Osteoporosis:Strength for LifePage 1 of 7*****Osteoporosis: Strength for Life (Part 1)*****NarratorWithout medical intervention, it’s a condition that can go unnoticed until the instant it strikes, when a fractureoccurs in the hip or spine. Osteoporosis attacks the main infrastructure of the body, the bones.Karl Insogna, MD, Yale School of MedicineWhen you lose enough skeletal mass that you develop fractures from minimal trauma, or just activities ofdaily living, then you are defined as having osteoporosis.Dr. Joseph Kleinman, MD, Boca Radiology GroupIt's been estimated that about 400,000 to 500,000 admissions every year to hospitals are related to peoplewith osteoporotic fractures. And the cost to the health-care system is enormous.NarratorHere’s how osteoporosis develops. Bones make up our skeletal framework. They’re composed mostly ofcalcium phosphate, and a small amount of calcium carbonate. Calcium is stored in bones and gives themtheir thickness and strength.Bone is living tissue, just like the skin, and older bone needs to be continuously replaced with new bone.But when the creation of new bone doesn’t keep up with the amount that needs to be replaced, it becomesthin. The result is called osteoporosis.Older women are particularly at risk because the estrogen production that begins at puberty helps promotebone building, and at menopause the amount of estrogen a woman’s body produces diminishes greatly.What results is a loss of bone mass. In fact, according to the National Osteoporosis Foundation, within 5 to7 years following menopause, a woman can lose 20 percent of her bone mass due to a lack of estrogen inher system.Here are some more statistics: in the United States alone, osteoporosis affects about eight million women,and nearly two million men. Eighteen million more have low bone mass, placing them at increased risk fordeveloping the condition. Osteoporosis contributes to as many as one and a half-million bone fracturesevery year.And a fractured bone doesn’t simply mean a painful inconvenience. At its most extreme, for example, withinone year after a hip fracture the risk of death increases 20%. And one out of four people who have anosteoporotic hip fracture will need long-term care. Fractures of spinal vertebrae are just as serious.Dr. Susan Broy is Professor of Medicine at Chicago Medical School and Director of Osteoporosis at IllinoisBone and Joint Institute.Susan Broy, MD, Illinois Bone and Joint InstitutePatients, after a vertebral fracture, can have significant symptoms. They can have chronic pain as theirbacks become bent over, they can have trouble breathing and have pulmonary problems, because there'snot enough room for their lungs.NarratorThe National Osteoporosis Foundation estimates that 50% of Caucasian women will have at least onefracture in their lifetime. Hispanic women as well as African-American and Asian-American women are alsoat risk. Osteoporosis can strike anyone at any age. For the young, it can occur as a result of taking certainmedications, or from being a premature infant with low bone mass. But for most people, osteoporosisshows up as their body ages.Page 2 of 7Our skeletal framework like the rest of the body breaks down as we grow older. But this wasn’t fullyunderstood until people began living longer.Bone fractures due to osteoporosis occur differently than fractures in people with normal bone density.Healthy bones are typically dense. And because they are, they can do the important job of carrying theweight of the body, and are less likely to fracture or break when confronted with the typical thumps andbumps of life.But with osteoporosis, bones become porous, thin, and brittle, and the bone density is low. The thinner thebone, the weaker it is, making fractures or breaks occur more easily. And these fractures often happenwhen doing simple, everyday tasks.72- year-old Jean Oeste, of suburban Chicago, discovered her osteoporosis after helping a neighbor.Jean Oeste, PatientWell, this one day I was helping a lady move from the second floor down to my car to carry things away andit didn't happen immediately, but I felt, “Oh, my back hurts” and it just seemed to hurt to where I said, “itreally shouldn't hurt this much.”And I went over to the emergency room at one of the local hospitals and they took an X-ray and they saidthat there was a fracture in one of the vertebrae there.NarratorFractures of the vertebra, called spinal compression fractures, or vertebral fractures, are some of the mostdebilitating, and happen more often than other types of osteoporosis related bone fractures. Over time, theycan cause the spine to bend forward in what is known as a Dowager’s Hump.When we return, we’ll find out how osteoporosis is diagnosed.*****Osteoporosis: Strength for Life (Part 2)*****NarratorDr. Joseph Kleinman is a Radiologist in Boca Raton, Florida. He performs bone mineral density tests toassess whether patients have osteoporosis and if they are at risk of fracture or to determine if a fracture hasalready occurred.Dr. Joseph Kleinman, MD, Boca Radiology GroupThe way that we diagnose osteoporosis as radiologists is using a machine called a bone mineraldensitometer. And we’re going to evaluate two sources. Generally the sources that we look at are thelumbar spine, and the left hip. And the reason that we choose these sites is these are sites that are verycommonly prone to fractures. And these can be the first signs, if you will, of osteoporosis when somebodydevelops a fracture in these sites.NarratorThe result of bone mineral density testing is measured by a numeric system using what are called T-scores.T-scores compare the patient’s bone density with the average density of a bone-healthy 25-year-oldwoman.Normal bone density has a T-Score higher than