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Earlier, Frequent Osteoporosis Screening Could Prevent Fractures, Doctors Say

Posted - Jan. 26, 2004 at 2:20 p.m.



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\ Women shouldn't wait until they fracture a hip to discover they have osteoporosis.

Instead, women-- as well as men-- should get bone density checked as they age, according to Dr. Elliot Pierce.

"We've not been seeing people early enough," said Pierce, medical director for the Osteoporosis Diagnostic Center in Albuquerque. "We should be screening a lot of people and treating a lot of people."

The center offers DEXA, or X-ray, scans to measure bone density in the hip and spine-- a test considered more reliable than scans on heels and other extremities.

The best argument for regular tests, Pierce said, is that medications are now available to stop and even reverse bone thinning as a person ages. If osteoporosis is found early enough, a person may be able to prevent a fracture, he said.

The National Osteoporosis Foundation recommends that all women 65 and older be tested, as well as post-menopausal women younger than 65 who have other risk factors for osteoporosis. Such factors include a family history of osteoporosis, a thin build (weighing less than 127 pounds, according to Pierce), use of steroids or thyroid hormones and a history of smoking.

Pierce said he thinks it would be a good idea, though, for women to get a baseline bone density test around age 50, with follow-ups scheduled depending on their risk factors and bone density.

His office charges about $344 for a scan, but insurance generally covers the cost for people deemed at risk, such as women past menopause or a person who has had a fracture in which osteoporosis is a suspected cause. The scan requires a doctor's referral, Pierce said.

The frequency of the tests would depend on evidence of bone thinning. The more bone loss that is detected, the more often a woman should be tested, he said.

For the first five years after menopause, a woman loses 3 percent to 5 percent of her bone mass each year, he said.

Men don't lose bone mass as early, but they should consider getting their bones checked by the time they turn 70, Pierce said. Out of every five patients with osteoporosis, one is a man, he added.

The problem is not trivial. Each year, 59,000 women die of complications from hip fractures, he said, compared to 35,000 who die of breast cancer.

The problem has its roots in the teenage years. Most of a person's bone mass is established in those years, with peak density occurring sometime between 25 and 35. If you don't establish a good foundation in your early years, health experts fear you can quickly enter the danger zone after several years of bone loss.

Dr. Elizabeth Szalay, associate professor of orthopedics and pediatrics at the University of New Mexico, is taking a look at what happens in the early years.

Carrie Tingley Hospital has gotten a machine to test bone density in children. It can scan the thigh bone in children lying on their side-- a more comfortable position for kids with some chronic health problems and a more accurate measurement of children's bone density, according to Szalay.

"This is really an area that's been ignored," she said. Yet studies have shown a 50 percent increase in forearm fractures for girls and 30 percent for boys over the last 30 years.

No one can say if that's because youngsters are involved in more injury-prone sports, or if it's because their bones are thinner, she said.

Szalay said she suspects bone density is the culprit. "We have a whole generation growing up with computers and TV instead of playing outside," she said. Regular, weight-bearing exercise helps build strong bones, along with calcium and vitamin D.

The peak time for girls to lay down calcium in their bones is 121/2, and the peak time for boys is 14, she said. "Those are the ages when kids are the least likely to be drinking milk," she added.

A National Institutes of Health study showed 90 percent of teen girls and 75 percent of boys are not getting enough calcium in their diets, she said.

Several studies are in the works involving the new scanner, which Carrie Tingley started using in September. One is looking at how bone density relates to a condition in which children's hips slide out of position, and another is considering the effect of vitamin D deficiency in children with chronic illnesses.

Children with cerebral palsy, for example, have very low bone density, Szalay said. "Some have such low bone density they can get a fracture getting their diapers changed or rolling over in bed," she said.

They are treated with the same category of drugs used in adults-- bisphosphonates such as Fosamax and Actonel-- but the medications are given intravenously, she said.

Other area pediatricians have been sending children to be tested on Carrie Tingley's machine, she said. Among the children in danger of thin bones are those on daily steroid medications, those with eating disorders or diseases that result in malabsorption of nutrients and those taking anti-seizure medications that interfere with vitamin D absorption.

Those types of medications also can affect adults' bone density, Pierce said, adding that steroid nasal sprays used for allergies aren't believed to cause a problem.

To keep your bones strong

  • Maintain a consistent routine of weight-bearing exercise. Other than swimming, most exercise is considered weight-bearing, including walking, running and skiing.

  • Men and premenopausal women should take 1,200 milligrams of calcium and 400 international units of vitamin D daily. Women after menopause should take 1,500 milligrams of calcium and 800 international units of vitamin D.

    The action of sunlight on the skin helps a person's body make vitamin D, but that process becomes less efficient as a person ages. Many multivitamins include the usual recommended daily intake of vitamin D: 400 international units.

  • Spread calcium supplements throughout the day-- your body can't absorb more than 500 milligrams at one time-- and take them with a meal.

  • Make sure your diet includes calcium. An 8-ounce glass of milk-- any type of milk, but many people recommend low-fat to avoid calories-- has about 300 milligrams of calcium. Other good sources include low-fat plain yogurt; Swiss, cheddar and ricotta cheese; broccoli; and orange juice and other products, such as tofu, fortified with calcium.

  • Limit caffeine. Moderate coffee consumption-- two or three cups a day-- won't harm you as long as your diet contains adequate calcium.

    Sources: Albuquerque Dr. Elliot Pierce and the Mayo Clinic Web site at www.mayoclinic.com.

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    Copyright 2003 Albuquerque Journal

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