Testing Boosts Options in the Fight Against Osteoporosis
Routine physical checkups for older women might soon include not only Pap smears and breast cancer screening but also tests to detect osteoporosis, a condition in which bones deteriorate and can fracture easily.
These tests would ideally begin around the time of menopause, says Dr. Stuart Silverman, medical director of the Osteoporosis Medical Center, a nonprofit research center in Beverly Hills.
About 25 million Americans, mostly older women, have osteoporosis, resulting in 1.3 million bone fractures annually, according to the National Osteoporosis Foundation. But until those fractures occur, few people have a clue about their condition.
Bone is constantly broken down and rebuilt in the body. Until about age 35, bone formation exceeds bone loss; after that, loss exceeds formation. At menopause, osteoporosis can accelerate as levels of estrogen, which help maintain bone, fall.
One type of test for osteoporosis is a bone density test, which measures how much bone mass you have at the present time. Silverman compares this test to an instant snapshot. There are several variations of the bone density test, but some techniques beam units of magnetic energy--photons--to various body sites. The magnetic energy is absorbed at different rates by bone than by soft tissue, thus helping the doctor gauge bone strength.
Blood and urine tests--some available and others under development--can help predict future bone loss. One urine test, called Crosslinks, detects dissolved bone in the urine and quantitates loss, says Lynda Wijcik, a spokeswoman for Metra Biosystems, the Palo Alto firm that developed the test. It’s expected to be approved next year and should cost about $7.
Performing both types of tests is ideal, experts say. “A doctor really needs both pieces of information” to assess accurately the extent and threat of osteoporosis, Silverman says.
Early detection is not the only area of interest among osteoporosis experts. A host of new treatments is aimed at arresting bone loss. Research is partially spurred by many women’s reluctance to take hormone replacement therapy, or supplementary estrogen, to slow bone loss.
Among the newer options:
* Calcitonin: Administering the hormone calcitonin by nasal spray might slow calcium loss from the bones. “Preliminary results from European studies of calcitonin use in several hundred women strongly suggest it at least preserves the spinal bone mass,” says Silverman. Results of the U.S. study of calcitonin, in which Silverman is involved, are not yet analyzed but might show even greater benefits, he says. More than 250 participants are included.
* Bisphosphonates: This new class of drugs works by blocking the reaction of bone resorption or breakdown, thus slowing the bone loss, says Dr. C. Conrad Johnston Jr., chairman of the scientific advisory board of the National Osteoporosis Foundation. Exactly how is not known, he says. Two bisphosphonates are already approved to treat other conditions; a handful of others are being researched to treat osteoporosis, he says.
Meanwhile, debate over the use of supplementary estrogen as a treatment for osteoporosis continues. “Estrogen therapy is most effective for those at risk,” says Kate Ruddon, spokeswoman for the American College of Obstetricians and Gynecologists. “But not every woman can take estrogen.” Women with a family history of breast cancer, for instance, might be at increased risk if on supplementary estrogen, according to the National Osteoporosis Foundation.
“Estrogen replacement therapy should not be used long-term and routinely for everyone,” says Cindy Pearson, program director of the National Women’s Health Network, a nonprofit national membership group, “because only a minimal number of women would suffer fractures. But we do acknowledge that everyone loses bone.”
No treatment is perfect, as Johnston points out: “The biggest problem is we don’t have anything much to help you acquire bone,” he says. “If you have lost 20% or 30%, you can’t get a lot of it back (via treatment). Maybe just 5% or 10%.”
What’s also needed, say Johnston and other experts, is increased awareness and education.
A 1991 Gallup survey, for instance, found that three-fourths of the 750 women polled were familiar with osteoporosis, but 80% of them did not know that the disease can lead to disabling hip fractures.
Knowing your individual risk factors is a good first step. Caucasian and Asian women are more susceptible to osteoporosis than others, experts say, as are those with a family history of the condition. Fair-skinned, freckled women with a slender build are at high risk, as are those who undergo menopause before age 45, smoke cigarettes or drink alcohol excessively.
But some experts caution that a lack of risk factors is no guarantee of good health. “No known combination of risk factors can predict the bone mass of an individual,” Silverman says.
Even so, most doctors recommend a number of preventive lifestyle measures to reduce the likelihood or progression of osteoporosis. Johnston recommends an intake of 1,000 milligrams of calcium a day, either from diet or supplements. Some experts recommend even more, up to 1,500 milligrams for post-menopausal women not on estrogen therapy. (One cup of milk has about 300 milligrams of calcium.) For patients older than 75, some doctors recommend extra Vitamin D, which helps the body absorb calcium.
Regular weight-bearing exercise like walking can help, too. Cutting down on colas, which can reduce calcium stores, is recommended.
