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Osteoporosis

Published by Contra Costa Times

Posted on Wed, Jan. 18, 2006

By Annie Cherayil, M.D.

ANNA, a 70-year-old Russian immigrant, couldn't believe she had broken her hip. She couldn't walk after a fall when getting out of her son's car, so she called her doctor.

Anna's doctor said a contributing factor to her hip fracture was her osteoporosis, a disease she didn't even know she had.

Osteoporosis, also called the "silent disease," is a common disorder among women marked by thinning and weakening of bones. It can lead to fractures, often of the hip or vertebrae, loss of height, excess curving of the back, and back pain.

Women are at greater risk for osteoporosis because women's bones are generally less dense than men's. Osteoporosis affects some women more than others.

One task force of experts (USPSTF) recommends that women age 65 and older get special X-rays to check for osteoporosis. Women with many risk factors may benefit from testing at age 60, and from taking medications to reduce their risk.

Women who answer "yes" to five or more of the following questions are at high risk of osteoporosis, and should talk to their doctor.

Did your mother or sister have a hip fracture?
Do you weigh less now than when you were 25 (not pregnant)?
Are you using oral corticosteroids (prednisone)?
Are you taking medicine for seizures?
Are you taking sleeping pills such as Valium?
Do you exercise less than twice a week?
Do you need your arms to help you get up out of a chair?
Have you had a fracture at age 50 or older?
Are you at least 80 years old?
Are you past menopause and not taking female hormones?
Are you on your feet less than four hours a day?
Is your resting heart rate (sitting quietly) more than 80 beats per minute?
Are you not African-American?

There are several tests to determine a woman's level of osteoporosis. The best test is the dual energy X-ray absorptiometry (DXA) of the hip. Tests that measure the bone density in the foot are often available at drug stores and can indicate a person's probable short-term risk, but shouldn't replace the DXA.

Effective steps women can take to reduce their risk for osteoporosis include:

Eating enough calcium. Good sources include dairy products, canned fish with bones like salmon and sardines, dark green leafy vegetables like collards and broccoli, calcium-fortified orange juice and breads, and calcium supplements such as calcium carbonate and calcium citrate.
Exercising on your feet for at least 30 minutes three to four times a week. Good exercises include walking, jogging, playing tennis and dancing.
Getting plenty of vitamin D. Good sources include 20 minutes of daily sun exposure, eggs, fatty fish like salmon, vitamin D-fortified cereal and milk, and vitamin D supplements.
Limiting alcohol consumption. Too much alcohol can damage your bones and increase your risk of falling.
Not smoking. Smoking decreases estrogen, and estrogen protects bones.

Osteoporosis is often painless, so many women don't know they have it until they actually break a bone. It's important to talk to your doctor about your risks and take preventive steps now to keep your bones healthy.

Dr. Cherayil practices family medicine at the Concord Health Center.