Many older women get osteoporosis as they age. This is bone loss/bone thinning with loss of the calcium from the bone. Some women with this just got shorter because the vertebrae in their back compressed like a box that you smash (This type of fracture is called a compression fracture). Others ended up with severe back pain when they fell and the bones compressed suddenly. And, alas, some ended up with hip or wrist or ankle fractures from minor falls.

In the past, we doctors used a lot of Estrogen (female hormones) after menopause, and this helped prevent the bones from thinning, but now, with the discovery that estrogen might cause heart attacks from making blood stickier and might make breast cancer grow faster, fewer women use it. So thinning bones are again a problem.

Ironically, in the past, one reason women didn’t get it as much is that they had heavier bones from heavy lifting. If you, like me, are a junkie of BONES or other TV history or crime shows, you know that people who did hard work could be identified from the thickening of the bones involved. So a study of skeletons in England and Norway showed no more osteoporosis than in modern women, but lots of wear and tear arthritis. But reason would make one think osteoporosis should have been more common back then, since having lots of kids and breast feeding them while not getting a decent diet or a lot of sunlight for Vitamin D all make you more likely to have thin bones…

Perhaps the difference is weight lifting. You see, back then the women lifted heavy kids and pots and did heavy housework, and this resulted in thicker bones–and more wear and tear arthritis. (one note about this: it’s hard to tell mild osteoporosis in dead bones, and of course, if you had ricketts or other bone diseases, you probably would have died at an earlier age).
The lesson from this is that weight training in the elderly helps prevent thin bones…who wudda thought that Grandmom would be pumping iron?

Adding calcium to the diet also helps. Westerners can drink milk, but what about those who can’t? Osteoporosis might be higher in Chinese than westerners because they don’t drink milk, but the story is complicated because they use soy products, and soy has natural estrogen. And many Asian populations use yogurt, which can be eaten by those with lactose deficiency. Taking calcium pills probably helps too.
But what do you do with those who have osteoporosis? And should you screen every older woman for her risk? Ah, ask five docs and you get five answers, and next week you will get a different one. This year, the Surgeon General recommends screening, but there is a question if the simple wrist screening is accurate, and the full screening requires XRays of the spine etc.and is very expensive (not to mention getting a lot of radiation exposure).
I always am suspicious of an expensive screening where an expensive drug is being touted as a cure all, in this case Alendronate or other biphosphonates. Who did the study? The drug company?
Now, these drugs are wonderful in slowing down osteoporosis, don’t get me wrong. But every drug has problems, and Alendronate has to be taken on an empty stomach and then you have to wait an hour to eat or it doesn’t work. Luckily, they did develop a once a week version, so it’s not as inconvenient. Another problem is that if it gets stuck in the esophagus, the tube that leads to the stomach, it can cause bleeding. (so can other drugs such as aspirin). So you are supposed to wash it down with a glass of water.

But for those with osteoporosis, where using them might mean not having a hip fracture (which in the elderly often leads to being placed in a nursing home), they are a literal life saving medication.

Although maybe screening every lady over 50 is a bit excessive, there are some people who do need screening, and one group are those who have taken a lot of steroids for arthritis or asthma.

This group is smaller now than twenty years ago, thanks to newer medications, but still exists. In the past, we all had patients with Rheumatoid arthritis who took Prednisone because it was once the only medicine that really helped. Alas, after twenty years, they ended up obese, often Diabetic, and with severe osteoporosis.

Nowadays, there are many other drugs to use, all of which have side effects, but compared to high dose Prednisone, they are much better.
A recent study shows that Alendronate does help these patients. (registration required).

So another use for a useful medicine. Remember this the next time someone complains about the high cost of US Medicine.

————————————

Nancy Reyes is a retired physician who lives in the rural Philippines with her husband, six dogs, three cats and a large extended family. Her webpage is Finest Kind Clinic and Fishmarket

Be Sociable, Share!