"In the United States, one in two women and one in four men, aged 50 and older will have an osteoporosis related fracture. It is important for all individuals--regardless of age--to take steps to protect their bones. What good are strong minds and strong hearts, if our bones are fragile and crumbling?"
- Judith Cranford, Executive Director, National Osteoporosis Foundation
By 2020 half of all Americans over age 50 will be at risk for fractures from osteoporosis and low bone mass, but osteoporosis is for the most part preventable. Weak bones should not be excused as a natural part of getting older; osteoporosis is not a normal part of the aging process. In recent years the medical community has made great strides in understanding the physical, mental and economic effects of osteoporosis. It has come to the forefront as one of the leading diseases threatening the health of people over 50. On October 14, 2004, US Surgeon General Vice Admiral Richard H. Carmona, launched the first-ever Surgeon General's Report on "Bone Health and Osteoporosis." This two year, 400 page, landmark report emphasizes the need for comprehensive, accurate information about bone health, signaling to all Americans that bone health must be considered a national public health priority.
Though osteoporosis and low bone mass are a major public health threat, currently affecting an estimated 44 million Americans, bone health is often an overlooked aspect of health care. Many call osteoporosis the "silent thief" because it progresses slowly over time, without symptoms, until a fracture occurs. While many believe that osteoporosis is an elderly Caucasian women's disease, in fact it affects men and women of all races. Four times as many men and nearly three times as many women have osteoporosis than report having the condition. Osteoporosis and bone disease result in painful and debilitating fractures effecting the mobility and mental health of the patients. All people need take action to protect their bones. A healthy skeletal system and strong bones are essential to overall health and quality of life. Strong bones protect the heart, lungs, brain and other organs from injury. Fortunately you are never too young or too old to improve your bone health. Even if you have been diagnosed with osteoporosis, it's not too late to take steps to protect your bones.
Below we have provided information from the National Osteoporosis Foundation, the leading nonprofit, voluntary health organization in the U.S. dedicated to promoting lifelong bone health. There you will find facts on osteoporosis outlining specific risk factors, treatment options and preventative care.
What is osteoporosis?
Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected. It is a disease where bones become more likely to break. Until the age of 30, bodies build and store bone efficiently. As part of the natural aging process bones begin to break down faster than new bones can form. For women, bone loss speeds up after menopause, when the body loses estrogen, the hormones that protects against bone loss.
Who is at risk?
"So many women tell me they are frightened they will get osteoporosis. They are scared of the pain that broken bones cause. They are worried about how it will impact their physical appearance and their lifestyle. Instead of being caught up by fear, I encourage people to take action. Osteoporosis is a largely preventable and treatable disease. We also need to remind men, this is not just a woman's concern. Osteoporosis affects men too!" - Judith Cranford
Chances are … it could be you. One in two women and one in four men age 50 and older will have an osteoporosis-related fracture in their lifetime. Ten million Americans already have osteoporosis and 34 million more have low bone mass placing them at increased risk for developing osteoporosis. Caucasian and Asian women have the highest risk but osteoporosis affects men and women of all races. Though it is often thought of as a disease that only affects the elderly, osteoporosis can strike at any age. Known as "the silent thief," osteoporosis progresses without symptoms or pain until bones start to break, generally in the hip, spine or wrist. Every year, roughly 1.5 million people suffer from a bone fracture related to osteoporosis.
What are the risk factors of osteoporosis?
Osteoporosis is a complex disease and not all of its causes are known. However, when certain risk factors are present, your likelihood of developing osteoporosis is increased. Therefore, it is important for you to determine your risk of developing osteoporosis and take action to prevent it now. Certain people are more likely to develop osteoporosis than others. The risk factors include:
• Personal history of fracture after age 50
• Current low bone mass
• History of fracture in a first degree relative
• Being female
• Being thin and/or having a small frame
• Advanced age
• A family history of osteoporosis
• Estrogen deficiency as a result of menopause, especially early or surgically induced
• Abnormal absence of menstrual periods (amenorrhea)
• Anorexia nervosa
• Low lifetime calcium intake
• Vitamin D deficiency
• Use of certain medications, such as corticosteroids and anticonvulsants
• Presence of certain chronic medical conditions
• Low testosterone levels in men
• An inactive lifestyle
• Current cigarette smoking
• Excessive use of alcohol
• Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well
How can I protect myself against osteoporosis?
