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Bone Quality Is As Important As Quantity

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 16 in the January 19, 2011 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Osteoporosis will afflict 1 in 4 women after the age of 50. Older age increases the chances of a bone fracture and osteoporosis increases this even more. Treatment does not prevent fractures, but reduces the incidence a little bit, a concept that is often not visited in the rush towards treatment.

Osteoporosis is one of the maladies that through confusion has a fearsome quality attributed to it. Many seniors will fracture a hip, from all causes combined and almost a quarter of those will succumb while struggling with the consequences in the year following their fracture.

Our bones are living changing things and do soften a bit with age, but osteoporosis refers to a skeletal disorder with compromised bone strength and predisposing to an increased risk of fracture.

If you are close to 50, you may have had a DEXA or Bone Density X-ray to look for this condition. Even the terminology we use on the reports causes confusion. No one is quite sure how the term “osteopenia” came into such frequent and misunderstood use. I tried to research the answer; it refers to a “normal” range of bone density which is different than the disease called osteoporosis. Osteopenic bones tend to be as strong as normal bones. On a similar note, osteoarthritis refers to a type of “wear and tear” joint disease and also has little to do with osteoporosis.

Physicians even start medical treatment with potent bone metabolism regulators because of the normal thinning or osteopenia seen on X-ray. Sometimes it is justified on seeing a fracture and other times it is used as a “just in case” measure.

The medical evidence for use of bone regulators or biphosphonates in osteopenic patients is very poor, and should be reserved for those actually diagnosed with osteoporosis. There are many elderly walking around who are afflicted but feel fine, and don’t believe in medical screening or choose not to. In this group the bone thinness is discovered after their first wrist, back or hip fracture.

Biphosphonates are a group of drugs that contain nitrogen, and bind for years to bone tissue and inhibit the enzymes that normally eat away bone during the repair process. Yet they are used continuously. A new concept has been recognized recently that is cause for concern. A unique fracture of the leg bone is starting to emerge in people who have used these drugs for several years. The bones look fine on X-ray but tend to fracture at a sharp angle

By interfering with normal bone turnover to prevent osteoporosis new conditions begin to emerge. As my daughter often points out; ”simply having the right ingredients does not a meal make”. Medications are only tools that should not be relied on as the sole treatment modality. Carefully combining the medications with a proper diet, exercise and toxin avoidance cannot be over overemphasized. There is no need to stop your medication but an occasional self critique of our lifestyle is of great value.

Related resources:

Clinical Practice Guideline for Osteoporosis Screening and Treatment from Medical Associates.
2010 Osteoporosis Clinical Guidelines from Osteoporosis Canada.
Osteoporosis from Wikipedia, the free encyclopedia.
Osteoporosis at a Glance: What Is Osteoporosis? from Osteoporosis Canada.
60 Second Osteoporosis Risk Quiz from Osteoporosis Canada.
Osteoporosis: Facts and Statistics from Osteoporosis Canada.
WHO Fracture Risk Assessment Tool. "To predict the 10-year risk of sustaining a major osteoporotic fracture, the WHO has developed a clinical assessment tool known as FRAX (fracture risk assessment), using composite scores that rely both on BMD and on validated clinical risk factors for fracture. This new model FRAX . . . incorporates bone density, age, sex, body-mass index, weight, height, previous fracture, parent with hip fracture, current smoking use, rheumatoid arthritis . . ."
Causes of Osteoporosis from WrongDiagnosis.com.
Prevention of Osteoporosis from eMedicineHealth.
Osteoporosis: Treatments, Medications, Symptoms, Signs, Prevention, Causes, Risk from MedicineNet.com.

Note: Dr. Kujtan's articles are intended for informational purposes only
and are not substitutes for professional medical advice, diagnosis, or treatment.

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