Keywords: osteoporosis hip back spine fracture bone calcium milk dairy exercise estrogen Premarin Estrace hormone menopause estradiol oestradiol side effects complications aging disability preventative medicine Fosamax bone density diagnosis treatment

Osteoporosis --meaning porous, fragile bones --is a disease in which there is exaggerated loss of quantity and quality of bone, causing an increase in the risk of fractures. It's normal for the bones of both women and men to get thinner and more fragile with age. But when the bones become so fragile that they break easily and health is endangered, that's the disease osteoporosis. Like other body tissues, bones continuously renew and repair. Old bone is removed and replaced by new bone. Osteoporosis occurs when there is an imbalance in bone metabolism. Either too much old bone has been removed or not enough new bone has been formed --or both. As a result, the honeycomb structure of bones becomes so hollow and fragile from the loss of mineral that they may break with only slight trauma such as opening a window, and sometimes can occur with no trauma at all. While the exact causes of this imbalance are unknown, osteoporosis is generally preventable and treatable. Age is the most important risk factor. Certain physical or lifestyle factors --such as a low calcium diet, lack of exercise, and smoking --can contribute to bone weakness in both sexes.

All bones suffer from this disease. But the majority of fractures occur in the vertebrae (spine), hip, and wrist. Fortunately, of those who have spine fractures, only a small percentage will be troubled by them. Fracture of the hip can be of considerable concern, since this injury often leads to immobility and loss of independence. A woman's risk of having a hip fracture is equal to the risk of breast, uterine, and ovarian cancer combined. Approximately 30% of women having a hip fracture die within six months.

Certain women are at special risk for osteoporosis. Women typically have lighter frames than do men, so they have less bone mass to draw from. Women also lose bone more rapidly during the first five to ten years following menopause when their ovaries produce less estrogen --the hormone that appears to protect against bone loss. Every woman's body goes through bone loss, bone replacement, and more rapid bone loss after menopause. Not every women, however, will develop osteoporosis.

There are certain risk factors for osteoporosis. These include

• Age; most fractures occur after age 75.
• Gender; women are at greater risk than men.
• Race; white and Asian women are at special risk.
• Heredity; if osteoporosis runs in the family.
• Being small-boned and thin
• Inadequate diet, especially not enough calcium and vitamin D.
• Physical inactivity.
• Use of cigarettes or alcohol.
• Certain bone-robbing medications (such as steroids and anti-seizure drugs).
• Prolonged immobilization.
• Being past menopause; women experiencing early menopause (before age 40), whether occurring naturally or medically induced (through surgical removal of ovaries, or ovarian damage from drugs or x-rays), have a higher osteoporosis risk because they live a longer time without estrogen's protection.
• Excessive exercise or extreme weight loss. Rate of bone loss is also increased by conditions that result in stopping menstrual periods before menopause

Osteoporosis is not easy to detect since most warning signs don't usually occur until the disease has become advanced. One clue is prolonged and severe pain in the middle part of the back. Other clues involve changes in the shape of the spine. But even without these warning signs, bones could still be getting thin. Therefore, often health care providers recommend that the density of the bones be measured; the gold standard today in bone density testing is dual energy x-ray absorptiometry (called DEXA for short). There are several new laboratory tests (Pyri-Links) which measure the rate of change in bone metabolism. These tests require an early morning urine specimen and may be used to monitor the effectiveness of therapy.

Drs. Caroline Dott and Andrew Dott are professional lecturers and teachers with a special interest in the interactions between the biological and psychological bases of human behavior at midlife.   Among their lecture topics are female and male menopause, the hormonal bases of human behavior, and issues related to depression and anxiety.  They are available to travel and give seminars on the topics covered in this website both nationally and internationally.