Dr Bella Beraha, born in Venezuela, joins us from Miami. She is an M.D. in Internal Medicine and runs a successful medically supervised weight loss program from the clinic.

When you think about staying healthy, you probably think about making lifestyle changes to prevent conditions like cancer and heart disease. Keeping your bones healthy to prevent osteoporosis may not be at the top of your wellness list. But it should be.

Osteoporosis is a common problem that causes bones to become abnormally thin, weakened, and easily broken (fractured). There were an estimated nine million osteoporotic fractures worldwide in 2000. Women are at a higher risk for osteoporosis after menopause due to lower levels of estrogen, a female hormone that helps to maintain bone mass.

Broken bones due to osteoporosis are most likely to occur in the hip, spine and wrist, but other bones can break too.

Broken bones can cause severe pain that may not go away. Some people lose height and become shorter. It can also affect your posture, causing you to become stooped or hunched.

Fortunately, preventive treatments are available that can help to maintain or increase bone density. For those already affected by osteoporosis, prompt diagnosis of bone loss and assessment of fracture risk are essential because therapies are available that can slow further loss of bone or increase bone density.

DIAGNOSIS:

The best test is a bone density test called the “DXA test.” It is a special kind of X-ray.

Candidates for testing

We suggest testing (DXA) in women 65 years of age and older and in postmenopausal women younger than 65 years of age with clinical risk factors for fracture. In the United States and Canada, the majority of groups recommend BMD assessment in postmenopausal women 65 years and older regardless of risk factors. This recommendation is based upon the findings of an increased incidence of fracture that occurs in conjunction with low BMD (bone density) after age 65 years and clinical trial data demonstrating a reduction in fracture when these women are treated.

We recommend measurement of BMD in men with clinical manifestations of low bone mass, such as osteopenia (thin bones – pre osteoporosis) on routine x-rays, history of low trauma fractures, and loss of more than 1.5 inches in height, as well as in those with risk factors for fracture, such as long-term glucocorticoid therapy, androgen deprivation therapy for prostate cancer, hypogonadism, primary hyperparathyroidism, and intestinal disorders. Some advocate testing all men over the age of 70.

Since hip fracture is often associated with significant morbidity and mortality compared with other fractures, DXA of the hip is generally regarded as the best site for diagnosis of osteoporosis. In contrast, the lumbar spine is often considered the best skeletal site to monitor because it shows less variability and can detect responses to therapy earlier than hip BMD.

FOLLOW UP:

Our approach in women and men with a normal baseline measurement is as follows:

1. In the presence of risk factors that may cause ongoing bone loss (eg, glucocorticoid use, hyperparathyroidism), we perform follow-up measurements approximately every two years, as long as the risk factor persists.
2. We perform follow-up measurements approximately every two years in high-risk women  during the first five years of menopause, when bone resorption is most prominent.
3. In women with no risk factors for accelerated bone loss we will typically perform a follow-up DXA in three to five years.

See iNews on Monday for PART 2: Osteoporosis prevention