Ask the Expert

This month, Suburban Hospital Rheumatologist Dr. Deborah Litman, answers your questions about osteoporosis. Dr. Litman graduated with honors from Duke University with a BS in Zoology and Psychology. She received her Medical Degree from the Medical College of Virginia and completed an internship and residency in Internal Medicine at Temple University. She completed her fellowship in Rheumatology at UCLA Medical Center. Dr. Litman is Board Certified in Internal Medicine and Rheumatology and specializes in the treatment of all forms of arthritis, autoimmune diseases and osteoporosis. She is also certified in DEXA Bone Densitometry, and is an Assistant Clinical Professor of Rheumatology at Georgetown University and in the private practice of Rheumatology in Chevy Chase, Maryland.

What is osteoporosis? Osteoporosis, which literally means porous bone, is a disease characterized by slow loss of bone mass, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist.

Is osteoporosis the same as arthritis? No. Osteoporosis refers to the gradual loss of bone density. This occurs as people, especially women, grow older. Arthritis refers to inflammation or degeneration of cartilage in the joints, not to a loss of bone strength.

Is osteoporosis common? Osteoporosis is a major public health threat for an estimated 44 million Americans. In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.

Are women more susceptible to the disease? Yes. Of the 10 million Americans estimated to have osteoporosis, 8 million are women and 2 million are men. White and Asian women are most often affected, especially after menopause. Black women, Native American women, heavy women, and women who have used birth control pills or hormones for many years seem to be protected.

So, should men be concerned about osteoporosis? Yes. Osteoporosis develops less often in men than in women because bone loss starts later and progresses more slowly, and there is no period of rapid hormonal change (such as in the female menopause) and accompanying rapid bone loss. However, in the last few years the problem of osteoporosis in men has been recognized as an important public health issue, particularly in light of estimates that the number of men above the age of 70 will double between 1993 and 2050.

But I’m not elderly, should I care about osteoporosis? Anyone can develop osteoporosis and at any age. There are certain people who are at higher risk for this disease, but anyone can develop fragile and easily broken bones. If you are a post-menopausal woman, fair skinned, thin, do not perform weight-bearing exercise regularly, and are calcium deficient, you are at increased risk for osteoporosis.

Are there other risk factors? Yes. Having no children, taking some medications such as cortisone (Prednisone) for prolonged periods of time, hyperparathyroidism, or having a family history of osteoporosis appear to be added risk factors. Other risk factors include estrogen deficiency as a result of menopause, abnormal absence of menstrual periods, anorexia nervosa, low lifetime calcium intake, low testosterone levels in men, an inactive lifestyle, current cigarette smoking and excessive use of alcohol.

What are the symptoms of osteoporosis? Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (stooped posture).

How common are bone fractures? Untreated, one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Osteoporosis is responsible for more than 1.5 million fractures annually, including: 300,000 hip fractures; and approximately 700,000 vertebral fractures; 250,000 wrist fractures; and 300,000 fractures at other sites.

Can these fractures lead to complications? Yes. An average of 24% of hip fracture patients aged 50 and over dies in the year following their fracture. Death is typically due to a blood clot, lung infection, or heart attack. One-fourth of those who were ambulatory before their hip fracture require long-term care afterward. At six months after hip fracture, only 15% of hip fracture patients can walk across a room unaided.

Is osteoporosis preventable? Osteoporosis is largely preventable for most people. Prevention of this disease is very important because, while there are treatments for osteoporosis, there is currently no cure. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. But no one step alone is enough to prevent osteoporosis. Four good preventive measures are: A balanced diet rich in calcium and vitamin D; weight-bearing exercise; a healthy lifestyle with no smoking and limited alcohol intake; and bone density testing and medication, when recommended by your physician.

What are some good exercises to prevent osteoporosis? The best exercises for your bones are weight-resistance exercises such as lifting, walking, dancing, jogging, stair-climbing, racquet sports and hiking. Always be sure to check with your healthcare provider before beginning any exercise program.

What is a bone density test? A Bone Mineral Density test (BMD) is the most accurate way to diagnose osteoporosis and determine your risk for future fracture. Since osteoporosis can develop undetected for decades until a fracture occurs, early diagnosis is important. A BMD measures the density of your bones (bone mass) and is necessary to determine whether you need medication to help maintain or build your bone mass and reduce fracture risk. The test is accurate, painless and noninvasive.

Are estrogen pills a good way to fight osteoporosis? Estrogen replacement is one of the best ways for women to protect their bones after menopause. However, there can be side effects to estrogen use. It is important to discuss the use of estrogen, the female hormone, with your healthcare provider to help see if this medication is right for you.