Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Osteoporosis

Generally osteoporosis is thought to be a health issue only for the elderly population. Though osteoporosis does not typically become a problem until menopause, prevention of osteoporosis should begin in childhood. Osteoporosis will result in fractures in more than 40% of women over the age of 50 and hip fractures will account for 15% of these fractures. Within one year after a hip fracture, up to 20% of the victims will die, 25% of the survivors will be confined to long-term care facilities, and 50% will experience long term loss of mobility. The diagnosis of osteoporosis often is made after a woman has suffered a clinically significant fracture. Thankfully, advances in technology now make the diagnosis of osteoporosis possible prior to the occurrence of a fracture. Osteoporosis is defined as 2.5 standard deviations from the mean below peak bone mass. Peak bone mass in both men and women occurs at approximately age 30. After reaching peak bone mass, about 0.4% of bone is lost per year until menopause. At the time of menopause, the drop in estrogen results in accelerated bone loss of 2-5% per year for the first 5 years after the menopause. This also applies to women who are placed in menopause early when their ovaries are surgically removed. Excessive bone loss may also be seen with certain diseases that affect bone metabolism and certain medicines such as steroids and heparin. Lifestyle has a significant role. Cigarette smoking, alcohol consumption more than 7 ounces per week, and a sedentary lifestyle are all associated with decreased bone mass and increased risk for fracture and disability. Family history is also important. The female children of women who suffered from osteoporosis are at greater risk of having osteoporosis than the general population. Women who are at increased risk because of chronic disease, family history, or lifestyle should be screened for osteoporosis independent of their age. Women without risk factors should be screened around the time of menopause or when the ovaries have been surgically removed. Dual x-ray absorptiometry (DXA) is now available to determine bone mass with minimal radiation exposure and high accuracy. The procedure is quick and painless and involves taking x-rays of the hip and spine. Though screening of osteoporosis should begin when women are at risk of developing osteoporosis, prevention of osteoporosis should begin in childhood by providing adequate calcium intake and exercise. Children between 1-10 years should receive 800mg of elemental calcium per day. Adolescents and pregnant women should receive 1500mg of calcium per day. Adult premenopausal women and postmenopausal women on estrogen replacement therapy should receive 1000mg per day. Postmenopausal women who are not on hormone replacement therapy should receive 1500mg of calcium per day. Vitamin D is also essential for bone formation but our bodies generally make sufficient amounts with exposure to sunlight. Vitamin D supplementation should be added for women who are in long-term care facilities. Many women who have osteoporosis have adequate intakes of calcium and vitamin D but bone continues to be reabsorbed by the body. Hormone replacement therapy remains the best treatment for bone loss in postmenopausal women. For women whom hormone replacement is not desired, non-hormonal medicines such as Fosamax, Actonel, and Evista are possible alternatives. Good health, weight bearing exercise, and adequate calcium intake should be practiced by everyone for the prevention of osteoporosis.