<<Disclaimer: Verify this information before applying it to your situation.>> 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.