Could I have Osteoporosis? Todd A.

Hoover, MD, DHt

Women over the age of 50 years are 5 times more likely to develop osteoporosis than men, and over 4.7 million women in the United States have osteoporosis of the hip at this time.i Another 35 million Americans currently have the less severe form of bone loss called osteopenia.ii Each year osteoporosis is responsible for many of the more than 250,000 hip fractures that occur in the U.S.iii If you have osteoporosis, chances are you have no symptoms making it that much harder to diagnose. Bone density is measurable using x-ray technology through a test called bone densitometry. Typically the hip and the lower spine are measured because fractures are common in these bones and these types of breaks can cause considerable problems for people. Sometimes wrists are also measured. When you have a bone density test, your results are compared to the average test values for a healthy 18 year old (the test assumes that this value for an 18 year old represents maximum or best bone density). As in many medical tests, different people have different results, but if you put everyones results onto a chart you will see all of the people at a certain age will have some variation in their result. Some will be average, while others will have more or less bone than the average. Doctors use a measure called a standard deviation to show how far a given result is from the average result. The standard deviation is a complicated statistical measure, but a simple way of understanding it is that 95% of results are usually within 2 standard deviations from the average. And almost 100% of the results are within 3 standard deviations. If you have this test, your doctor will look at 2 main results. The T-score is your bone density compared to a young adult in peak health (the 18 year old standard). The Zscore is your bone density compared to a group of people your same age and sex. These scores are reported as standard deviations. So for example if you have a T-score of 0 then your bone density is as good as a healthy 18 year old. If you have a Z-score of -2, then about 95-98% of people your age and sex have better bone density than you. Negative numbers are used to show that the bone density is lower than average. Having lower bone density only means that you are more likely to break a bone with any given trauma than someone with better bone density. Lots of young people break bones, but usually there is a lot of force involved. As bones become less dense, we can break a hip just by slipping and falling. Osteopenia is defined as bone density with a T-score of -1.0 to -2.5. Osteoporosis is defined as bone density more than -2.5. Bone loss occurs for most people as we age. There are many factors that can be related to bone loss including:

Genetic (family history of this problem) Smoking Sedentary lifestyle (lack of exercise) Menopause (loss of hormones that protect bones) Medicines (especially steroids) Vitamin D deficiency High phosphorous intake (as in sodas) Poor dietary calcium intake Excess alcohol use Certain medical conditions including cancer, lung disease, and kidney disease

Screening is currently recommended by the U.S. Preventive Services Task Force for all women over the age of 65 years, and women from 50 65 years with risk factors including: Previous fracture Parent with a hip fracture Current smoking Use of steroid medicines History of medical problem that can cause osteoporosis Rheumatoid arthritis More than 3 drinks of alcohol per day History of low bone density

Bone density screening for men is not recommended at this time due to the low frequency of osteoporosis and fractures. This type of testing may be recommended for certain men who are at high risk for fracture based upon their medical history. If you are a woman over the age of 50, you should ask your primary healthcare provider about the need for testing for bone density. If you are a man over the age of 50 and you have many of the risk factors listed above, you should discuss the possibility of osteoporosis with your health care provider.

A.C. Looker, L.J. Melton, T.B. Harris, L.G. Borrud, and J.A. Shepherd. Prevalence and Trends in Low Femur Bone Density Among Older US Adults: NHANES 2005-2006 Compared with NHANES III. Journal of Bone Mineral Research. 2010; 20:64-71. ii Ibid. iii Centers for Disease Control and Prevention. National Hostspital Discharge Survey: 2009 table, Average length of stay and days of care - Number and rate of discharges by first-listed diagnostic categories. 2009, Accessible online at http://www.cdc.gov/nchs/data/nhds/2average/2009ave2_firstlist.pdf. Last accessed May 29, 2012.
i