Sounding Up Against The Silent Disease

Osteoporosis can be put off for as long as possible

Most people think that certain conditions that come with ageing are inevitable, so they deal with these conditions rather fatalistically. They take it for granted that these are just the way things are, that it is but a natural fact of ageing that they develop heart disease, or go deaf, or be totally infirm. They go, "These are bound to happen anyway."

    But the fact is ageing doesn't have to be painful or troublesome. Why accept them as natural, when they can be put off for as long as possible, if not totally banished? As always said in sports competitions, it is always worth fighting a good fight.

    One of the conditions that need not be accepted as a natural course of ageing is osteoporosis.

    At present, hundreds of millions of people-most of them women-are believed to be suffering from this "silent killer." Silent, because many of those suffering from it don't realize they have the disease until their first fracture. Data from the National Osteoporosis Foundation show that one in four women 50 years or older have the disease, while one out of eight of their 70 and above male counterparts have the disease. If current trends continue, the International League against Rheumatism projects 1.5 million Asian women will suffer from hip fractures owing to osteoporosis by 2025, and the number will double by 2050.

    While the dramatic physical manifestations of the disease surface only later in life, bone damage could actually set in much earlier. That's why people at risk of succumbing to fractures from osteoporosis should be immediately identified.

    In 1996 an international panel of experts came up with the concept of preventing the first fracture. For one, asymptomatic patients who have not yet experienced any fracture but have low bone mass are more susceptible to experiencing fracture. For another, the possibility of fracture increases 1.5 to 2.5 times for every SD below mean PBM in healthy 25 to 35-year-olds. For yet another, there is an inverse relationship between bone mass and fracture rate. Lastly, immediate identification of high-risk patients who have not yet had any fracture allows for early intervention that entails the prevention of bone decay and events leading to the first fracture. It has been noted that those who have had an osteoporosis-related fracture are at a fivefold risk of suffering a second fracture. For those who have low bone mass and a previous vertebral fracture, their relative risk for a second fracture goes as high as 24-fold.

    For patients who are considered high-risk, various methods of diagnosis are employed, such as the filling out of risk questionnaires, which identify exposure to risk factors as well as information on calcium intake, race, estrogen level, body weight, history of fractures, coffee and alcohol intake, smoking history, and age.

    But for a more detailed determination of osteoporosis risk, bone mineral density (BMD) is determined via central dual-energy X-ray absorptiometry (DXA). But not all women need to be subjected to BMD testing. The US National Osteoporosis Foundation recommends BMD testing for the following groups: all women 65 years or older; postmenopausal women under 65 with one or more identified risk factors (aside from menopause) for developing osteoporosis; postmenopausal women who have had a fracture; women who have low BMD but are considering hormone replacement therapy; and women under long-term HRT.

    DXA accurately measures BMD in key skeletal sites-spine, hip, and wrist. BMD is measured in grams per square centimeter, with a corresponding T-score. Every standard deviation from what is considered normal-meaning a T-score higher than -1-translates to about a twofold risk of a fracture. A T-score lower than -2.5 indicates osteoporosis. J. P. de Guzman