Myth - osteoporosis only affects older white women

Osteoporosis means “porous bones” and it is the most common of bone ­diseases.

It is described as the thinning of bone tissue and loss of bone density over time. It occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both.

Despite the millions of people who are affected by osteoporosis, awareness is low and physicians often do not screen adequately in time to prevent the first fractures.

There are many myths concerning osteoporosis, but the following example: “it only affects older white women”, is simply not true. The National Osteoporosis Foundation in the USA ­reports that 10 million Americans currently suffer with osteoporosis and another 34 million have ­osteopenia (low bone mass) and are at risk of developing the disease. Twenty percent of those affected are men. In addition, while ­older persons and certain racial groups are at greater risk, osteoporosis can affect all ages and all races.

According to the International Osteoporosis Foundation, osteoporosis is a global problem which ­affects approximately one in three women and one in five men over the age of 50 years and is increasing in significance as the population of the world grows in size and is living longer.

The process of bone loss begins gradually when we are in our mid to late ­thirties and progresses so slowly that it may take many years before we ­become aware of it.

Osteoporosis is classified as either Primary Osteoporosis (further classified as either Primary Type 1 or Primary Type 2), or Secondary Osteoporosis.

Primary Type 1 is referred to as post-menopausal ­osteoporosis and occurs in women between the ages of 50 and 70. The hormones oestrogen and progesterone offer some protection against bone loss and thus the risk for osteoporosis ­increases once menopause occurs. Bones in the spine are at particular risk and persons may develop a kyphosis or spinal hump, also known as a “Dowager’s Hump”, in the area of the shoulder blades.

Primary Type 2 disease is referred to as age-related osteoporosis or senile osteoporosis and generally affects those 70 years or older. It occurs in both females and males at a ratio of about 2:1.

Secondary Osteoporosis can occur at any age due to predisposing disease or medical problems, or the prolonged use of certain medications. Medical ­conditions include menopause before age 45 through natural or surgical means, for example women undergoing a hysterectomy accompanied by removal of the ovaries, amenorrhea (the absence of menses in women of reproductive age), alcoholism, eating ­disorders, Crohn’s Disease and Type 1 Diabetes.

Medications such as ­glucocorticoids, a class of steroids used to treat chronic conditions including asthma and lupus, as well as transplant patients; and drugs which treat epilepsy, also increase the risk for developing osteoporosis.

Until the Women's Health Initiative report of 2002, hormone replacement therapy (HRT) was commonly prescribed for women to treat unpleasant menopause symptoms such as “hot flashes” and this therapy had the added ­benefit of decreasing the risks for osteoporosis and heart disease. The study found however that women taking a combination of ­oestrogen and progesterone for at least five years, ­doubled their risk of developing breast cancer. 

Hormone use has plummeted since then and women who still elect to use this therapy are advised to use it no longer than three years.

Risk factors

Several other risk factors for osteoporosis include, family history, smoking, poor diet and low activity level. While it may be ­impossible to avoid all risks for osteoporosis, the ­disease is largely preventable by maintaining a healthy lifestyle beginning from childhood. The bones in our body are constantly being reshaped by ­osteoblasts (bone builders) and osteoclasts (bone ­absorbers). The loss of bone mass occurs when we begin to absorb or break down more bone than we build. It is therefore vitally important to build a strong skeletal structure before we reach adulthood.

The two most important bone building blocks are calcium and Vitamin D. Good sources of calcium ­include milk and other dairy products, almonds, sardines with bones, turnip greens, mustard greens, kale, broccoli, dried peas or beans. For most people, a daily intake between 1000 and 1500 mg of calcium is adequate. Getting sufficient Vitamin D is more of a challenge as foods such as salmon, herring, liver, and eggs contain small quantities and it is not likely that you will get sufficient levels from diet alone. Vitamin D production in the skin ­depends on exposure to the sun, but this function is ­diminished in adulthood and sun exposure should be guarded because of the risks of skin cancer.

Recommended daily ­intake is 400 - 600 international units but older adults may be advised to take 800-1000 international units per day. Be aware that taking too much calcium or ­Vitamin D can have adverse effects and should only be taken under your doctor’s supervision. Regular ­moderate weight-bearing exercise is the third building block for a healthy skeleton. Exercises such as walking, jogging, hiking, dancing, stair climbing, step aerobics and weight lifting not only help to ­preserve bone mass, but also increase it. Like ­muscles, bones atrophy and weaken when they are not used.

The next step in preventing osteoporosis is appropriate screening. A bone mineral density test (BMD) is the best way to determine your bone health and can identify osteopenia or osteoporosis, determine your risk for fractures, and the need for dietary supplements and/or drug therapy. The BMD test is painless, uses low levels of radiation, and provides doctors with a T-score — a measurement that compares your results with optimal bone density. A negative number indicates low bone mass. The greater the negative number, the greater the risk of fracture.

Baseline test

The Bermuda Cancer and Health Centre recommends a baseline test at the onset of menopause and repeated as indicated by your doctor. Women and men with a family history or other medical predisposing conditions should speak with their doctor regarding the appropriate age to begin screening. Remember, osteoporosis is a serious but largely preventable disease. Don’t wait until your first fracture to determine your personal risks. For additional information you can visit the National Osteoporosis Foundation website at www.nof.org. The centre’s lending library also has a large selection of books on the topic. 

Rhonda J. Smith-Simmons RN is the education officer for the Bermuda Cancer and Health Centre.