Osteoporosis
By Rear Adm. Joyce Johnson, D.O., M.A.

My mother suffers from osteoporosis, and I'm worried that I will, too. What are its symptoms, and what can I do to prevent it?

Osteoporosis is the fourth-most-common chronic disease (about 25 million Americans have some degree of it), and it costs Americans $14 billion annually in medical care and lost productivity.

Osteoporosis is an ongoing, net loss of bone tissue. Each day, bones normally resorb (lose calcium) then form new tissue to replace the loss. If, however, the amount of resorption eventually exceeds the amount of formation, osteoporosis sets in and renders the remaining bone structure weak and easily fractured.

Since estrogen affects bone resorption, osteoporosis generally afflicts postmenopausal women. But there are other contributing factors, including endocrine imbalances such as hypothyroidism, Cushing's disease (or increased cortisol), and hyperparathyroidism, that can alter bone metabolism. Older men, especially those with diabetes or testosterone deficiencies, also can be at high risk.

Osteoporosis has few symptoms and usually isn't recognized until a fracture occurs. Blood levels of calcium and phosphorus are usually normal, and routine X rays don't show signs of the disease until it's quite advanced. The first sign usually is a loss of height. Later, there may be a noticeable hunched posture with abdominal protuberance, respiratory problems, and pain if there have been fractures in the past. By then, much of a patient's bone loss is permanent.

Various radiological bone-density techniques have been developed to diagnose osteoporosis earlier. Screening often is recommended for postmenopausal women who have a tall, thin body structure; experience menopause early; are of Asian or European descent; smoke; use alcohol regularly; have diabetes; or have consumed inadequate amounts of calcium since childhood. Osteoporosis tends to run in families, and its prevalence increases with a person's age.

To help prevent osteoporosis, lifelong adequate dietary calcium intake and weight-bearing exercises are important. To treat osteoporosis, avoid overly vigorous exercise that could increase your risk of breaking fragile bones. Some patients may benefit from hormone replacement therapy or biphosphonates.

Also take care to avoid falls that could lead to fractures. Nearly 300,000 hip fractures and more than 600,000 spinal fractures are attributed to osteoporosis annually. (For information about preventing falls, see The Retired Officer Magazine, April 2000, page 54.)