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When most people hear
about osteoporosis, a disorder that leaves bones weak and prone to
fractures, they often think of elderly women whose disease results from
hormonal changes following menopause. Many people may be surprised to
learn that "brittle bone disease," as osteoporosis is sometimes called,
often affects many other groups of people.
Osteoporosis affects approximately 25 million Americans and causes
nearly 1.5 million fractures each year, according to a recent National
Institutes of Health report. People with kidney disease and those on
long-term medication, including transplant recipients, are at increased
risk of developing the disease. These people often develop osteoporosis
as a result of medications or a disease process rather than menopause or
through the normal aging process.
Bone is a continually changing throughout life, explains Jill Lindberg,
MD, CO-director of the Metabolic Bone Clinic at the Ochsner Medical
Clinic in New Orleans, Louisiana. Dr. Lindberg has done extensive
research on osteoporosis that is not related to aging. Most recently,
she has studied loss of bone mass among marathon runners and military
academy cadets.
In healthy bone tissue, according to Dr. Lindberg, calcium and other
minerals from a strong supportive network where sugar, protein and
minerals are stored and blood cells are produced. To maintain the
strength of this network, the body continually breaks down old bone and
replaces it with new stronger tissue in an ongoing bone renewal program.
Although this renewal process continues throughout life, bone strength
is greatest in early adulthood. "There is evidence that shows everyone
reaches peak bone density in their mid-20s, says Dr. Lindberg. "After
that, we all begin to slowly lose bone mass." For most people who have
developed strong, healthy bones during their youth, the loss of bone
tissue is so gradual that it does not affect bone strength. However,
osteoporosis occurs if bone breaks down too rapidly; if there is not
enough calcium for the bone to replenish what is lost or if calcium is
not absorbed into the bone. The supportive structure weakens and
fractures and can result in disfiguration, pain, or a loss in height,
Lindberg says.
Anyone who takes steroids is at increased risk of osteoporosis and more
than 80% develop some form of the disease Steroids are common, effective
medications for treating many diseases, They suppress the immune system
and are therefore effective in controlling diseases in which the immune
system is harmful to the body's own tissue, such as with asthma,
arthritis, lupus erythematosus, and some forms of kidney disease.
Steroids are also commonly used to help guard against rejection
following organ transplantation. However, steroids also suppress bone
formation and cause the kidneys to waste calcium by blocking its
absorption from the gastrointestinal tract.
Unfortunately, many of the people who must take steroids to suppress the
immune system already have other risk factors for osteoporosis. An
older, post-menopausal woman with arthritis already is at risk for
developing osteoporosis. Steroids, while helping control the arthritis,
will have a negative effect on her bone density.
Transplant patients, especially kidney recipients, often face additional
risk of developing osteoporosis. Kidney disease prior to transplant may
have already caused a loss of bone mass. In addition, medications taken
to prevent organ rejection can accelerate bone loss and inhibit the
reformation of new bone. These medications represent a multi-prolonged
attack on the bone. Prolonged use of some seizure control medications,
such as Dilantin, also can contribute to osteoporosis, Dr. Lindberg
notes because they may interfere with vitamin D metabolism. Also,
heparin, used to prolong clotting times, can speed up the natural
mechanism that breaks down bone cells. Because these medications are
vital to a patient's well-being, their use may not be able to be
discontinued or even lessened. Therapies for osteoporosis, which must
take into account the patient's complete medical needs, could include
supplemental calcium and biologically activated vitamin D,
administration of other medications, or surgery, if the parathyroid
gland is enlarged.
Researchers are seeking to develop new medications that stimulate bone
growth. At present, these medications are still in the investigational
stages. Diet and exercise also have important therapeutic value. Bone,
especially those areas at risk, such as the wrist, spine and hip,
responds well to exercise. Walking, water exercise, stationary bicycling
or weight training may be effective in maintaining bone density. It's
important for all people to be aware of the possible indicators of
osteoporosis, including cessation of a menstrual period or low sex
drive, pain or repeated bone fractures. Those who are at increased risk
of bone disease due to their age, a particular health condition or
medications should discuss these risk factors with their physician.
Testing for osteoporosis can be as simple as having a low-dose X-ray
taken and a blood sample checked for calcium levels. Dr. Lindberg says
that prevention against osteoporosis must begin during childhood and
teenage years. "A healthy diet that is strong in calcium for young
people is a good way to build up bone mass for later years."
Unfortunately, many of the people who must take steroids to suppress the
immune system already have other risk factors for osteoporosis. An
older, post-menopausal woman with arthritis already is at risk for
developing osteoporosis. Steroids, while helping control the arthritis,
will have a negative effect on her bone density.
Transplant patients, especially kidney recipients, often face additional
risk of developing osteoporosis. Kidney disease prior to transplant may
have already caused a loss of bone mass. In addition, medications taken
to prevent organ rejection can accelerate bone loss and inhibit the
reformation of new bone. These medications represent a multi-prolonged
attack on the bone. Prolonged use of some seizure control medications,
such as Dilantin, also can contribute to osteoporosis, Dr. Lindberg
notes because they may interfere with vitamin D metabolism. Also,
heparin, used to prolong clotting times, can speed up the natural
mechanism that breaks down bon e cells. Because these medications are
vital to a patient's well-being, their use may not be able to be
discontinued or even lessened. Therapies for osteoporosis, which must
take into account the patient's complete medical needs, could include
supplemental calcium and biologically activated vitamin D,
administration of other medications, or surgery, if the parathyroid
gland is enlarged.
Researchers are seeking to develop new medications that stimulate bone
growth. At present, these medications are still in the investigational
stages. Diet and exercise also have important therapeutic value. Bone,
especially those areas at risk, such as the wrist, spine and hip,
responds well to exercise. Walking, water exercise, stationary bicycling
or weight training may be effective in maintaining bone density. It's
important for all people to be aware of the possible indicators of
osteoporosis, including cessation of a menstrual period or low sex
drive, pain or repeated bone fractures. Those who are at increased risk
of bone disease due to their age, a particular health condition or
medications should discuss these risk factors with their physician.
Testing for osteoporosis can be as simple as having a low-dose X-ray
taken and a blood sample checked for calcium levels. Dr. Lindberg says
that prevention against osteoporosis must begin during childhood and
teenage years. "A healthy diet that is strong in calcium for young
people is a good way to build up bone mass for later years."
Osteoporosis: The reality of brittle bone disease
was authored by: Dr. Jill Lindberg
the above article is included on this web site with Dr. Lindberg's
permission
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Young People Get Osteoporosis Too Organization
Copyright © 2001 All rights reserved.
Revised: 03/11/08.
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