That's the case when it comes to bone loss, which can often occur with no symptoms or warning signs " until bending over to tie a shoe causes a bone in the spine to snap. But with appropriate testing, bone loss can be spotted and treated before it leads to a fracture.
Osteoporosis is a loss of bone mass, which causes bones to become brittle and frail, putting people at high risk for fractures or breaks. For some people, the problem of bone loss may not have progressed to osteoporosis but may be an early form of that condition called osteopenia.
Osteopenia signals a loss of bone mass that is less severe than osteoporosis. It has the potential to turn into osteoporosis if the bone loss continues or worsens. While osteoporosis affects 10 million people in this country, osteopenia affects another 18 million.
"Many times there are no signs of osteopenia. The first sign may be a fracture. A woman may find that she's losing bone when she goes for an X-ray. Sometimes I have patients that had some dental X-rays completed and the dentist noted on the films that there was a lot of bone loss," says Liselle Douyon, M.D., an endocrinologist at the University of Michigan Health System.
The best way to determine for certain if bone loss is occurring is to have a bone mineral density test, which measures the strength of your bones. This is done as a special X-ray of the spine, hip or forearm.
Normal X-rays will not detect bone loss until more than 30 percent of the bone mass has been lost. A bone mineral density test is more sensitive and can detect problems at an earlier stage. It is different from a bone scan, which is used to look for fractures or inflammation. The test is painless and takes less than 10 minutes.
The information from the scan is used to determine a T-score, which compares your bone density to that of a healthy young adult. A score of 0 to -1 is normal; -1 to -2.5 is considered osteopenia; and a score lower than -2.5 signifies osteoporosis.
If bone loss can be caught before it progresses from osteopenia to osteoporosis, the slide can often be halted.
"The best way to avoid osteopenia and osteoporosis is to have an adequate calcium and vitamin D intake, get plenty of exercise, avoid smoking and avoid excessive alcohol use," says Douyon, a clinical assistant professor of internal medicine in the U-M Medical School. "As people age, they tend not to be as active as before. Current recommendations are that at least 90 minutes of exercise weekly seems to have a beneficial impact on the bones."
Medications may also be used to help decrease the risk of fractures in people with osteoporosis. The drugs Fosamax or Actonel, both bisphosphonates, have been shown to decrease the risk of hip and spine fractures in postmenopausal women with osteoporosis. Raloxifene, a medication available under the brand name Evista that has some of the properties of estrogen, decreases the risk for spine fracture " and as a bonus may reduce the risk for breast cancer. Calcitonin is a nose spray that appears to protect against spine fractures.
Hormone replacement therapy of estrogen and progestin after menopause had been linked to increased bone density and fewer fractures, but it has recently been found to increase the risk of heart disease as well as breast cancer and may not be a good choice.
Healthy bones develop during childhood. Girls reach 90 percent of their peak bone mass by 18 and boys by 20. Proper diet and exercise can help shore up that bone mass bank. As people reach middle age, they see a gradual decline in bone density. The curve is particularly steep immediately after a woman goes through menopause.
"Peak bone density is established somewhere between the age of 20 and 30, so you want to be sure that you reach peak bone density in order to avoid bone loss that typically occurs with the aging process," Douyon says. "It's very important that kids get an adequate amount of exercise and a healthy diet high in calcium."
Risk factors for osteopenia or osteoporosis:"¢ The condition affects women more often than men"¢ Age 65 or older"¢ Post-menopausal status in women"¢ Caucasian or Asian women are twice as likely as African-American women to develop osteoporosis"¢ Fractures outside of a severe trauma"¢ Family history of osteoporosis or osteopenia"¢ Current cigarette smoking"¢ Low body weight"¢ Long-term use of certain steroids or anti-seizure drugs"¢ Medical conditions that impair gastrointestinal absorption, such as sprue or Crohn's disease"¢ Alcoholism"¢ Severe liver disease"¢ Kidney failure
Preventing osteopenia or osteoporosis:"¢ Eat a balanced diet."¢ Get 1200-1500 mg of calcium per day, through diet and supplements."¢ Get 400-800 IU of vitamin D per day."¢ Aim for at least 90 minutes of physical activity weekly."¢ Refrain from smoking."¢ Limit alcohol use to one drink per day for women and two drinks per day for men.
Resources:
UMHS patient information on osteoporosis:http://www.med.umich.edu/1libr/guides/osteo.htm
UMHS Health Topics A-Z: Bone mineral density testinghttp://www.med.umich.edu/1libr/aha/aha_bondenst_crs.htm
Osteoporosis and Related Bone Diseases National Resources Center:http://www.osteo.org
National Osteoporosis Foundation:http://www.nof.org
International Osteoporosis Foundation:http://www.osteofound.org/osteoporosis/index.html
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