minus 1. Osteoporosis is diagnosed when the T-Score islower than minus 2.5. A T-Score between those two values (from minus 1 and minus 2.5) indicates someloss in bone mass, a condition called osteopenia.Bone density tests are typically offered to all women 65 and older and to women under 65 with multiple riskfactors such as being thin, on steroid therapy for long periods of time, and to older men who are atPage 3 of 7increased risk. Tests are also used for anyone being treated for osteoporosis as a way to monitor theeffectiveness of their treatment.For those fortunate enough to live a long life, osteoporosis and bone loss may not be totally avoidable, butsteps can be taken to lessen its impact. Increasing calcium intake is one.Toddlers between the ages of 1 and 3 need 700 mg of calcium daily. For young growing children betweenthe ages of 4 and 8, that increases to 1000 mg daily. Older children ages 9 to 18, should get 1300 mg ofcalcium daily. Doctors recommend that adults age 19 to 50, get 1000 mg daily, and people older than 50should get 1200 mg of calcium each day. Consuming dairy products is an easy way to fulfill daily calciumneeds. For instance, a cup of skim milk has 302 mg. of calcium and a cup of whole milk has 291 mg. An 8oz. container of plain low-fat yogurt has 415 mg. And one oz. of cheddar cheese has 204 mg. of calcium.Most Americans get less than 800 mg of calcium in their diet, so calcium supplements are often necessaryto achieve the recommended total intake. Calcium with vitamin D is recommended by many doctors andcan be purchased at pharmacies and most grocery stores.From birth, our bodies begin the process of building up calcium levels. And by the time we’re 35, wetypically reach our maximum level of bone density. It’s at that point we begin to lose calcium, and shouldstart to replace this loss with more dietary intake and calcium supplements. For young women especially,the more calcium that can be stored prior to age 35, the better off they will be as calcium levels begindropping after 35 and as menopause also begins.Generally, people with large physical frames will have less trouble with osteoporosis because their bonesare thick, and therefore will take longer to breakdown to the point of creating a fracture risk. In contrast,people with smaller physical frames have thinner bones, and will have a much greater head start to the kindof bone loss that can lead to a fracture.Here in the Mineral Metabolism Laboratory at Yale School of Medicine, Medical Technologist ChristineSimpson is conducting a procedure that separates the amount of vitamin D from the rest of the componentsof the blood. Without adequate levels of vitamin D, dietary absorption of calcium is impeded, potentiallyweakening existing bone, and stopping the formation of strong, new bone.Studies by the National Institutes of Health show that vitamin D deficiencies exist in up to half of all elderlywomen who experience a bone fracture.When we return, we’ll meet three women who remain physically active as a way to fight osteoporosis andosteopenia.*****Osteoporosis: Strength for Life (Part 3)*****NarratorGina Epperson has lived an active life. She was born in Italy and came to the United States in 1958. Today,she lives in Waterbury, Connecticut. Gina is 73, and has suffered a great deal with osteoporosis. But likemost people, she did not know she had the disease until a bone fracture actually occurred, the first of 11.Gina Epperson, PatientI was working, I was, take paint off a door, doing some work outside and I did a lot of work that week. Then Iwent to bed, a bit uncomfortable, but the next day I couldn't get up, I was, I was just like this, I could notmove, it was such pain.Page 4 of 7NarratorAt the Yale School of Medicine, the Director of the Yale Bone Center, Dr. Karl Insogna, is an internationallyrecognized expert in the field of metabolic bone disease. Dr. Insogna has been treating Gina Epperson forjust over 2 years.Karl Insogna, MD, Yale School of MedicineSo, she is a woman who suffers from spinal osteoporosis, who was treated with the best available agentsthat we had at the time, and yet was left with really debilitating back pain that prevented her from working,getting her housework done and getting out into the community.NarratorThat’s when Gina went to see Dr. Insogna.Karl Insogna, MD, Yale School of MedicineAnd we were able to, with a combination of new therapies and physical therapy, really allow her to reclaimher life. She’s now much more physically active, going to the gym, exercising, going back to volunteering inthe community and just feels a lot better and has a lot less pain.Gina Epperson, PatientEven now, I join the classes sometimes, I do the stretching then, because I like it, I do a little bit of themovement, you know, but not like I used to.NarratorAnd although she remains concerned about her osteoporosis, she has been fracture free for 2 years. Theplace is Miami, the sound is Latin music, and the class, called Zumba, is for people over 50. LindaSchneider comes here to stay physically active, and to help her take active steps in her fight againstosteopenia.Linda Schneider, PatientDancing is something I’ve done all my life, I was a dance major in college so I’ve just continued on with that.And I tend to be a dancer, once a dancer, always a dancer. I have something called osteopenia, which isthe step right before osteoporosis. Uh, you don’t have as much bone loss but you can see the signs of boneloss.NarratorThis Zumba class is designed to help older people maintain a healthy and active lifestyle. For people likeLinda, the kind of weight bearing exercise found in dancing helps in her quest to build stronger bones.That’s because weight bearing exercise creates stress on the bones, which