It is estimated that osteoporosis affects between 10 and 25 million Americans, the majority of them postmenopausal women. However, there are new advances in diagnosis and treatment which permit those at risk to lead better and longer lives.

Osteoporosis is a disease characterized by low bone mass. Normally, bone consists of a thick outer cortex, surrounding a network of spongy trabecular bone, much like the way bricks surround steel girders in a building. With aging, and particularly past the age of menopause, the trabecular framework becomes thinner and thinner and eventually the cortex does too. The bone becomes more porous and fragile, and more prone to fracture, sometimes with little or no trauma. The areas most at risk are the spine, hip and wrist. Spinal compression fractures result in progressive loss of height, rounding of the back and are a source of persistent disabling pain. Fractures of the hip are the most serious complication of osteoporosis, resulting in marked disability and increased mortality. In fact, among patients with hip fracture, 12-20% die within 1 year after the fracture, and more than 50% of survivors are unable to return to independent living. Fractures of the wrist also lead to deformity and interfere with the activities of daily living.

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Everyone normally loses bone mass during their lifetime as a result of the aging process. In women, the bone loss is accelerated in the first decade after menopause as a result of the loss of the "bone protecting" effect of estrogen. In men, bone loss also occurs, but much later in life. In addition, there are a host of other factors which predispose to the development of osteoporosis in both sexes. These include Caucasian or Asian race, sedentary lifestyle, smoking, family history of osteoporosis, excessive alcohol intake, prolonged calcium-deficient diet, and prolonged use of certain medications such as corticosteroids and thyroid hormone. If low bone mass is discovered, several independent factors influence the risk of developing subsequent fractures, especially those of the hip. These include a history of fracture after 40, a maternal history of hip fracture, greater height and an increased likelihood of falling due to poor vision, use of sedative medications, etc.

There are certain obvious clinical manifestations of osteoporosis, such as loss of height, kyphosis ("dowager's hump"), back pain, and, of course, fractures. However, it is clearly preferable to make a diagnosis of osteoporosis well before these clinical findings, which indicate advanced disease, are present. Today, the best and most reliable test available is Dual Energy Xray Absorptiometry or DEXA Scanning. In this simple test, the density of bone at multiple sites, usually the spine, hip, and wrist, is determined with a low energy Xray beam by comparing the amount of Xray absorbed by the patient's bone with a standardized reference bone phantom. The denser the patient's bone, the more X ray is absorbed. With progressively more porous bone, less x ray is absorbed. The patient measurements are then compared to two control populations: young premenopausal patients, yielding the T score, and to adults of the same age, producing the Z score. According to criteria set forth by the World H

The test usually takes between 10 and 15 minutes and there is no special preparation. The amount of radiation is quite low, much less than a single view chest Xray. Results are available immediately. Though there are many methods to measure bone density, for example with CAT Scan, regular Xray and even ultrasound, DEXA is considered by most experts in the field to be the most reliable and most reproducible method. The New York Partnership for Women's Health offers DEXA scanning on the state-of-the-art HOLOGIC QDR 4500 Scanner, considered by most authorities to be the "gold standard" in osteoporosis detection.

There are several general measures which can be implemented to prevent osteoporosis and preserve skeletal integrity. These include a nutritious diet rich in calcium and vitamin D, engaging in regular weight bearing exercise, curtailing smoking and limiting alcohol intake. If low bone mass or osteoporosis is detected, additional therapies are available through your doctor, including estrogen replacement therapy (ERT), bisphosphonate therapy (Alendronate) and calcitonin. Each of these therapies require close physician supervision and follow-up. The right therapy needs to be individualized as these drugs may have important side effects such as postmenopausal bleeding with estrogen therapy and stomach upset with some of the other therapies. In the works now are new, more powerful bisphosphonates, as well as selective estrogen receptor modulators (SERMs or "designer estrogens"), that have the beneficial effects of estrogen on bone, but little or no effect on the breast or uterus. 

The first step in preventing disabling osteoporosis is detection. The New York Partnership for Women's Health is a leader in bone density measurement. We also have access to experts in nutrition and endocrinology, if indeed osteopenia or osteoporosis is detected and needs to be treated. Don't delay and take the first step toward proper skeletal health-make an appointment for your DEXA scan now!

If you have any questions about osteoporosis or DEXA scanning, please contact Dr. Craig Sherman, 212 838-4243