Tune into Fracture Risk Factors

Monday, 19 April 2010 20:50

As risk factors, age and gender are givens. Women are far more susceptible than men to osteoporosis. In fact one in two women over the age of 50 is at risk for osteoporosis. This is because women’s bones even at their best (age 25-30) are generally smaller and less dense than men’s bones. Additionally, women lose more bone than men during aging. There is more research being done in men and we are finding that 25% of them over age 50 are also at risk for osteoporosis.

Following is a brief review of other significant risk factors:

Smoking – This addiction (habit) is a strong risk factor for heart disease, lung and other cancers, chronic lung disease—and reduced bone mass. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, smoking was tagged as a risk factor for osteoporosis more than 20 years ago. Determining the impact of smoking on bone health is complex, because other factors can be involved. Smokers, for example, often tend to drink alcohol more, exercise less, and have poor diets. The bottom line, most studies indicate, is that smoking increases fracture risk. Quitting may reduce the risk, but even cutting down may help.

Drinking Alcohol – At age 35, most people’s bones are as strong as they will ever be. Lifestyle factors, including alcohol use during adolescence and young adulthood, influence bone structure and mass. Research published by the National Institute on Alcohol Abuse and Alcoholism indicates that chronic heavy drinking during a person’s earlier years can compromise bone quality and may increase the risk of osteoporosis—and potential fractures—even after drinking has stopped. At this point there has been little formal research into how alcohol consumption interacts with other factors, such as smoking, exercise, and body weight.

Steroids (corticosteroids) – Drugs in this category are often prescribed to treat chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease and chronic obstructive pulmonary disease (COPD). Unfortunately, the need to use them at increased doses can frequently cause osteoporosis and fractures. These unwanted side effects are dose dependent and are directly related to the ability of steroids to hinder the formation of bone, curtail absorption of calcium in the gastrointestinal tract, and increase the loss of calcium through the urine. In fact, this form of osteoporosis advances even more rapidly than the naturally occurring form because of those specific, toxic effects of steroids,

Rheumatoid Arthritis – In this debilitating autoimmune disease—which strikes two to three times more women than men—the body attacks healthy cells and tissues in the areas surrounding the joints, resulting in severe joint and bone loss. Steroids, such as Prednisone, may make life easier, but they can also trigger bone loss as discussed under “steroids”. And, adding to the complexity of this scenario, the pain and poor joint function reduce activity levels, further accelerating the development of osteoporosis and fracture risk.

Other Chronic Disorders – Celiac disease, Crohn’s disease, and ulcerative colitis, are often linked to bone loss which can be accelerated by their frequent and necessary treatment with steroids. A common factor in all these conditions is the gastrointestinal tract’s reduced ability to absorb enough calcium to create and maintain strong bones. The Crohn’s and Colitis Foundation of America notes that 30 to 60 percent of people with inflammatory bowel disease may also have low bone density.

Diabetes deserves special mention. Patients with Type 1 diabetes often have low bone density, though researchers are not sure why. Typical onset of Type 1 diabetes is in childhood when bone mass is building, and some sufferers also have celiac disease. The vision problems and nerve damage that frequently accompany diabetes can contribute to falls and related fractures. In Type 2 diabetes, typically with onset later in life, poor vision, nerve damage, and inactivity can lead to falls; although bone density is typically greater than with Type 1 diabetes, bone quality may be adversely affected by metabolic changes due to high blood sugar levels.

Previous Fractures – Many studies, in both men and women, indicate that suffering a fracture nearly doubles the risk of having another fracture in the future. Spine (vertebral) fractures are strong predictors of more spine fractures to come, but these fractures often occur so slowly that there is no painful “event”. Women should ask for accurate height measurements at their annual medical examinations, since loss of height more than an inch or two could indicate the presence of spine fracture. This risk of fracture related to prior fracture is largely independent of bone density, meaning that a history of fractures may point an increased risk of falling or bone problems not revealed by bone density tests.

Genetics and Family History – Women whose mothers or sisters fractured their hips have twice the risk of hip fractures as women whose mothers did not.