Other Columns on Health-Related Topics

Osteoporosis: A Misunderstood Disease

Osteoporosis is one of the most common medical problems in our society today. Sadly, it is also one of the least commonly diagnosed and treated. I am writing this article in an attempt to bring the importance of this misunderstood disease into focus.
Osteoporosis is often confused with the term osteoarthritis. While people may indeed have both of these diseases at the same time, they really are not at all the same thing. While osteoarthritis is a painful disease of the joints, osteoporosis is not in itself painful at all.

The term osteo means bone. Porosis refers to something being porous, or hollow. The insides of our bones look a lot like a sponge. Our bones are not solid like a piece of metal, but instead, are hollow in order to provide a space for our body to produce red blood cells. The hollow nature of our bones is also important since solid bone would be much heavier and our limbs would be harder to move. The problem with osteoporosis is that our bones become a bit too hollow, so to speak. In other words, they become less dense.

Imagine a block of cheddar cheese. It has a certain amount of density. It is pretty solid. Now, imagine a block of Swiss cheese that is the same size. It has the same dimensions as the cheddar, it just has holes throughout the inside. Therefore, it is less dense. The bigger and more numerous the holes on the inside, the less dense it becomes, or the more hollow. This can happen without ever changing the outer dimensions of the block of swiss cheese. Well, the same thing happens inside our bones as we age. The holes become more numerous and larger, and our bones become less dense, just like swiss cheese.

Now, a certain amount of this decreasing density is to be expected. As a matter of fact, our bones are most dense somewhere around the age of 30 in most people. After that, our bone density begins to decline as we age. In women, the decline becomes even more rapid after menopause. That is because estrogen has a lot to do with maintaining bone density.

You might wonder why we make such a big deal about this if I just told you that this was a natural process. Well, that is because osteoporosis refers to an accelerated decline in bone density. For reasons that we do not fully understand, some people have a much more rapid decline in their bone density than others. These are the people who are most at risk for hip fracture. They are also the people who have a hunched appearance and loss in height. This is due to deterioration of the vertebrae in our spinal column. The bones in our back become frail and unable to support our weight, so they begin to slowly collapse like a melting ice cream cone. All of this is due to decreased strength of the bone because it is becoming less dense.

Each year in the United States, there are about 500,000 hip fractures. Of these, nearly 50% of the victims will never walk again without some type of assistance. Many die from complications like pneumonia or bed sores that occur after the fracture. Obviously, this is a big problem. Yet, there are some misconceptions about osteoporosis prevention. For instance, taking calcium is important, but it will not prevent osteoporosis. All of the milk commercials on TV would make you think otherwise, but trust me, you need more than milk. You see, calcium is the main ingredient in bone. Without calcium, you would not

even be able to live, much less be able to have bones in your body. Yet, osteoporosis does not occur due to lack of calcium. Instead, is seems to have more to do with how the body uses its calcium in keeping the bones strong.

Think of it like this - You cannot have a brick house without bricks. Seems simple, I know. But, all of the bricks in the world will not get the house built. You have to have bricklayers, and mortar, and the right tools, and so forth. Bricks may be the main ingredient, but there are a lot of things going on when you build the house. Calcium is the main ingredient, but there are a variety of important processes that must occur to have strong, dense bone. The bone's ability to absorb and utilize calcium is vital to the treatment of osteoporosis. That is where medicine plays a role. Many of the medicines we use to treat and prevent osteoporosis work by helping our body and our bones use calcium more effectively and efficiently to maintain our bone density. Your doctor can explain which medicine might be right for you.

Finally, an x-ray is not a good tool for diagnosing osteoporosis. Instead, we use a machine called a bone densitometer that actually measures bone density. The test is simple and painless, requiring no needles or blood work. It can be done in about 20 minutes right here in Malvern at HSC Medical Center. Medicare will pay for this every 2 years, and most insurances will pay as well.

In women especially, the sooner osteoporosis is diagnosed, the more effective the treatment. The complications that can occur with osteoporosis like hip fracture can be devastating. They can result in lack of independence, nursing home placement, and even death. Yet, osteoporosis can be treated and even prevented with exercise, diet, and medicine when necessary. A simple test will tell you if you need treatment.

And, while just about all physicians recognize the importance of this disease, we are often guilty of forgetting to talk about it with our patients. Therefore, your best bet is to ask your doctor if you should have a bone density test in the near future. Mention it to your parents. Ask your grandmother if she has been tested. It really is that important, and it could even save a life.

Dr. Shawn Purifoy, a Family Practice Physician with the Malvern Family Medical Clinic, reads and interprets bone density studies for HSC Medical Center.