Reports From National Arthritis Meeting 2003
Dr. Shiel
Gives Perspectives Of Interest On Osteoporosis From 2003 Annual
Scientific Meeting Of The American College Of Rheumatology.
Below are
perspectives on key reports presented at the recent national meeting of the
American College of Rheumatology:
Introduction
Osteoporosis is
a disorder of the skeleton in which bone strength is abnormally weak. This
weakness leads to an increase in the risk of breaking bones (bone fracture).
Normal bone is
composed of protein collagen and calcium. Osteoporosis depletes both the
calcium and the protein from the bone, resulting in either abnormal bone
quality or decreased bone density. Bones that are affected by osteoporosis can
fracture with only a minor fall or injury that normally would not cause a bone
fracture. The fracture can be either in the form of cracking (as in a hip
fracture) or collapsing (as in a compression fracture of the vertebrae of the
spine). The spine, hips, and wrists are common areas of osteoporosis-related
bone fractures, although fractures can also occur in other skeletal areas, such
as the ribs.
Osteoporosis
can be detected by measuring the bone density. Bone mass (bone density)
decreases after age 35 years, and decreases more rapidly in women after menopause.
Risk factors for osteoporosis include genetics, lack of exercise, lack of
calcium and vitamin D, lack of estrogen, cigarettes and alcohol, and certain
medications. Patients with osteoporosis have no symptoms until bone fractures
occur. The diagnosis can be suggested by x-rays and confirmed by tests that
measure the thickness of the bone (bone density tests). Treatments for
osteoporosis include stopping alcohol and cigarettes, weight-bearing exercise,
calcium, vitamin D, estrogen, and medications to increase bone density.
Prevention Available, Underused
In a large study of patients seen in the setting of a
rheumatic diseases division of a major university, one quarter of patients at
risk for osteoporosis by taking cortisone medication for diseases such as
rheumatoid arthritis and lupus were not receiving ANY form of prevention for
osteoporosis.
Dr.
Shiel's Perspective: The entire field of osteoporosis management has changed in recent
years. Guidelines for the prevention of osteoporosis clearly emphasize that
persons who are chronically taking cortisone medications should receive
osteoporosis prevention counseling. This should include recommendations for
diet, exercises, avoiding cigarette smoke, and when appropriate, estrogen
replacement and/or medications to build bone density.
Patients
with systemic lupus erythematosus were reported to be inadequately screened for
osteoporosis.
Dr.
Shiel's Perspective: An old rule of medicine that I teach students,. "If you don't
take a temperature, you can't find a fever." We as healthcare givers must be
more vigilant in identifying and treating this preventable illness.
Risks
In Men
Researchers
from the University of Cincinnati found that men over 70 years of age are
clearly at high risk of having osteoporosis, regardless of race.
Dr.
Shiel's Perspective: This is very important news because we now have medications that
have been shown to be effective in treating osteoporosis in men! More over, the
researchers suggest screening ALL men over the age of 70 years for
osteoporosis.
Women's Preferences For Prevention
Researchers from Yale University found that if women were given a choice, a majority of them would prefer to take regular medication to prevent osteoporosis rather than risk being afflicted with it.
Dr. Shiel's Perspective: This means, again, that doctors,
medical societies, and pharmaceutical companies need to do a better job of
getting the word out. Osteoporosis is not healthy, leads to serious
physical issues and work disability, AND is PREVENTABLE.
For more information, please visit the
Osteoporosis
Center.
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Last Editorial Review: 7/6/2004
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