Brittle bones

Margaret Lucas of Northeast has pain in her bones. Her discomfort started after eight months of chemotherapy for colon cancer.

Since her doctors are concerned that the treatment may have caused osteoporosis, Ms. Lucas, 76, recently underwent a dual emission X-ray absorptiometry (DEXA) scan, also known as a bone density test, at Washington Hospital Center in Northwest.

“Some days my bones don’t hurt. Some days they do,” she says. “If I try to walk a block, I’ll have to stop, but it doesn’t hurt when I’m sitting or laying down.”

Last week, Dr. Richard H. Carmona, U.S. surgeon general, issued the first-ever report on the state of bone health in the nation, “Bone Health and Osteoporosis: A Report of the Surgeon General.” By the year 2020, one in two Americans older than age 50 will be at risk for fractures from osteoporosis or low bone mass, accordingto the U.S. Department of Health and Human Services in Southwest.

Currently about 10 million Americans over the age of 50 suffer from osteoporosis. In addition, another 34 million people are at risk for getting the disease. Although the majority of the people suffering from theillness are women, men also suffer from the condition.

It can be an extremely disabling if a person has a fracture, says Dr. Jack Wilkenfeld, attending physician with privileges in rheumatology at Inova Fairfax Hospital. Patients that suffer hip fractures may never be able to walk again. Spinal and wrist or forearm fractures also are common.

“For the longest time, osteoporosis and fracture were considered a normal consequence of aging,” he says. “We’ve highlighted that this is an illness and something that we should treat… instead of just accepting that you’re just getting older.”

Although osteoporosis is usually a disease of older-aged women and men, choices people make in their younger years will affect their chances of having the condition, says Dr. David Downing, resident program director for OB/GYN at the Washington Hospital Center.

People most likely to get osteoporosis are small and thin, or Caucasian or Asian women who smoke. Having a family history of osteoporosis or a personal history of fractures also increases the risk of illness. Per day, people should limit themselves to one alcoholic drink and no more than two 8-ounce cups of coffee.

Consuming enough calcium and vitamin D throughout life is important to prevent the disease, Dr. Downing says. People should also take part in weight-bearing exercises.

“Normal bone is chock-full of calcium,” he says. “When there’s a lack of calcium, it looks like there’s a bunch of little holes in the bone…. As you get older, you lose the calcium.”

Osteoblasts are cells that put calcium in the matrix of the bone, while osteoclasts are cells that take the calcium away and diminish the internal strength of the bone, Dr. Downing says. Since estrogen tends to stimulate osteoblasts, when women experience menopause and lose estrogen, they usually lose calcium and bone structure diminishes.

However, even those in perfect health need the osteoclasts to redistribute bone mass during different times of life. Bone mass and mineral adjust to support the places where the most outside force occurs.

For instance, people on bed rest lose calcium because of the lack of weight-bearing exercise. Signs that the osteoclasts are overactive could include a fracture, the curving of the back or pain.

“You don’t want a teenager going through a growth spurt to sit on the couch all day,” Dr. Downing says.

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