Not many years ago, we thought about osteoporosis - if we thought abut it at all - as being the usual state of our grandmothers and mothers in their late life, with their stooped posture, foreboding loss of height, and the hip fractures dooming them so often to dependency in a nursing home.
We now know that bone health is a lifelong journey, with adequate nutrition, vitamins and exercise beginning in childhood and adolescence, into young adulthood ( we each achieve our peak bone mass at age 25-30), on through the female menopause and it changes and consequences for bone health, and to that later life increasingly hoped for as a time for active enjoyment.
And we now know that osteoporosis can be detected early, can be prevented, and can be treated successfully before fractures and deformities occur. Osteoporosis is the fourth leading cause of death in postmenopausal women.
And so the health of our bones is an important topic for each of us - especially for the 25 million Americans directly affected by osteoporosis (osteoporosis affects half of all women after menopause).
In the past few years, reliable and accessible testing for bone health (bone density tests) and effective and safe medications for preserving bone health and for repairing weakened bones have become widely available.
The most reliable testing of bone health measures bone density, which is the best predictor of fracture risk and the closest measure of bone strength.
The standard measurement of bone density is the DEXA test (dual energy x-ray absorptiometry), measuring density of bone at 2 or more sites (usually the hip and lumbar spine). The test is non-intrusive (does not require disrobing); painless; fast (10-15 minutes); and safe (the radiation exposure is less than that from natural sources during a several - hour airline flight). Although other technology for testing is becoming available for screening (measuring bone density of the finger, heel or wrist), only the "central" or "table" DEXA test is approved by the FDA both for establishing the diagnosis of osteoporosis and for monitoring changes in bone density in later years to determine the efficacy of medication intervention.
Who should have a DEXA test of bone density?
A national consensus group recommended in 1996 the following general guidelines for testing:
DEXA testing is becoming widely available in Utah. Your physician's office or your local Yellow Pages can help you locate a nearby DEXA test site; or you may call the National Osteoporosis Foundation at 1-800-223-9994.
New Medications for a New Time
A new era in bone health and prevention of fractures has begun, with effective and safe medications for prevention of osteoporosis and for treatment of established osteoporosis. Although there is no cure for osteoporosis, bone can be saved from loss by preventive medication and can often be partially repaired when depleted by advancing osteoporosis.
Women after menopause are at great risk for developing osteoporosis and its associated fractures later in life. Bone loss occurs significantly in the first 5 years after menopause (and in some women very rapidly in the first year or two after menopause), as the body's natural estrogens decline.
Fewer than one-third of American postmenopausal women receive adequate, long-term estrogen replacement therapy. Those who do not are at risk for silent, progressive osteoporosis leading to later fractures.
Important medications which can prevent bone loss after menopause and which are approved by the FEA for prevention are:
Cardiovascular disease is the leading cause of death in postmenopausal women. Estrogens and Evista have significant additional benefits in reducing serum lipids and cardiac risk. Evista has no adverse effect on breast or uterine tissue, an important new finding.
Many physicians recommend that all women after menopause receive medication to prevent bone loss.
Medications currently approved for treatment of established osteoporosis are:
New medications being investigated include new bisphosphonates (Fosamaz is in this class of drugs), sodium fluoride, and vitamin D and parathyroid hormone analogues.
Other important preventive measures include:
Later life can be a time for magnificent, active enjoyment. That enjoyment, indeed that structure which is ourselves, rests upon preserving the framework of healthy bones.
Continuing Education Questions:
To earn 1.0 Continuing Education contact hours please send this answer sheet along with a check for $5 (UNA members) or $10 (Non - UNA members)
to:
Utah Nurses Association
3761 South 700 East
Suite 201
Salt Lake City, UT 84106
phone 801 293-8351