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:


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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