MEDICAL SURFARI: NO BONES ABOUT IT

This is the final article in a four part series on menopause and post-menopausal health issues.

Bones -- there are 206 in your body and despite popular myth, bone is not a stony, dead material within our bodies that our soft parts cling to. It is a dynamic, living tissue. Think about it, everyone knows that when you break a bone it will usually heal. Bone continuously remodels its own architecture to bear the daily stresses imposed by exercise, work, injury and body weight.

Your bone mass (total body bone) is like a savings account and how much you have depends upon how much you deposit. The critical years for depositing are from teens to about age 30 and some experts believe that bone mass can be increased by as much as 20 percent during these years. This presents an opportunity for most women to significantly prevent osteoporosis.

Osteoporosis is a condition caused by low bone density, which makes bones brittle and easily fractured. It affects about 28 million Americans, 80 percent of whom are women, and is responsible for 1.5 million fractures each year. Fractures are more common in women than heart attack, stroke and breast cancer combined.

Last year in the United States hip fractures resulted in approximately 300,000 hospital admissions and an estimated $9 billion in direct medical costs.

Have you ever heard of or seen a "dowager's hump" and wondered what it is? It is the hump that some elderly women develop on their upper back and it is associated with "the little old lady" stereotype. This hump is actually caused by multiple compression fractures (broken backbones) that cause the spine to bend and angulate, resulting in a kyphosis (hump).

Why do these fractures occur? In bone, as in other aspects of our lives, there are givers and takers. Two armies of cells with opposite functions live within the lacy caverns of bone, normally remodeling our skeleton through a balanced system of bone formation and resorption (bone loss). If more resorption than formation occurs, there will be a decrease in bone mass. As part of the natural aging process resorption outpaces bone formation --- the takers outpace the givers. In women, bone loss often accelerates after menopause when the ovaries stop making estrogen, a hormone that reduces bone loss.

Two of the most commonly prevailing myths about osteoporosis are that it is an inevitable part of aging and that it only affects women. One out of every two women and one out of every eight men have a risk of suffering an osteoporotic fracture sometime during their life and these can be prevented. Successful prevention of this disease requires raising physician and public awareness about lifestyle and dietary effects upon the age related process within the bone so that measures can be taken at an appropriate time to prevent this condition. Unfortunately, once you develop osteoporosis there is no cure but it can be treated. There are now a variety of medications available to physicians that may be helpful in some patients who have this condition.

Normal or early menopause brought on naturally or because of surgery increases the risk of osteoporosis. Smoking tobacco and drinking too much alcohol as well as inadequate consumption of calcium and little or no weight bearing exercising increases your risk. Certain medications, especially steroids, may increase risk, as well as some medical conditions that reduce one's ability to exercise. Also, young women whose mothers have a history of osteoporosis seem to have reduced bone mass and may be at increased risk.

Regardless of your age, discuss your risk analysis for this condition with your physician to determine pre-emptive solutions. The tragic personal and financial consequences of this condition are not inevitable and can be reduced in the twenty-first century.

WORLD WIDE WEB RESOURCES

National Osteoporosis Foundation

www.nof.org/

This site has medically sound, up-to-date information for patients, families and professionals about prevention, detection and treatment of osteoporosis.

Missouri Osteoporosis Foundation

www.moof.org/

The purpose of this not-for-profit foundation is to increase public awareness of osteoporosis, promote physician education and provide support to osteoporosis patients.

Mayo Clinic

www.mayohealth.org/mayo/pted/htm/osteopor.htm

This Mayo Clinic patient education web site provides comprehensive information about causes, prevention, diagnosis and treatment of osteoporosis.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.