It is important to understand that bone is not a hard and lifeless structure; it is, in fact, complex, living tissue. Our bones provide structural support for muscles, protect vital organs, and store the calcium essential for bone density and strength. Think of your bones as a savings account. There is only as much bone mass in your account as you deposit. The critical years for building bone mass are from prior to adolescence to about age 30. Some experts believe that young women can increase their bone mass by as much as 20 percent - a critical factor in protecting against osteoporosis. There are ways to prevent developing osteoporosis. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. There are six steps, which together, can optimize bone health and help prevent osteoporosis. They are:
• A balanced diet rich in calcium and vitamin D
• Weight-bearing exercise
• A healthy lifestyle with no smoking or excessive alcohol intake
• Maintain a healthy weight throughout your life
• Bone density testing and medication when appropriate
• Take steps to minimize the risks of falling, including regular vision tests.
Encourage children to do these things, so they can avoid developing this devastating disease.
How much calcium and vitamin D do I have to take?
Calcium plays an important role in maintaining bone. However muscles and nerves must also have calcium to work. If your body is not getting enough calcium from the food you eat your body simply takes it from your bones. Calcium alone cannot prevent or cure osteoporosis, but it is an important part of an overall prevention or treatment program. Yet, national surveys have shown that many Americans are not consuming enough calcium. Many women, in fact, consume less than half of the daily-recommended amount of calcium. The average adult, under 50 needs about 1000 mg of calcium per day.
One way to increase the amount of calcium in your diet is to eat calcium-rich foods like low-fat milk, cheese, broccoli and others. Many foods are fortified with calcium and are readily available and affordable. Foods like orange juice, cereals and breakfast bars have calcium added to them, so it is easier than ever before to consume the recommended level of calcium for every age. Having extra calcium in a variety of foods also makes it easier for parents who are trying to ensure that their adolescent children are getting enough calcium.
If you avoid dairy products because of concerns about fat intake, remember that skim milk, fat-free yogurt, and ice milk retain 100% of their calcium while sparing you the fat and extra calories. If you are lactose intolerant, you may want to try reduced-lactose or lactose-free dairy products, which are also rich in calcium. Calcium supplements in tablet or capsule form can help you ensure that you're getting enough of this vital mineral. While it is preferable to obtain calcium from food, supplements are a viable way to satisfy average daily calcium requirements. Since there are several different types of calcium and a variety of supplements available, you should discuss the choice of calcium with your doctor.
Vitamin D is produced by the skin by exposure to the sun and is found in fortified milk and other foods. It plays a major role in calcium absorption and bone health. The relationship between calcium absorption and vitamin D is similar to that of a locked door and a key. Vitamin D is the key that unlocks the door and allows calcium to leave the intestine and enter the bloodstream. Vitamin D also works in the kidneys to help reabsorb calcium that otherwise would be excreted. The major food sources of vitamin D are vitamin D-fortified dairy products, egg yolks, saltwater fish and liver. Some calcium supplements and most multivitamins contain vitamin D, so it is important to check the labels to determine how much each contains. The average adult, under 50 needs about 200 International Units (IU) of Vitamin D per day.
What kind of exercise should I do?
Bone is living tissue that responds to exercise by becoming stronger. When you put stress on your bones your body reacts by adding new cells to help make your bones stronger. Two types of exercises are important for building and maintaining bone mass and density: weight-bearing and resistance exercises. Weight-bearing exercises are those in which your bones and muscles work against gravity. This is any exercise in which your feet and legs are bearing your weight. Jogging, walking, stair climbing, dancing and soccer are examples of weight-bearing exercise with different degrees of impact. Swimming and bicycling are not weight-bearing.
The second type of exercise is resistance exercise or activity that use muscular strength to improve muscle mass and strengthen bone. These activities include weight lifting, such as using free weights and weight machines found at gyms and health clubs.
How can I minimize my risks of falling?
