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Review of Osteoporosis

About half of all women over 50 will get a fracture related to osteoporosis (CNN).

An article published in the Journal of the American Medical Association (JAMA) provides these quick facts:

  • Each year in the United States, hip fractures result in approximately 300,000 hospital admissions and an estimated $9 billion in drug medical costs.  Most of these fractures are a result of osteoporosis.
  • Measurement of bone mineral density (BMD) is the best tool available to assess osteoporotic fracture risk for women after menopause.
  • 93% of estrogen-deficient women in the United States who had osteoporosis are unaware of the condition.

The Aging Process

Bone tissue is made of living cells.  Old cells are broken down and replaced with new cells.  Around the age of fifty, more cells are broken down than replaced.  People with osteoporosis have large gaps in their bones, making the bones weaker and easier to break.

A study at the University of Chicago many years ago pointed to the affect of postmenopausal estrogen levels and osteoporosis.  Estrogens and androgens help control the rate of bone formation.  A significant percentage of postmenopausal women have osteoporosis, with the osteoporotic bone having a smaller volume than normal bone.  This is an “aging phenomenon”, a physical change:  not a disease.

During menopause women lose bone quickly, and then continue to slowly for the rest of their lives.  By age 65-70, men lose bone at the same rate as women.

Osteoporosis Risk Factors

According to the NIA, Caucasian and Asian women are the most likely to have osteoporosis.  For these women, the main risk factor is a lack of vitamin D.  Vitamin D works with Calcium to enhance bone growth.  Most people’s vitamin D comes from the sun, and Caucasian and Asian women are likely to get less sun exposure due to their fair skin and tendency to burn.  Vitamin D can also be obtained from eggs, fatty fish, and vitamin-D fortified milk.

Other risk factors include:

  • A family history of broken bones or osteoporosis
  • Having a broken bone as an adult
  • Surgery to remove one’s ovaries before periods have ceased
  • Early menopause
  • Low calcium intake
  • Extended bed rest

Medicare

On July 1, 1998, the Medicare Bone Mass Measurement Coverage Standardization Act established national criteria for bone density test reimbursement in the Medicare program.  Previously, each Medicare carrier made its own coverage decision. (JAMA).

Osteoporosis Treatment

In June 2010, the FDA approved a new injectable osteoporosis drug, Priola (denosumab).  It is said to “promote bone strength and prevent fractures in postmenopausal women with osteoporosis who are at high risk.” It is injected every six months by a doctor.  It is the first drug of its kind to block the cell that breaks down the bone. The drug is a biologic, which is a genetically engineered human protein.

The drug was studied for three years.  The study was sponsored by the drug’s manufacturer, Amgen.  Seven percent of the placebo group experienced a fracture, while only two percent of women in the Prolia group did.