causes them to retain morecalcium. This is the body’s natural way to add more bone where it’s needed.Michael Virga is a 56 year-old backpacker with osteoporosis. As she and her daughter, Kendall, walk alongthis scenic trail overlooking the Golden Gate Bridge in San Francisco, you’d never guess that Michaelrecently broke her leg. It’s a common injury for those with osteoporosis.Michael Virga, PatientI love the solitude I love getting away from all the mechanism and it also gives a great sense ofindependence to be totally self-sustained.NarratorMichael has spent three decades traveling from her home in Bakersfield, California to backpack thewilderness trails in state and national parks. It is a passion she’s passed on to her daughter who has beenon the trails with her mother since she was an infant. Michael has been aware of the osteoporosis threat toPage 5 of 7her health most of her adult life. She watched her mother and her grandmother suffer fractures and brokenbones. It was on a visit to see her mother in Texas that Michael slipped on a step and broke her leg.Michael Virga, PatientI had to fly across country in this full plaster leg cast to be back in California to get the bones set.NarratorMichael Virga is organizing, “Hike for Osteoporosis,” to raise awareness about the disease and highlight thebenefits of knowing t-scores.Michael Virga, PatientThis idea of hike for osteoporosis in which women, especially women with osteoporosis or the potential,hike the national trails, backpack and hike the national trails hoping it to be something like the walk forbreast cancer, the ride for AIDS.NarratorMichael plans to take her message to women throughout the country. She believes bone health is tooimportant to ignore.Weight bearing exercise like dancing and hiking, are beneficial for all ages. Other forms of weight bearingexercise include free weights and other gym-oriented, muscle strengthening exercises. Most peopleassociate this kind of exercise as a way to strengthen muscle only. But it actually helps build new bone aswell.For older people, balance enhancing exercise helps create a better, more secure sense of equilibrium.These exercises include things like walking, dancing, and tai chi. Better balance helps reduce the chance offalling, where thinning bone can easily fracture.When we return, we’ll look at pharmaceutical and surgical steps in the fight against osteoporosis.*****Osteoporosis: Strength for Life (Part 4)*****NarratorFor many patients, oral medications are prescribed to help reverse bone loss due to osteoporosis.Bisphosphonates adhere permanently to the surfaces of the bones and slow down the bone-eroding cells.This allows the bone-building cells to work more effectively.And altered forms of estrogen in pill form called selective estrogen receptor modulators are used for theprevention of osteoporosis in postmenopausal women. In a 2-year study, women using selective estrogenreceptor modulators had significant increases in bone mineral density in bone scans performed on thelumbar spine, total hip, femoral neck and total body.A natural hormone produced in the thyroid gland called calcitonin can also be used to treat osteoporosis.Available as a nasal spray or injection, calcitonin is normally prescribed for women who are 5 years postmenopause. Whereas bisphosphonates, and selective estrogen receptor modulators, are considered thefirst line of therapy against osteoporosis, calcitonin is considered a second line of therapy. It works, but isnot believed to be as effective as the other oral medications.For those whose bone loss has led to a fracture, there are surgical procedures that are used to help correctthe damage. Surgery for a hip fracture is necessary to keep the patient from being bedridden, whichtypically leads to increased pain and death. The type of surgery depends on how severe the fracture is, andcan range from using metal screws to hold the bone together while the fracture heals, to replacing part ofthe femur if the broken bones are easy to align, or performing a total hip replacement altogether.Page 6 of 7But with the medications, surgery, dietary advice, and physical therapy available today, some roadblocksstill exist in getting treatment where it’s needed.Susan Broy, MD, Illinois Bone and Joint InstituteJust to give you an example, patients after a hip fracture, only about 10 to 20% of those patients will betreated for osteoporosis, and yet once they have a hip fracture they’re at high risk of having a subsequentfracture. These patients need to be treated.Karl Insogna, MD, Yale School of MedicineI think we may come up with new therapies that will remarkably allow us to improve people's bone mass. Ithink that coupled with a really concerted public health effort to educate people about the things they can doright now to protect their skeleton, I think should help us to control this epidemic.NarratorThe older our population becomes, the more important it will be to communicate the risk factors associatedwith osteoporosis. And an awareness of the steps that can be taken to reduce its effects is important nomatter what our age. First, to stem the tide of bone loss, the proper amount of calcium is needed.Vitamin D plays an important role in calcium absorption in bone.Weight bearing exercise such as walking or moderate weight lifting, can increase calcium levels in bone.Bone density measurements can give an accurate picture of potential spinal and hip fracture problems, andprovide important T-Score information.All of these tools are important in trying to turn the tide of osteoporosis. Taking these steps early couldmake a tremendous difference in fighting its debilitating effects, and keep everyone strong and moving for alifetime.© The Wellness NetworkPage 7 of 7