Osteoporosis – The Silent Disease
with Dr. Gerald Vitamvas, OB/GYN, Advanced Healthcare
Osteoporosis is a condition that drains away at the calcium in bones, weakening the structural frame of our bodies, doing its damage so slowly that doctors and victims may not suspect a problem until a bone unexpectedly snaps.
The disease then may cause not only pain, but also a lasting disability coupled with the constant anxiety of another fall, another broken bone, a further loss of independence.
Dr. Gerald Vitamvas, an OB/GYN with Advanced Healthcare, said osteoporosis is not given the attention it deserves in the media. Consequently, women do not have the same fear of it that they do of breast cancer. "The number of women who die following a hip fracture far exceeds the number of women who die from breast cancer. People don’t understand that osteoporosis is such a devastating disease, that it’s more than just a broken bone," Dr. Vitamvas said.
Gerald Vitamvas, M.D.
Advanced Healthcare
One in three women over the age of 50 will suffer a vertebrae fracture due to osteoporosis, and the numbers are expected to rise as the population ages.
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Following a fracture, a broken bone needs time to heal. If a hip is broken, the resulting need for weeks of bed rest usually causes more loss of bone mass. And, because of anxiety about breaking another bone, the patient may curtail activities, leading to even further loss, explained Dr. Vitamvas.
Startling statistics
Osteoporosis is sometimes called the "silent disease" because its effects often occur without symptoms. Osteoporosis causes 1.5 million fractures per year. It also leads to collapsing spines and stooped posture in the elderly.
According to federal health statistics, 8 million American women and 2 million American men currently have osteoporosis. In addition, 34 million more Americans are at risk due to low bone density.
Osteoporosis is primarily a disease of aging. All people lose bone mass as they age, but the loss can be slowed, allowing for long and active lives.
Preventing osteoporosis
Some of the most beneficial prevention should be done when a person is young and bone mass is still forming. In a large part, a person’s susceptibility to osteoporosis is determined before the age of 30. Diet and lifestyle, as well as other uncontrollable risk factors play a part. (
See Risk Factors for Osteoporosis.)
By age 20, the average woman has acquired 98% of her skeletal mass. Research indicates that building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later in life. Teenagers need to be informed about how their nutrition and lifestyle choices will help prevent osteoporosis.
Calcium intake is critical and those who need it most – younger women and girls – may not be getting enough. Vitamin D is crucial too because it helps the body absorb calcium.
Why exercise is important
Dr. Vitamvas adds that calcium alone doesn’t protect women. "The calcium in the diet doesn’t get incorporated in the bones unless there is some bone stress from weight-bearing exercises, such as walking. This stimulates the bones to utilize the calcium that is available to it." (
See Exercises for Bone Health.)
Even healthy people lose bone mass when they do not do any weight-bearing activities. "Experiments done on astronauts who spend a significant time in space (in zero-gravity situations) have found that they come back with bone loss – with osteoporosis," Dr. Vitamvas said. This indicates the importance of weight-bearing exercise for all adults.
Bone density testing
Until recently, X-rays could not detect osteoporosis until it was in the advanced stage. New technologies now make the early testing of bone density easier and more accurate. Because of the strong relationship between bone mass and risk of fracture, bone scans are now done routinely on many high-risk women. Aggressive treatment is put in place if tests indicate the need. (
See Testing for Osteoporosis.)
Osteoporosis and menopause
Estrogen is the hormone that protects bones. Without this protection as they grow older, women will lose an estimated 5% of bone mass per year for the first five years after menopause.
With many women living a quarter to a third of their lives after menopause, it is particularly important to pay attention to bone health during this period.
"Menopausal women need to make sure they are taking in enough calcium," Dr. Vitamvas said. He recommends 1,500 milligrams of calcium a day. (
Click here to see how much calcium you need and learn more about calcium-rich foods.)
Women at menopause also are encouraged to be screened for osteoporosis so that treatment can be started early, if necessary. Since women without risk factors can also get the disease, it is important to be aware of bone health and prevent calcium loss.
Role of estrogen - a continuing debate
In addition, Dr. Vitamvas recommends estrogen replacement therapy (ERT) or estrogen/progesterone therapy (HRT) as the best treatment for osteoporosis in menopausal women. "There is one study which compared women who took estrogen but not calcium and did no physical activity with women who exercised and took calcium. The couch potatoes on estrogen had the healthier bones," he said.
It’s been proven that estrogen in women, and in a similar way testosterone in men, protects bones. But with estrogen replacement therapy suspected of raising the risk of breast cancer in women, it’s imperative to talk with your physician.
"When I discuss estrogen replacement therapy with a patient, we individualize her risks and her benefits. We balance benefits to the bones against the risk of blood clots, strokes and heart attacks. Most of my patients have pretty strong feelings when they come in to see me. I try to be sensitive to their feelings. If they want to go off estrogen there are drugs such a Fosamax to protect against osteoporosis," Dr. Vitamvas said.
Dr. Vitamvas does not think the link between breast cancer and HRT is as strong as the media presents it. "The Women’s Health Initiative Study showed a 26% rise in the incidence of breast cancer in the estrogen/progesterone test subjects… However, that was only a few added cases. When they ran tests of statistical significance based on this data, it seems that the increase may have been due to chance… The bottom line is that even though there is this theory that estrogen replacement therapy produces breast cancer, that evidence is still not convincing."
He added, "If you look at all the literature, about 60 studies on the relationship between estrogen and breast cancer, the vast majority of studies have shown no relationship. The bottom line is that…the evidence is not convincing."
