OSTEOPOROSIS Aletris Center in Scottsdale, AZ
It is estimated that 1 in 3 women and 1 in 12 men over the age of 50 have osteoporosis worldwide. Osteoporosis is responsible for millions of bone fractures annually, most commonly involving the lumbar vertebrae, hip, and wrist .
The U.S. Preventive Services Task Force (USPSTF) recommends that all women 65 years of age or older should be screened with bone densitometry, also called a DEXA scan. The Task Force recommends screening women 60 to 64 years of age who are at increased risk. The best risk factor for indicating increased risk is lower body weight (weight < 70 kg).
Surprisingly, the one year mortality rate following hip fracture is approximately 20%. Vertebral fractures can lead to severe chronic pain of neurological origin and deformity. Though rare, multiple vertebral fractures can lead to a severe hunch back (kyphosis), and the resulting pressure on the lungs can impair one's ability to breathe.
Conventional medicine does little to treat osteopenia – a condition of milder bone density loss. At Aletris, we consider anything less than normal bone density a concern.
The mechanisms influencing the formation of the disease are complex. Most cases do not result from inadequate calcium intake, but include other factors affecting bone matrix formation and reabsorption. These include: cigarette smoking; sedentary lifestyle with little weight bearing exercise, such as walking; a family history of osteoporosis; and being age 30 or older. Trabecular bone is the sponge-like bone in the center of long bones and vertebrae. Cortical bone is the hard outer shell of bones. In contrast, trabecular bone is more active, more subject to bone turnover, and to remodeling. Long before any overt fractures are present, the small spicules of trabecular bone break and are reformed in the process known as remodeling. Bone will grow and change shape in response to physical stress. For example, the bony prominences and attachments in runners are different in shape and size than those in weightlifters. It is an accumulation of fractures in trabecular bone that are incompletely repaired that leads to the manifestation of osteoporosis. Common osteoporotic fracture sites, the wrist, the hip and the spine, have a relatively high trabecular bone to cortical bone ratio. These areas rely on trabecular bone for strength.
Low peak bone mass is important in the development of osteoporosis. Bone mass peaks in both men and women between the ages of 25 and 35 and diminishes thereafter. Achieving a higher peak bone mass through exercise and proper nutrition during adolescence is important for the prevention of osteoporosis.
Bone remodeling is heavily influenced by nutritional and hormonal factors. Calcium and vitamin D are nutrients required for normal bone growth. Parathyroid hormone regulates the mineral composition of bone, with higher levels causing loss of calcium and bone. Glucocorticoid hormones also cause bone breakdown. Calcitonin, estrogen and testosterone all increase bone growth. The loss of estrogen following menopause causes a phase of rapid bone loss. Similarly, testosterone levels in men diminish with advancing age and are related to male osteoporosis. In addition to estrogen, follicle-stimulating hormone (FSH) affects bone density.
Those who suffer certain auto-immune and inflammatory disorders are prone to have a higher level of cytokines in the body. The presence of these proteins increase the body's inflammatory response which may upset the process of the osteoblast and osteoclast cycle and increase a person's risk for osteoporosis.
People who remain physically active throughout life have a lower risk of osteoporosis. Conversely, people who are bedridden are at a significantly increased risk. Physical activity has its greatest impact during adolescence, affecting peak bone mass most. In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%.
At Aletris, our physicians have designed programs both to prevent the onset of osteoporosis and to treat women currently diagnosed with osteoporosis. Therapies involve optimizing bone health through diet, lifestyle modifications, weight-bearing exercise and nutritional supplements.
