Gynecology - Osteoporosis
Osteoporosis in Women
Osteoporosis is a disease that thins and weakens bones to the point where they may break easily. This disease most often causes fractures of the bones of the hip, spine, and wrist. It is a systemic disease of the skeletal system characterized by low bone mass and/or poor bone quality, which predisposes to an increase risk of fractures.
The prevalence of osteoporosis and osteopenia increases with increasing age. 80% of those affected are women and 20% are men. The prevalence is higher in Caucasian women than in African-American women, because African-American women achieve a higher peak bone mass, but osteoporosis still occurs in 5% of African-American women over the age of 50. The prevalence in Hispanic women is 10% over the age of 50. It is estimated that there are 10 million Americans over 50 years old with osteoporosis and 18-34 million with osteopenia.
The osteoporosis fracture incidence in the U.S. is approximately 1.5 million per year with 700,000 spine fractures, 300,000 hip fractures, 200,000 wrist fractures and 300,000 other. Approximately 1 in 2 women and 1 in 8 men over the age 50 will have an osteoporotic fracture in their lifetime. The current annual cost of all osteoporotic fractures is estimated to be 17 billion dollars and rising. The prevalence of osteoporosis and osteopenia is approximately 28-44 million Americans compared to the prevalence of hypertension at 30-54 million, elevated cholesterol at 52 million and diabetes at 14 million. The lifetime risk in women of an osteoporotic fracture is greater than the risk of breast, endometrial and ovarian cancer combined. The lifetime risk in men of an osteoporotic fracture is greater than the risk of prostate cancer.
Clinical detection of osteoporosis occurs late in the disease process when a fracture has already occurred. Bone mineral density (BMD) testing is the recommended method for the early detection of low bone mass, which is one of the risk factors for osteoporosis. There are a wide variety of techniques for measuring bone mass but BMD testing in the form of Central Dual Energy X-ray Absorptiometry (DXA) is the gold standard and everything else is compared to it.
In young healthy adults, bones continue to grow, reaching their greatest strength around ages 20 to 35. After that, bones slowly become weaker as you get older.
The bones of the spine are a common area of thinning. Often, over time, the bones of the spine (vertebrae) collapse on themselves, one at a time, causing loss of height, back pain, and a stooping posture (dowager's hump).
Your health care provider may discover you have osteoporosis from an x-ray taken for some other problem. Otherwise, the diagnosis might be made from a review of your medical history and symptoms, a physical exam, x-rays, and blood tests. You may have a test to measure your bone mineral density, such as a DXA scan.
National Osteoporosis Foundation
Web site: www.nof.org
ACOG.org for more information.
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