The Silent Disease
Bone is a metabolically active tissue which continuously remodels itself by breaking down old bone and replacing it with new bone. Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body or both. The leading causes of osteoporosis are age, genetic factors and low body weight. Aging leads to osteoporosis partially due to the drop in estrogen menopause; a drop in testosterone with age occurs in some men. In addition, aging of the cells in the bone that make new bone is an important cause. Genetic factors are the most important factor to for peak bone strength (attained in women in the early 20s and in men in the mid 20s) and an important contributor to bone loss with age.
Osteoporosis is often called “the silent disease” because bone loss usually occurs gradually over the years without symptoms. Many people aren't aware that they have osteoporosis until they either have a bone densitometry test (DXA) or have a minor fall which causes a bone to break. Often, this “fragility fracture” (a fracture resulting from a mild fall from standing height) is the first sign of osteoporosis.
Dr. Streeten says that when someone is diagnosed with osteoporosis, it is important to investigate for causes of osteoporosis other than aging.
“After diagnosing osteoporosis, it is important to do a complete history, physical exam and lab work to look for secondary causes of osteoporosis other than age, such as vitamin D deficiency, excessive loss of calcium in the urine and chronic use of medications that weaken bone, such as Prednisone. Up to one half of men and one third of women have an underlying secondary cause of their osteoporosis.”
According to Dr. Streeten, patients diagnosed with osteoporosis should have lab tests including a chemistry panel (for kidney and liver function, blood calcium), a complete blood count (to evaluate for anemia), a vitamin D level [called 25(OH)D], a thyroid test (TSH) and a spot urine or 24 hour urine test for calcium. Patients with severe osteoporosis with multiple fractures often require further tests.
To make an appointment with Dr. Streeten at the Metabolic Bone Diseases Clinic, please call 410-328-5196, 410-328-6219, or toll-free at 1-800-492-5538.