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Focusing on bone health

June 7, 2012
By GARRETT NEESE - DMG writer ( , The Daily Mining Gazette

HOUGHTON - The susceptibility to fractures that comes with osteoporosis can lead to a downturn in quality of life. But it is possible to prevent or manage its effects.

Bones can become thinner and less dense over time when calcium and phosphate are reabsorbed into the body.

It most commonly starts in patients older than 50. For women, the most typical cause is the drop in estrogen that accompanies menopause, said Marilyn Dewald, a doctor at Aspirus Keweenaw Medical Arts in Houghton; a rarer cause is physically demanding activities such as heavy running or professional dancing that affect cycles. Men experience their own drop in testosterone levels after age 50. Osteoporosis will affect half of all women older than the age of 50; for men, it's a quarter.

Article Photos

Garrett Neese/Daily Mining Gazette
Kim Peltier of Hancock pushes her son Grady, 5 months, in a stroller along the waterfront trail in Houghton Wednesday. Regular walking and other weight-bearing exercises are among the methods recommended to reduce the risk of osteoporosis.

Things such as excessive smoking and alcohol use can make osteoporosis occur earlier. Along with avoiding those pitfalls, Dewald also recommends getting sufficient calcium (1,000 milligrams a day, or the amount found in three 8-ounce glasses of milk) and getting the right amount of vitamin D. On average, people should be able to receive a proper amount of vitamin D through 15 to 20 minutes a day of sunshine.

The official recommendations are for 400 to 800 units a day for people younger than 50, rising to 1,000 units per day for 50 and older. But that's for areas with more regular exposure to the sun.

"Some specialists are recommending if you're far north like we are, 2,000 units a day for people over 50," Dewald said.

Treatments are focused on optimizing the levels of calcium and vitamin D. Popular drugs such asa Fosamax slow down the reabsorption of nutrients into the bone. However, in rare cases, people who take the drug for long periods of time may develop a rare jaw disorder causing swelling and infection.

"The worry is, if you don't let the bone turn over, the bone may become kind of brittle," Dewald said.

A drug used for women is Evista, which stimulates the bone like an estrogen; that has its own drawback in the form of hot flashes, Dewald said.

Myacalcin is used for bone pain from compression fractures in the back. Formerly taken in shot form, it now comes as a nasal spray administered once daily.

The strongest medication, Dewald said, is Forteo, which instead of reducing the breakdown of the bone, speeds up how quickly bone builds. There are downsides with that, too: Though humans have not been found to be affected, some animals have gotten osteocarcoma, a type of cancer. A less serious minus is the cost: A daily injection costs $600 a month. However, many insurers will cover it if people have unsuccessfully tried other medications, Dewald said. The drug can currently be taken for two years.

It's been successful in one patient who had previously suffered a collapsed backbone, Dewald said.

"They were actually put on Forteo and haven't broken another bone in two years," she said.

In most cases, osteoporosis will be a chronic, though perhaps manageable, condition. But some people can actually regain normal density, Dewald said.

One tool for early detection is a bone density scan, which looks at the hip and back area to determine changes over time. Another is a calculator that takes into account factors such as bone density, age, sex, hormonal status and computes the 10-year fracture risk.

"The people with the highest fracture risk are the ones who benefit the most from being on medication," Dewald said.



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