Dear Dr. Garner,
I am concerned, as it seems that each year I get a little bit shorter. I am a 72-year-old who is otherwise in good health. I have noticed this in my friends too. Do you think that I have osteoporosis?
Shrinking in Sunset Park

Dear Shrinking,

Your problem is not an unusual one, as the annual incidence of osteoporosis and fractures associated with osteoporosis is greater than the combined incidence of heart attack, stroke and breast cancer in women. (Note: Men are also affected by osteoporosis, but to a much less degree than women. My answer will address osteoporosis as it relates to women. Men should ask their doctors about the condition as well.)

Osteoporosis is an under-diagnosed and under-treated illness. In fact, until 1994, osteoporosis was not specifically classified as a disease. Osteoporosis currently affects approximately 25 million women in the United States, and over 50% of women will experience a fracture related to osteoporosis. Unfortunately, often the first symptom of osteoporosis is a broken back, which is why the condition is also known as the ‘silent crippler.’ People do not realize that they have osteoporosis until it’s too late.

Up until the age of 30, more bone is produced than the old bone that dies. At about the age of 30, this process begins to shift, so that there is a negative balance created. New bone is added more slowly than the old bone that is removed, and as a result the bone loses density and becomes brittle. It loses between 1-2% a year until menopause, and then 2-5% per year thereafter. There are certain women at increased risk of osteoporosis. These include:

• Caucasian and Asian women.

• Very thin women.

• Women who smoke.

• Women who drink more than two alcoholic drinks a day.

• Women who do not exercise.

• Women with limited calcium intake.

• Women who have malabsorption disease or conditions such as Crohn’s disease or ulcerative colitis.

• Women who take large amounts of antacids and drugs such as Prilosec and Nexium, as these interfere with the absorption of calcium.

• Women with impaired sight.

• Women with impaired mobility – homebound.

There are ways to prevent osteoporosis. The following will be helpful:

– Weight-bearing exercise, which can be accomplished through a brisk walk. Light weights to build up the upper body are also useful.
– All women over the age of 27 should speak to their physician about taking a calcium and vitamin D supplement. This will ensure adequate supply necessary to keep the bones strong.

– Do not smoke.
– Avoid alcohol.
– Try to have three-to-five minutes of sunlight exposure per day.

How does one know if she has osteoporosis?

There is a simple, relatively inexpensive test known as a DEXA scan. This test uses low dose radiation to evaluate the density of bones. It can detect decreased bone mass, which is the same thing as osteoporosis. However, a more simple test is for one to measure her height every six months. Any decrease, however small, is a sign that osteoporosis may be present. If there has been a history of fractures particularly with low impact injuries, this is also a sign that the bones may be osteoporotic.

Treatment – Up until now treatment has consisted of the lifestyle changes that I have mentioned above, and a class of drugs which helps to keep the bones strong, known as bisphosphonates. Most would be more familiar with the name “Fosamax” or “Boniva.” These pills are cumbersome to take, as they require an empty stomach and require that the patient remain upright for 30 minutes after taking the medication. It can also cause severe heartburn. As a result, it is quite common to have women stop taking the medication and after one year, 60-80% of women are no longer compliant.

A major breakthrough is near. There is a new medication known as Reclast that is to be approved shortly by the FDA. This is given intravenously only once a year.

This will ensure that women at risk or who have early osteoporosis can have treatment to prevent their fractures and complications such as loss of height, as you mentioned. The studies show a 70% reduction in fractures of the backbone and a 40% reduction in hip fractures, with the new medication.

I urge all women who are around menopause or later to ask their doctor for a DEXA bone density test.

Your letter is an important one. I hope it serves to educate younger women that osteoporosis starts in the late twenties, and that healthy lifestyle and adequate nutrition are critical, as well as early recognition and treatment. You should see your doctor, to arrive at a plan, to help preserve the bone that is present in your body, and to prevent further fractures and loss of height from occurring. I thank you for your interesting question.

Dr. Steven Garner is affiliated with New York Methodist Hospital in Park Slope. He is a Fidelis Care provider. He also is the host of the popular call-in cable TV program “Ask the Doctor” seen on The Prayer Channel.