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Medical Articles »Stephen Conrad, M.D.
Osteoporosis in the Workplace
Stephen Conrad, M.D.
Orthopedic Surgery
Osteoporosis is an increase in the porosity of the bone. It is a condition that affects many of us later in life and results in an increase in skeletal fragility, with a tendency to fracture.
Skeletal studies indicate that we increase bone mineral content and strengthen our bones until approximately the age of 33. After this, both men and women experience a progressive decline in bone mineral and strength.
Women are affected to a greater extent then men; women lose bone mineral at the rate of .5% per year, and men, at the rate of .3% per year (type II osteoporosis). At menopause, there is a rather sudden decrease in estrogen production in women. This has many effects, ranging from hot flashes to accelerated loss of bone mineral. Women lose this bone mineral at the rate of 2 to 3% per year, during the 6 to 10 years following menopause (type I osteoporosis). Following this rapid decline in bone mineral, women then resume bone loss at its former, relentless rate of .5% per year.
Although these rates of bone loss may seem insignificant, when they are considered over a lifetime, they are more impressive. By the age of 65, at the end of our working career, most women have lost 33% of their bone mass due to the combined effects of type I and type II osteoporosis. Men have lost 10 % due to the effects of type II osteoporosis. Therefore, both men and women experience significant increase in skeletal fragility and a propensity for fracture. Studies indicate a significant increase in wrist, spine, and hip fractures, in both men and women, but especially in women after menopause. As our bones become more fragile, they fail with less impact and fracture with greater fragmentation (communition). Although the fractures inevitably heal, they do so with a significant decrease in function.
A loss in bone mineral, and therefore bone strength, occurs in all of us after the age of 33. However, some individuals are affected more than others. Women of northern European ancestry, who have fair complexions, seem to be affected to a greater extent. Individuals who smoke, are sedentary, and have poor dietary and health habits, are at higher risk. Osteoporosis can be partially prevented by the ingestion of calcium and vitamin D. Exercise is also helpful, however, excessive exercise, especially in women, can be detrimental due to interference with estrogen.
Hormone Replacement Therapy (HRT), for post-menopausal women, remains controversial. The side effects include an increase in the possibility of breast cancer (from 12 cases per 100 women to 14 cases per 100 women) and a slight increase in uterine cancer. Nevertheless, there is ample evidence to show that estrogen replacement, during the post-menopausal phase, ameliorates the affect of estrogen deprivation, and reduces the impact of type II osteoporosis. Moreover, there is evidence that estrogen replace therapy reduces the incidence of cardiac disease in women. There are many other treatments for osteoporosis and promising new cures on the horizon. Nevertheless, as in all diseases, an ounce of prevention is worth a pound of cure.
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