Reports From National Arthritis Meeting 2004

Dr. Shiel Offers Perspectives Of Interest On Osteoporosis From
2004 Annual Scientific 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.

New Drugs

Ibandronate, a drug that is taken by mouth once a month is safe in treating postmenopausal osteoporosis.

Dr. Shiel's Perspective: This drug will likely be the next big blockbuster in osteoporosis treatment! The drug is in a class of drugs called antiresorptive drugs (these include Fosamax and Actonel) and works by inhibiting the leaching of calcium from bone. It is still under study, but preliminary results indicate its effectiveness and now its safety.

Strontium was found by European researchers to be effective in reducing the risk of vertebral fractures in postmenopausal women with osteoporosis.

Dr. Shiel's Perspective: Potentially promising as another method of treating this condition. Strontium is unique in its action, working by both increasing bone formation as well as by decreasing bone resorption!

X-rays Inadequate

Researchers from the Boston confirmed previous reports that there is under-reporting of vertebral compression fractures and osteopenia if routine x-rays are used for diagnosis.

Dr. Shiel's Perspective: I agree with the researchers conclusions that accurate diagnosis of compression fractures, promptly, is essential. With timely diagnosis, comes timely initiation of appropriate treatment. I have found bone scanning and MRI scanning very helpful in the diagnosis of vertebral compression fractures. X-rays are also inadequate for diagnosing osteoporosis in general. The current gold standard is bone scanning by DEXA scan or CT scan.

For more information, please visit the Osteoporosis Index.

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Last Editorial Review: 11/2/2004



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