You can minimize your risk of falling by removing items such as small rugs that may cause tripping. Use non-slip mats in the bathtub and shower and have grab bars installed. Improving the lighting around your home, regular vision tests and other medical assessments are easy ways to make sure that impaired vision does not lead to falls. In addition regular exercise can improve coordination and balance and help prevent falls.
Are there symptoms of osteoporosis?
"Osteoporosis is a disease that one is unaware of until it makes a sound. And that sound is not really an audible sound. To me that sound was the sound of pain experienced when a bone breaks," said Linda, a patient.
Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.
How do I know if I have osteoporosis?
The Surgeon General recommends a bone density test for all women over the age of 65 and for any man or women who suffers even a minor fracture after the age of 50. To determine if you have osteoporosis or may be at risk for the disease, your doctor will ask you a variety of questions about your lifestyle and medical history. Be sure to share with your doctor all of the medications you take as some can cause bone loss. Your doctor will want to know if anyone in your family has suffered from osteoporosis or if they have fractured any bones. Based on a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. This test will safely and accurately measure your bone density and reliably predict your risk of future fracture. Specialized tests called bone density tests can measure bone density in various sites of the body. A bone density test is safe, quick and painless and uses x-rays or sound waves to measure the strength of the bones. It can:
• Detect osteoporosis before a fracture occurs
• Predict your chances of fracturing in the future
• Determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of a year or more.
What if I already have osteoporosis?
You can live actively and comfortably by seeking proper medical care and making some adjustments to your lifestyle. Your physician may prescribe a diet rich in calcium and vitamin D, a regular program of weight-bearing exercise and medical treatment. In addition you and your doctor should discuss ways you can reduce your risk of falling.
What is a bone fracture?
As a result of low bone mass, bones become weak and can break or fracture more easily. Bone fractures often occur from falling or other common accidents. Spine fractures can occur without trauma. The most typical sites of fractures related to osteoporosis are the hip, spine, wrist and ribs, although the disease can affect any bone in the body. The rate of hip fractures is two to three times higher in women than men; however the one year mortality following a hip fracture is nearly twice as high for men as for women. An average of 24% of hip fracture patients aged 50 and over die in the year following their fracture. At six months after a hip fracture, only 15% of hip fracture patients can walk across a room unaided. A woman's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.
8 COMMON MYTHS ABOUT OSTEOPOROSIS
1. Osteoporosis is an inevitable part of aging.
• Osteoporosis, for the most part, is preventable. Prevention of osteoporosis should begin in early childhood and continue throughout the stages of life. Building a strong skeleton during childhood, adolescence and young adulthood may help individuals avoid osteoporosis later in life.
• There are four steps that can optimize bone health and help prevent osteoporosis. They are: a balanced diet rich in calcium and vitamin D, weight-bearing exercise, a healthy lifestyle with no smoking or excessive alcohol intake and bone density testing and medication when appropriate.
• Continuing or starting preventive measures even after fractures have occurred is important; this will minimize further bone loss and help prevent additional fractures and more severe disability.
2. Only older women get osteoporosis.
• Women and men can develop osteoporosis at any age, especially if they have a chronic condition such as asthma or arthritis that requires treatment with medications such as glucocorticoids (e.g. prednisone) that can lead to bone loss.
• Twenty percent of those affected by osteoporosis are men. Men with osteoporosis and low bone mass total over 14 million. This figure is expected to increase to over 17 million by 2010 and to over 20 million by 2020.
• Men over the age of 50 have a greater risk of suffering an osteoporosis-related fracture than developing prostrate cancer.
• Each year, 80,000 men suffer a hip fracture and are nearly twice as likely as women the same age to die the in first year after breaking a hip.
3. Only Caucasian women get osteoporosis.
• 52 percent of Asian women age 50 and older are estimated to have low bone mass.
• 49 percent of Hispanic women age 50 and older are estimated to have low bone mass.
• 35 percent of non-Hispanic African American women age 50 and older are estimated to have low bone mass.
• 10 percent of Hispanic women age 50 and older are estimated to have osteoporosis.
4. Osteoporosis is not very common.
• Osteoporosis and low bone mass affect 44 million women and men aged 50 and older in the United States. The 10 million people with osteoporosis and 34 million with low bone mass represent 55 percent of the people aged 50 and older. By the year 2010, it is estimated that over 52 million women and men in this same age category will either have osteoporosis or be at increased risk due to low bone mass. By the year 2020, NOF expects this number to increase to over 61 million.
