The Washington University Bone Health Program offers a comprehensive and personalized assessment of osteoporosis and fracture risk, and provides individualized recommendations for fracture prevention, with a “one-stop shopping” approach.
In the same day, patients undergo measurement of bone mineral density, are assessed by a physician or a nurse practitioner and discuss the results of their bone density test and fracture risk with their provider in “real-time.” Your provider may order X-rays, blood and urinary tests, and (in rare cases) a bone biopsy. Such comprehensive, in-depth assessment allows our physician specialists to formulate personalized recommendations for preventive or therapeutic actions.
What is osteoporosis?
Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue. This leads to bone fragility and an increased susceptibility to fractures of the hips, spine, and wrists. While bone loss can be slowed down by calcium and vitamin D supplements and lifestyle changes, an appropriate treatment must be individualized based on in-depth evaluation of a patient’s skeletal health. Prescription medicines are available that prevent progression of the disease and significantly reduce fracture risk.
What does it look like?
On the left is a cut-through of a vertebra from a woman with normal bone density. Note the fine and well organized trabecular pattern inside the bone. On the right is a vertebra from a woman with osteoporosis. Note the rarefied trabecular pattern, disconnected trabeculae and even some holes in the trabecular mesh of the bone tissue. All these changes decrease bone strength.
How common is it?
- 25 million Americans are affected, 80% of whom are women. Of these, 7-8 million have osteoporosis and 17 million have low bone mass and increased risk.
- 1 of every 2 women & 1 in 8 men will have an osteoporosis-related fracture during their lifetime.
- By age 75, 1/3 of all men will be affected.
Osteoporosis is not just an older person’s disease; it strikes at any age. In Missouri alone, it is estimated that 168,000 women and 43,500 men have osteoporosis and 320,400 women and 62,300 men have low bone mass.
How does it affect me?
- Osteoporosis is responsible for 1.5 million fractures annually, including 300,000 hip fractures, 700,000 vertebral fractures, 200,000 wrist fractures and more than 300,000 fractures at other sites.
- Loss of dentition (teeth) is also related to bone loss in the lower jaw, or mandible.
- 40% of all women will have at least one spinal fracture by age 80.
- A woman’s risk of hip fracture is equal to her combined risk of breast, uterine & ovarian cancer.
Hip fractures are very serious, especially in older people. Among those living independently prior to a hip fracture, 15- 25% of them will remain in long-term care institutions a year after the injury. Men and women who fracture their hip have a 5- 20% greater risk of dying within the first year following the fracture than others in their age group.
What are the symptoms of osteoporosis?
Osteoporosis is a so-called silent disease, because bone loss occurs without symptoms. The first external sign of osteoporosis may be a fall or a fracture. The bones become so weakened that a sudden strain, bump, or fall causes a bone to fracture or a vertebra to collapse.
Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height or spinal deformities, such as stooped posture, or a dowager’s hump.
What are the risk factors for osteoporosis?
There are two kinds of risks – those that you cannot change and those that you can.
- Being female
- Being thin and/or having a small frame
- Of advanced age
- Having a family history of osteoporosis
- Having an early menopause
- Being Caucasian or Asian
- Having rheumatoid arthritis
- Having a low dietary intake of calcium
- Developing anorexia nervosa or bulimia
- Having an inactive lifestyle or lack of exercise
- Exercising excessively
- Smoking cigarettes
- Drinking alcohol excessively
- Taking corticosteroid (prednisone) or certain anti-seizure medicine (Dilantin, barbiturates)
How do I estimate my risk of fractures?
A bone density test is the best procedure to estimate fracture risk. Your physician will interpret the bone density test result in the backdrop of all the risk factors for osteoporosis and laboratory tests, when necessary, to give you customized recommendations for lifestyle and dietary adjustments and drug therapy, if appropriate.
The World Health Organization has developed an on-line tool, the FRAX calculator to aid in estimating the risk of osteoporotic fractures based on bone density and the risk factors listed above. The FRAX calculator is useful, but has some limitations that patients should be aware of, including the fact that DXA measurement at the proximal femur (hip) is required, and that it cannot be used to monitor the efficacy of drug treatment for osteoporosis. While this tool is freely available online, we strongly encourage you to consult with your specialist physician or health care provider to devise the most appropriate approach to improve and maintain your bone health.
For more information about the Bone Health Program at Washington University School of Medicine, call 314-454-7775 or fax 314-996-3087.
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