- The Washington Times - Monday, March 5, 2007

Baltimore resident Dr. Benjamin F. Trump was climbing a set of stairs at his second home in Colorado when he fell backward and broke his hip.

Dr. Trump, retired chairman of the pathology department at the University of Maryland School of Medicine in Baltimore, was surprised to find out after he fell in 2001 that he had osteoporosis, a disease that mainly affects women. He had a pin placed in his hip, but the treatment failed to work, so he had partial and then full hip-replacement surgery.

“It was a major setback because now I can’t walk without a cane,” Dr. Trump says. “My wife has to take care of me.”

Dr. Trump, who began an exercise program and took prescription medication, vitamin D and calcium to strengthen his bones, no longer tests for osteoporosis.

Osteoporosis — the most common cause of hip fractures — decreases bone strength, leading to bone fragility, says Dr. Elizabeth Streeten, assistant professor of medicine and pediatrics and co-director of the Adult Genetics Clinic at the University of Maryland Medical Center.

“A fracture from mild trauma is the most specific way to tell if somebody has fragile bones,” Dr. Streeten says.

In the year following a hip fracture, odds of death increase by 25 percent from being sedentary and other medical problems, says Dr. Katalin Roth, associate professor and division director of geriatrics at George Washington University Medical Center.

Fifty percent of those who survive regain independent function, but the rest have to use a cane, walker or wheelchair and may be admitted into nursing or other care, Dr. Roth says.

“It really is a catastrophe for an older person to have a hip fracture,” she says.

Osteoporosis causes a higher rate of bone loss than can be replaced and a more severe loss of bone strength than in the normal aging process, says Dr. Eric De Jonge, director of geriatrics at Washington Hospital Center.

As people age, the thickness or density of their bones naturally decreases, causing the bones to become thinner and more porous, says Rose Aehle, a registered radiographer and coordinator of the radiologic technology program at Montgomery College in Takoma Park/Silver Spring.

“In the skeletal system, the bones constantly remove and replace bone, but unfortunately, as we age, more bone is removed than is replaced,” Mrs. Aehle says.

Ten million Americans are estimated to have osteoporosis, according to the Web site of the National Osteoporosis Foundation, headquartered in Northwest. Of those 10 million, it says, 8 million are women and 2 million are men.

Women build extra bone up to age 30, then begin to make as much bone as they lose until menopause, when they begin to lose bone, says Dr. Ethel Siris, president of the National Osteoporosis Foundation. She is professor of clinical medicine at Columbia University in New York City.

A low intake of calcium and vitamin D can attribute to low bone mass, Dr. Siris says. Calcium can be found in dairy products and other foods, such as fish, as well as supplements. Vitamin D is produced by the body from sun exposure and often is added to dairy products to help the body absorb the calcium.

Other risk factors for low bone mass and osteoporosis include smoking, excessive alcohol consumption, eating disorders and use of some medications, including systemic steroids and blood thinners, metro-area physicians say. Caucasian and Asian women, along with post-menopausal women who weigh less than 127 pounds, also are at increased risk, they say.

Physicians recommend taking calcium and vitamin D supplements, which are the building blocks of bone, and doing weight-bearing exercise to improve circulation, build bone strength and stimulate bone growth as preventative measures against osteoporosis.

“Age, gender and genetics are probably the most important factors,” Dr. Streeten says. “Although a lot of the risk is genetic, there is a significant percentage you can do something about.”

Those diagnosed with osteoporosis can take prescription medications to lower their risk of fracture, such as bisphosphonates, or start hormone-replacement therapy to increase estrogen levels, Dr. Siris says.

The NOF recommends that women older than 65 get a bone-mineral density test, such as the Dual Energy X-ray Absorptiometry (DXA) scan, with follow-up testing if osteoporosis is found, Dr. Siris says. Younger women should be tested if they have a family history or other risk factors for osteoporosis or experience early menopause, she says.

The DXA scan measures and compares bone-mineral density of the spine and hip (and sometimes the wrist or forearm) to that of an average healthy young woman at maximum bone density, Dr. Siris says.

The average is given a T score of 0, Dr. Siris says. A score of up to 10 percent deviation, or a -.1 T score, is considered normal, she says. A T score of -1 to -2.49 indicates osteopenia, or low bone mass, she says. A T score higher than -.25 shows osteoporosis, she says.

Sixteen percent of Caucasian women older than 50 test in the osteoporosis range and 42 percent in the osteopenic range, Dr. Streeten says. More than 90 percent of women in their 80s are in the low-bone-mass range, she says.

“With increased age, the statistics go up,” Dr. Streeten says.

One in two women will experience some type of fracture after menopause, Dr. Siris says. In addition, each year, 300,000 or more Americans get a hip fracture, she says.

The most common types of hip fractures are the femoral neck and intertrochanteric fractures, Dr. Streeten says. In the femoral neck fracture, there is a break where the ball of the femur — or thighbone, near the hip socket — connects to the shaft of the femur, she says. The intertrochanteric fracture is a break to the area of bone just below the femoral neck, she says.

“If you fall from standing height and break your hip or another bone, you have osteoporosis,” she says. “A mild slip and fall shouldn’t result in a bone that’s broken.”

Following a hip fracture, treatment typically begins with an X-ray and possibly other scans, then continues with surgery to pin and stabilize the hip or insert a hip prosthesis, or false hip, and rehabilitation to help regain mobility, metro-area physicians say.

“In older, frail individuals, hip fractures are difficult to recover from,” Dr. Siris says.

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