• In the U.S. alone, osteoporosis causes 1.5 million fractures annually. These include 300,000 hip fractures, 250,000 wrist fractures, 700,000 vertebral fractures and 300,000 fractures at other sites.
• A woman's risk of hip fracture is equivalent to her combined risk of developing breast, uterine and ovarian cancer.
• Half of women over the age of 50 will have an osteoporotic fracture before they die.
5. Osteoporosis isn't a serious or deadly condition.
• The consequences of osteoporosis are devastating and painful. Hip fractures, which occur about twice as often in women as in men, are more serious than people realize: approximately 20 percent of hip fracture patients will die in the year after fracture, usually from complications such as pneumonia or blood clots in the lung, which are related to the fracture or to the surgery to repair the fracture.
• Vertebral fractures are difficult to quantify because only one third of these fractures come to clinical attention. Up to half of patients with a prior vertebral fracture will experience additional fractures within three years, with many occurring within the first year. The survival rate following clinically diagnosed vertebral fracture is comparable to that following hip fracture.
• More than half of those who survive a hip fracture will not be able to walk or move about easily, and a quarter will need long-term nursing home care.
• Frail, elderly women and men who have suffered multiple fractures in the upper spine may develop stooped posture, or "kyphosis". They often have chronic lower back and side pain and difficulty walking. In extreme cases, people have trouble breathing and eating.
6. Medical costs from osteoporosis aren't high.
• In 2003, the inpatient, nursing home, and outpatient medical treatment costs of osteoporotic fractures in the U.S. is estimated to be almost $17 billion, of which nearly 40 percent is due to fractures other than hip fractures.
• Each hip fracture represents an estimated $40,000 in total medical costs.
• This cost to the healthcare system associated with osteoporotic fractures is expected to exceed $60 billion by the year 2030.
7. If I had osteoporosis, I would know it.
• No, not usually. Osteoporosis is often called "the silent disease" because it progresses slowly over time, without symptoms, until a fracture occurs. For example, many people continue to assume height loss is a normal part of aging. However, it may be due to a collapse in the bones of the spine, called vertebrae, weakened by osteoporosis. NOF advises everyone to routinely monitor their height and talk to their healthcare provider if they notice a loss of more than an inch. Patients often don't realize they have osteoporosis or are even at risk until they suffer a fracture - most commonly of the hip, spine or wrist - after a fall or from doing ordinary activities. At this point, they have already suffered the consequences of osteoporosis.
• Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis include being female, having a personal history of fracture as an adult, current smoking, current low bone mass, being thin and/or having a small frame, advanced age, or a family history of osteoporosis. For a complete listing of osteoporosis risk factors, please contact NOF (information listed below).
• Many people are not having appropriate testing to determine if they have osteoporosis before, or even after they fracture. As many as 95 percent of adults who break a bone are being treated without being evaluated for osteoporosis. Bone mineral density tests can measure the amount of bone in different parts of the skeleton and can predict the risk of future fractures.
8. Once I have osteoporosis, there is nothing I can do about it.
• Even if you have been diagnosed with osteoporosis, it's not too late to take steps to protect your bone health. Consuming the recommended amounts of calcium and vitamin D, performing weight-bearing exercises and quitting smoking can help slow bone loss.
• There are also several treatment options available to slow bone loss and even build new bone. Talk to your doctor to decide if one is right for you.
The National Osteoporosis Foundation is the leading voluntary health organization solely dedicated to promoting lifelong bone health in order to reduce the widespread prevalence of osteoporosis and associated fractures, while working to find a cure for the disease through programs of research, education and advocacy.
For more information on the prevention, diagnosis and treatment of osteoporosis, visit here.
For more information on the first-ever Surgeon General's Report on "Bone Health and Osteoporosis" visit here.
Special thanks to Judith Cranford, Executive Director of the National Osteoporosis Foundation, Laura Diamond, Director of Communications and Marketing, and Rosalind Whitehead, member of the National Osteoporosis Foundation Board.