It’s reported that 10 million Americans over the age of 50 have osteoporosis and another 34 million are at risk for developing the disease. More sobering: osteoporosis is responsible for 1.5 million bone fractures at an estimated $18 billion per year in health care costs. Osteoporosis is a significant and costly health care problem but one that, with improved technology and education, can be managed.
Once thought to be a normal part of aging, it is now known that osteoporosis can be slowed and fractures avoided with early detection and treatment.
Osteoporosis cannot be prevented so, for that, it is a ‘normal’ part of aging. Mineral mass or bone density develops to its peak while we’re in our early teens or 20s. From there, we all slowly begin to loose bone mineral over time and at various rates depending on many factors including diet, family history, race, gender, amount of vitamin D and calcium in diets etc. Women lose about .5 percent a year until menopause, after which that rate can increase to one percent a year.
Loss of bone mineral causes the bones to soften and weaken. Known as the ‘silent killer,’ undiagnosed and untreated osteoporosis most often goes unrecognized until a fall results in forearm fractures, pain betrays a compression fracture in the spine, or a fall, spin or stress results in a hip fracture. Osteoporosis is most dangerous because of its morbidity and mortality: complications that lead to death because of it.
For example, most of us have seen older women or men who have become nearly bent in half from osteoporosis. What we don’t see and don’t notice are the innumerable associated problems with the posture: reduced lung and oxygen capacity, stomach and digestive complications, as well as additional strain and pressure to the heart and otherorgans. All these complications shorten lives and significantly reduce the quality of life.
There is very good news, however; there are improved ways to diagnose it earlier and treat it more effectively.
Previously, osteoporosis was diagnosed via x-ray or CT scan but these include high doses of radiation so they are not necessarily good screening or early detection tools. The newly FDA-approved Lunar iDXA™ (dual-energy x-ray absorptiometry-DXA) provides physicians unprecedented image quality with the best precision and accuracy, allowing them to detect, diagnose and monitor treatment of osteoporosis. The crisp and high resolution images of all skeletal sites reveal vertebral deformities never able to be seen before and provide doctors and patients with accurate measurements free from error, every time. With the iDXA imaging, doctors can see and track changes that previously were too small to detect. And, for patients, there is minimal exposure to radiation and there is no need for dyes or contrast.
There are also new medications that reduce the rate of loss, and in some instances, can actually rebuild bone density.
These include Fosomax, Boniva and Forteo. Side effects are manageable and the medications may be taken daily, monthly or self-injected for a period of time.
In addition, there are new surgical interventions that repair compression fractures and reduce pain. Kyphoplasty and vertebroplasty are procedures in which surgeons inject bone cement into the crushed spinal bones (vertebrae) through a needle. Vertebroplasty is used to relieve pain from spinal compression fractures. After giving a local anesthetic, the doctor inserts a needle into the patient’s vertebrae and injects a cement-like mixture into the crushed area. The needle is guided with an imaging technique called C-arm fluoroscopy. The cement mixture hardens in about half an hour, and after a short recovery period the patient is sent home. Kyphoplasty can be used to restore the vertebrae to a more normal shape. Following a local or general anesthetic, a small incision is made in the back and a balloon device is inserted into the fractured vertebrae and inflated, A cement-like material is injected into the space created by the balloon. The cement hardens, filling the previously compacted space, reduces pain and helps restore a more normal structure to the spine. Both procedures take about one hour for each treated vertebra, and the patient may return home the same day or, if necessary, stay in the hospital overnight.
As with most diseases, early detection is truly the key. What women should know about osteoporosis is that, while it cannot be prevented, there is technology available to alert them earlier than ever before to the risk and there are successful treatments. My recommendation would be to make it part of the habit of annual mammogram appointments.
Include the iDXA bone density screening during the same visit. It’s always advisable to return to the same place year after year for screenings and tests to ensure immediate and historical access to those earlier results and consistency in procedures and equipment. The sooner osteoporosis and other diseases are identified, the faster doctors and patients can get treatment, limit the damage and reduce or avoid disability.
Henry Krebs, MD, of Atlanta Radiology Consultants and Saint Joseph’s Hospital, has been practicing interventional-diagnostic radiology for 22 years and is a certified clinical densatomitrist.
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