Osteoporosis Paper Melinda Re June 10, 1999 "A Grade" Project # 2 - Spring

The Disease

Osteoporosis is a disease of the skeleton characterized by a gradual loss of bone mass due to depletion of the minerals essential to bone formation. Affected bones become porous and brittle and susceptible to fractures. In the United States an estimated 15 million people have osteoporosis. Osteoporosis causes more than 1.5 million fractures each year, and the cost to the U.S. healthcare system is more than $13.8 billion per year. The Diagnosis of Osteoporosis

In March 1999, I had my bone density measured through a bone scan and was informed by the technician that I was osteoporotic. The Ultrasound Bone Mineral Density Testing performed by the Osteoporosis and Bone Health Institute in Sioux Falls, South Dakota consists of a radiation free scan that uses ultrasound to test the bone density of the heel bone. It is a good predictor for further testing and therapy. I simply completed a simple personal data sheet and put my foot in the densitometer.

The machine gives a "T-Score". The score is then compared to criteria set forth by the World Health Organization. If the score is below negative 1, it is considered osteoporotic. I scored a negative 1.8, which is very high for a Caucasian woman of my age. I was advised to notify my physician of the results immediately. The diagnosis of osteoporosis needs to be confirmed through a dual-energy x-ray absorptiometry, a non-invasive imaging technique that costs about $250.00.

As a Licensed Dietitian and a confirmed cheese lover, I was shocked. I immediately began reviewing everything I could find to discover the causes of osteoporosis and hopefully, the cures.

Causes and Risk Factors

The cause of osteoporosis is not known. Osteoporosis needs to be understood as a multifactorial condition. Nutrition, hormones, exercise, lifestyle, disease, and medications all affect bone health and fracture risk. As I read through the risk factors for osteoporosis, I realized that my penchant for dairy foods wasn't going to save me from this disease. Although meeting calcium needs throughout life may reduce the risk of osteoporosis by as much as one-third to one-half, it will not prevent it. Risk factors for osteoporosis include: Age - Osteoporosis increases with age. More than 1 in 3 women over 50 have lost a significant amount of bone. I am 46 years old.

Gender - Women are 4 times more likely than men to get osteoporosis. I am a woman.

Race - White and Asian women are at the highest risk. I am white.

Heredity - If it runs in the family, a higher risk may be inherited. My mother has osteoporosis.

Bone Structure and Body Weight - Small-boned, thin women have the greatest risk. I am small-boned and lifetime thin.

Diet - Inadequate calcium contributes to the disease. I love cheese, yogurt and milk and have always considered the overconsumption of dairy foods my worst dietary habit.

Physical Activity - Inactivity increases the risk. I walk 3 miles everyday and have exercised regularly for many years.

Use of cigarettes - Smoking hastens the loss of bone. I am a non-smoker.

Alcohol and/or caffeine - These habits interfere with the body's use of calcium and an increased loss. I drink both coffee and wine.

Medications/Medical Conditions - Certain diseases (kidney or liver disease) and medications (cortisone) can significantly increase calcium loss. I have none of these.

Menopause - The rate of bone loss is increased by menopause. I am menopausal.

I have risk factors in 7 of the above 11 categories! I investigated traditional treatments for osteoporosis and one complementary treatment.

Biomedical Treatment of Osteoporosis in Women

According to the National Institutes of Health, the main cause of osteoporosis is postmenopausal estrogen deficiency, and that smoking, heavy alcohol consumption, and physical inactivity are much more important factors in the development of this disease than calcium deficiency. It would, therefore appear that taking calcium supplements is effective only when combined with estrogen replacement therapy and regular exercise.

This is confirmed in that the most common biomedical treatment for osteoporosis in women combines the taking of calcium supplements with hormonal replacement therapy and regular exercise. However, at least one study has found that combining estrogen with the new group of medications called biphosphonates, may increase the benefits. Treatment strategies include:

Calcium Supplementation - 1,500 milligrams daily is recommended. The cost of calcium supplementation is about $1.20 per month.

Hormonal Replacement Therapy (HRT) - consists of a daily dose of estrogen and synthetic progesterone (progestin). HRT prevents the accelerated postmenopausal calcium depletion. The cost of this treatment is $21.00 per month.

Exercise - weight bearing exercise such as walking, and resistance exercise such as lifting free weights is recommended on a regular basis. This can be accomplished virtually free of charge by walking outside and lifting canned goods (prior to eating of course!).

There are other medications that have emerged recently and been added to the treatments available for osteoporosis:

Fosamax is the first in a new class of drugs called biphosphonates to treat osteoporosis in postmenopausal women. It has been shown to build healthy bone. This treatment costs $64.79 per month.

Miacalcin slows down the bone loss rate and increases bone mass. This was until recently only available by injection, but a nasal spray has recently become available. This treatment costs $62.39 per month.

Evista is a hormone-like substance that helps stop the loss of bone after menopause in the same manner as estrogen, but to a lesser degree. This treatment costs $78.39 month.

Self-care involves life-style changes to reduce the risk factors that are controllable: dietary calcium, physical activity, cigarette smoking, use of alcohol, caffeine consumption and the taking of certain medications. Self-care would include the eating of a healthful diet, which includes dairy foods.

A Complementary Therapy for the Treatment of Osteoporosis in Women

The complementary therapy that I investigated is Naturopathy. I interviewed Dr. Allen Anderson, Naturopathic Practitioner, in May 1999, and asked him how he would treat osteoporosis. He, like a conventional physician would require a bone scan as part of the diagnostic process.

He indicated that he would prescribe Ipriflavone, an enzymatic therapy, in combination with natural progesterone and a dietary supplement containing calcium, magnesium, vitamin K, copper and silicon. He would advise his patients to consume soy foods and leafy green vegetables and exercise regularly. The cost of this treatment is approximately $125.00 per month.

Self-care involves life-style changes to reduce the risk factors that are controllable: dietary calcium, physical activity, cigarette smoking, and use of alcohol, caffeine consumption and the taking of certain medications. Self-care would also include a healthful diet that contains soy foods and leafy green vegetables. Comparison and Contrast of Biomedical and Complementary Therapies

Treatment Biomedical Complementary Hormones Estrogen and progestin Progesterone Medications Fosamax; Miocalcin; Evista Ipriflavone Supplementation 1,500 mg calcium 1,500 mg calcium Magnesium Vitamin K Copper Silicon Diet Adequate dairy foods Soy foods Green vegetables Exercise Regular exercise Regular exercise Estimated Cost $42.20/mo $125/mo calcium & hormones $106.99/mo with biphosphonate

I have sent a copy of my bone scan to my physician and asked him to contact me to discuss treatment options. Whatever I choose to do, I feel like I have done my homework and am better able to make an informed decision.

-- Anonymous, June 10, 1999