology and Osteoporosis Research Program at the National Institutes of Health, reported that osteoporosis Medicare costs are well over $14 billion, according to a 1995 survey.

The negative impact of a fall can be reduced when frail patients are given cushioned hip protectors, according to one nursing home study. Sherman said this and other simple, commonsense measures can prevent or minimize long-term hospitalization, loss of mobility and extreme pain in senior citizens. In perimenopausal women, weight-bearing exercises and increased intake of calcium and vitamin D can optimize bone health.

Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia Presbyterian Medical Center, said it is crucial that bone density tests be given regularly to all women over the age of 65. Bone mineral density tests should be given to women over 50 who show the following risk factors: being thin, being a smoker, experiencing a broken bone or having a family history of osteoporosis.

“You don’t know you have high blood pressure until you get a reading,” Siris said. “People should approach osteoporosis in the same way” and get bone-mineral density tests at least once every two years.

“And if you are diagnosed with osteoporosis or low-bone density, you can be much more proactive about preventing further bone loss and getting effective treatment.”

Osteoporosis sufferers in the past had only two treatment choices: to take or not take estrogen. At present, osteoporosis sufferers have a variety of more effective therapies to choose from. Siris noted that estrogen is certainly an effective treatment.

“You get more bang for your buck,” Siris said, noting estrogen is a bone-plus drug. But at the same time, Siris cautioned that estrogen treatments can cause side effects such as bleeding, bloating and deep-vein thrombosis.

With new classes of drugs, including selective estrogen receptor modules, the medications act like estrogen in some parts of the body and block the negative effects of estrogen in other parts of the body, Siris said.

Other drugs, including Raloxifene, bisphosphonates, Cacitonin and teriparatide, may work better for some. Raloxifene reduces the risk of breast cancer and has no risky or harmful effects on the heart, unlike estrogen.

The bottom line is if you have osteoporosis, you should get the tailored pharmacological treatment you need. And now, with more osteoporosis knowledge in the medical community, those with osteoporosis can expect an overall high quality of life instead of a painful decline.

“As our society ages, a greater percentage of people will be at risk for preventable bone fractures,” Siris said. “If we do not gain control of this situation, there will be a log of broken hips and a lot of broken lives.”

Originally published December 17, 2001