For a woman with osteoporosis, simply lifting a box or slipping on a wet floor can result in a broken hip or spinal fracture. Such an injury may be all it takes to disable an active woman, and all too often it leads to early death. Osteoporosis is called the “silent epidemic” for good reason; there are no symptoms to alert women to the progressive weakening of their bones.
According to the National Osteoporosis Foundation, an estimated 10 million people in the United States have osteoporosis and 80% of them are women. In the United States about 40% of white women over the age of 50 will fracture their hip, vertebrae, or wrist because of osteoporosis; fracture rates in other ethnic groups are much lower. The annual cost of osteoporotic fractures in the United States is projected to be more than $20 billion by 2015.
Bone strength is dependent on bone mineral density (BMD) (also called bone mass) and other aspects of bone microarchitecture such as mineral crystal size, collagen structure, and heterogeneity of mineralization. The major risk factors for an osteoporotic fracture include low BMD scores, older age, lower body mass index, inactive lifestyle, smoking, high alcohol intake, parental history of a hip fracture, history of exposure to glucocorticoids, rheumatoid arthritis, history of a fall, back pain, prior history of an osteoporotic fracture, and early menopause.
A consideration of lifestyle factors is fundamental to effective prevention and management. When osteoporosis progresses despite lifestyle changes, then hormone therapy or pharmacotherapy, including bisphosphonates and estrogen agonists/antagonists (also known as selective estrogen receptor modulators, or SERMs), may be considered.
Calcium and vitamin D deficiencies must be corrected before initiating pharmacologic therapy.Estrogen and estrogen-plus-progestin use in post-menopausal women, increases in BMD were greater and fracture rates were lower in women using hormone therapy compared with the control groups. Both hip and vertebral fracture rates were more than 30% lower in women taking estrogen plus progestin and almost 40% lower in women taking estrogen alone.