FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CAUCASIAN WOMEN MOST PRONE TO OSTEOPOROSIS

Question: I'm concerned that I may develop osteoporosis and have a broken bone because of it. I've heard different claims about what causes osteoporosis and which treatments, particularly which foods, will prevent it. What things make it more likely to get osteoporosis?

Answer: Osteoporosis is a serious condition involving the health of bones and, therefore, the health of the entire individual. It is most common in Caucasian women after menopause, but can also occur in women from other racial groups. It's even possible for older men particularly those who are very slender and "frail" in appearance to develop this condition.

Bones are made of stored minerals mostly calcium and several types of living bone cells. Some of these cells "re-absorb" existing bone, and others constantly lay down new bone. Osteoporosis is actually a disturbance in this normal, orderly process of bone growth and bone re-absorption.

All bones, whether in an adult or a child, are continually growing. Until early adulthood the rate at which bones are being made is greater than the rate of bone re-absorption. Therefore, there is an increase in the total amount of bone in the body in other words, growth. During adult years the amount of bone growth is equal to the amount of bone re-absorption. This produces no net change in the strength of bones because the amount of stored minerals and living bone cells is constant.

Osteoporosis is a disease characterized by a loss of bone mineral content. This loss can be the result of a number of illnesses, such as diabetes, renal diseases and abnormalities of nutrition. In some of these, the balance of bone growth and bone re-absorption is upset by increased bone re-absorption, and in others the problem stems from decreased bone growth.

The most common type of osteoporosis afflicts women after menopause. The loss of bone strength from the decreased mineral content results in a crushing type of fracture in the vertebra in the region of the shoulders and low back. Most of these fractures occur suddenly with only minor exertion often lifting, jumping or riding in a car traveling a bumpy road. The fracture produces acute pain in the area of injury and is accompanied by much spasm in the surrounding muscles.

Repeated vertebral fractures are a common history for individuals suffering from osteoporosis. This subsequently produces a loss of body height and a stooped posture. In severe cases, a characteristic "hump back" deformity develops in the upper back. Osteoporosis also produces weakening of the leg bone at the hip. The weakened hip bone is prone to breaking with only minor injury. Stumbling over a curb or a gentle fall may be all it takes to break that weakened bone. In order to build strong bones, the body needs calcium. The most common dietary source of it is dairy products. However, most adults don't consume sufficient milk and milk products to meet their calcium needs. So, the products that advertise their calcium content as a health benefit are correct. The average post-menopausal woman should have 1500 milligrams of calcium each day. This won't guarantee freedom from osteoporosis, but it certainly does reduce the risk of this dreaded illness.

Other dietary habits can affect one's risk of osteoporosis. Coffee consumption has been implicated as worsening osteoporosis. But, one recent study found that this damaging effect could be prevented by also drinking at least one glass of milk each day.

Smoking has also been shown to reduce the amount of bone. In an interesting Australian study of twins, the non-smoker or the one who had smoked at least 20 "pack years" (packs per day x number of years) less than the other twin had 9 percent more bone at the hip. Regular exercise and estrogen replacement therapy also reduce the risk of osteoporosis dramatically.

So, the best way to prevent osteoporosis is to exercise regularly, consume adequate amounts of calcium, avoid use of tobacco, and if you are a woman, talk with your doctor about the benefits of estrogen replacement therapy.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.