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                     The Osteoporosis Revolution
                     ---------------------------
                      by E. Michael Lewiecki, MD
                summarized by Carolyn and Tom Sullivan

The following is summarized from a presentation on Sep. 29, 2000 by
E. Michael Lewiecki, MD, FACP, Osteoporosis Director, New Mexico
Clinical Research & Osteoporosis Center, Inc., Albuquerque, NM at the
CSA Annual Conference.

Dr. Lewiecki noted:
   * Anyone with Celiac Disease is at a higher risk for osteoporosis.
   * Osteoporosis is a common disease.
   * Osteoporosis is a very serious disease.
   * It is easy to determine if one has osteoporosis.
   * Osteoporosis can be prevented and treated.
   * Osteoporosis is NOT an inevitable part of aging.

Progressive spinal deformity occurs in osteoporosis.  This shortens
the spine, lowers the rib cage, puts pressure on the intestines, and
causes the belly to distend.  The normal 55 year old adult will have
4-5 inches between the bottom of the rib cage and the pelvis.  If,
while standing, one cannot get their fingers between the rib cage and
the pelvis, it may indicate trouble.

The impact of osteoporosis is not small:

   * 28 million adults have osteoporosis or bone loss that can lead to
     fractures.

   * There are 1.5 million osteoporosis fractures annually.  700,000
     are vertebral fractures (only 30% of which are clinically
     apparent), 300,000 are hip fractures, and 200,000 are wrist
     fractures.

   * The annual health care cost is $15 billion.

A form of osteoporosis that can occur due to inactivity is called
Disuse Osteoporosis.  Astronauts, for example, are concerned and
exercise regularly to avoid it.

There are several common risk factors for osteoporosis:
   * Family history
   * Being Caucasian
   * Advanced age
   * Being female
   * Having hormone deficiencies
   * Low body weight (less than 127 lbs.-relatively few overweight
     individuals have osteoporosis problems)
   * Poor nutrition
   * Malabsorption
   * Smoking
   * Medications

In addition, there are several common risk factors for bone fractures:

   * Low bone density
   * Previous fractures
   * Advanced age
   * Frequent falling
   * Rate of bone turnover
   * Frailty
   * Difficulty rising from a chair
   * Being sedentary
   * Having muscle weakness

"Lewiecki's Rules", or the six rules of osteoporosis are:

1. Don't fall.  Make yourself "fall proof".  Use common sense:
   eliminate wires across the floor; eliminate loose rugs on the
   floor; eliminate wet floors; use grab bars; use a walker; use night
   lights; don't wear spike heels.

   Kids fall on the chin or nose.  If adults fall forward it is not
   bad even if a wrist is broken.  As we age, however, we tend to fall
   sideways.  Hip protector pads are available for people who fall.
   (Popularity is low because they make the hips look bigger.)

2. Exercise.  Weight bearing exercise is best.  Walking is fine.  The
   use of small weights such as a can of Campbell's soup in each hand
   is fine.  But exercise alone is not sufficient--enough calcium and
   vitamin D are also required.

3. Calcium.  Calcium intake should be 1200-1500 mg/day.  (The average
   American gets 500-600 mg/day.)  It is best to get calcium in the
   diet.  If a supplement is taken, no more than 600 mg should be
   taken at the same time.  The least expensive supplements are
   calcium carbonate found in Tums or Caltrates.  (NOTE:  Vivactin
   contains vitamin K and should be avoided if one is also taking
   cumidin.)

4. Vitamin D.  Vitamin D intake should be 400-800 IU/day.  Vitamin D
   opens the door for calcium to work.  Sunlight plus skin equals
   vitamin D.  As we age, the skin is less efficient and we get less
   vitamin D.  A blood test can show the vitamin D level.  However,
   the lab values given for normal (some use >5) , are often totally
   wrong.  Look for a value of 30 or higher.

5. Medication.  Medicines are available to increase bone density.  The
   FDA has approved estrogen replacement therapy, Fosamax (Aldronate),
   Risedronate Actonel, Calcitonin-Salmon (Miacalcin), and Raloxifene
   (Evista).  All have proven to improve spine bone density.  All
   except Miacalcin and Evista have also proven to improve hip bone
   density.  The bone density improvement is a maximum of 8% but there
   is a 50% reduction in bone fractures.

6. Don't get osteoporosis.  Prevention is far easier than treatment.

The traditional treatment for spinal fractures of osteoporosis is
vertebroplasty.  This procedure injects bone cement into the fracture
which relieves pain in 90-95% of the cases and stabilizes the fracture
zone.  However, it does not correct the structural abnormality.

A treatment now being tried for spinal fractures of osteoporosis is
kyphoplasty.  This procedure blows up a balloon in the fracture zone
like angioplasty does in an artery.  Bone cement is then injected into
the fracture.  This relieves the pain, reduces and stabilizes the
fracture, restores the vertebral height, and reduces the spinal
deformity.

During the Q&A period, Dr. Lewiecki cautioned anyone taking Fosamax
that it must be taken correctly to avoid complications, that is, it
must be taken on an empty stomach with 8 ounces of water and then wait
30 minutes, with the upper body in a vertical position, before
consuming anything else.

He noted that if one is malabsorbing, the Fosamax may not be absorbed.
For people with GI symptoms, IV injections can be taken once every 3
months.

Dr. Lewiecki also noted that for those at high risk for breast
cancer, Evista is the medicine of choice.