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DR. ROLLINS: Don’t fall for brittle bones

Scott Rollins
INTEGRATE YOUR HEALTH
Free Press Health Columnist

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Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to fragile and brittle bones that are prone to fracture, especially at the hip, spine and wrist, although any bone can be affected.

It is important to understand that bone is not a hard and lifeless structure; it is, in fact, complex, living tissue. Our bones provide strength for muscles, protect vital organs, and store the calcium essential for bone density and strength.

Think of your bones as a savings account. There is only so much in your account as you deposit. The critical years for building bone mass are from prior to adolescence to about age 30. Some experts believe that young women can increase their bone mass by as much as 20 percent — a critical factor in protecting against osteoporosis.



Because bones are constantly changing, they can heal and may be affected by diet and exercise. Until the age of about 30, you build and store bone efficiently. Then, as part of the aging process, your bones began to break down faster than new bone can be formed.



HEALTH RISKS

Osteoporosis is a major public health threat for an estimated 44 million Americans or 55 percent of the people 50 years of age and older. In the U.S., 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.

Of the 10 million Americans with osteoporosis, 80% are women. Risk is for people of all ethnic backgrounds. While osteoporosis is often thought of as an older person’s disease, it can strike at any age.

One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his lifetime. Osteoporosis is responsible for more than 1.5 million fractures annually, mostly in the spine, then hip, wrist, and other sites.

The estimated national direct care expenditure, including hospitals, nursing homes and outpatient services, for osteoporotic fractures is $18 billion per year (in 2002) and rising.

The rate of hip fractures is 2-3 times higher in women than men; however, the one-year mortality rate following a hip fracture is nearly twice as high for men. A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.

In 2001, about 315,000 Americans over 45 were admitted to hospitals with hip fractures. An average of 24% of patients over age 50 will die in the year following the fracture and one in five will require long-term care afterward. Six months after hip fracture only 15% can walk across a room unaided. One in five hip fracture patients ends up in a nursing home.

SCREENING

Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A BMD test can detect osteoporosis before a fracture occurs, help predict chances of future fracture, and determine rate of bone loss and/or monitor the effects of treatment.

Another useful test is the urine N-telopeptide or urine NTX. A simple urine sample can measure the amount of bone collagen lost in the urine, giving an indication of how much bone turnover is happening and how much bone is being lost. A low score is good. I use this test to help further stratify risk with the BMD test as well as monitor ongoing therapy.

RISK FACTORS

Osteoporosis is often called a “silent disease” because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. Collapsed vertebra may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.

Risk factors for osteoporosis are many and include a personal history of fracture after age 50 or current low bone mass, history of fracture in first-degree relative or family history of osteoporosis, being female, being thin and/or having a small frame, advanced age, estrogen deficiency as a result of menopause, low testosterone, anorexia nervosa, low calcium intake, vitamin D or K deficiency, inactive lifestyle, certain medications (steroids, chemo, seizure drugs, etc), certain chronic medical conditions, cigarette smoking and excessive alcohol intake.

PREVENTION & TREATMENT

Think of bone as being much like a concrete wall. The concrete is strong, but brittle, and the metal rebar that runs through the concrete is what gives the wall tensile strength, or the ability to resist tension. Bone is much the same and the calcium is similar to the concrete, while flexible collagen is laid out in a grid throughout the bone. The collagen, called the bone matrix, provides the tensile strength.

There is a sequence of activity needed to make strong bone. First, hormones such as estrogen, testosterone, thyroid and growth hormone act to “turn on” bone development. Vitamin D is needed to absorb calcium from the gut while Vitamin K allows calcium to be deposited in the bone matrix and keep it from building up in artery walls. Of course, proper nutrition provides the calcium, and other vitamins and minerals necessary to build strong bone.

Calcium is in the news lately, with questions about increased heart disease in folks taking supplemental calcium, particularly a large amount. At this point the ongoing studies are suggesting we not to supplement calcium if we are getting enough in our diet, and then not to supplement more than about 500mg daily. There will be conflicting guidelines on this so stay tuned.

Hormone replacement therapy is the mainstay of treatment for my patients. Strong muscle equal strong bones, so weight-bearing and strength-building exercises are key. Good nutrition is essential, along with targeted supplements including calcium, vitamin D3 and K2, and minerals such as boron and magnesium. As an example, one of my favorites is Bone Restore from Life Extension. I also use a milk protein isolate called “enriched lactoferrin” and a mineral called “strontium citrate,” both of which promote bone formation.

I don’t routinely find any need for the prescription drugs such as Boniva or Fosamax which build bone density by inhibiting the cells that cause bone breakdown. There are common side effects, serious risks and questions of efficacy. Frankly, by implementing the previously mentioned treatments, osteoporosis is becoming a rare thing in my practice.

Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.


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