Osteoporosis Often Goes Undetected by Physicians

Many physicians are failing to identify and treat osteoporosis in postmenopausal women, according to a new survey in the American Journal of Public Health.¹ Osteoporosis is degeneration of the bone that often leads to hip, spine, and wrist fractures and affects as many as 30% of all women over the age of 65. This new report suggests that millions of postmenopausal women with osteoporosis are likely unaware of their condition and may be at increased risk of breaking a bone.

Osteoporosis can be difficult to diagnose since there are usually no symptoms until a fracture occurs. The National Osteoporosis Foundation recommends that postmenopausal women older than 65 years or women who are at increased risk (for example, those taking cortisone and related drugs) get bone mineral density testing, although not all experts agree. The authors note that osteoporosis accounts for three million office and hospital visits in the United States each year, costing almost $14 billion. They feel that attention to appropriate diagnosis and treatment of a preventable disease “should be considered a public health priority.”

For women with osteoporosis and those who are at increased risk of developing the disease, evidence suggests that certain nutritional supplements can prevent and may even reverse bone loss. Studies have shown that taking 800 to 1,000 mg of supplemental calcium per day can reduce the rate of bone loss in postmenopausal women.^{2 3} Most,^{4 5}but not all,⁶ studies have shown that ipriflavone, a synthetic compound chemically related to substances found in soy, can prevent and reverse osteoporosis. The recommended amount is 600 mg per day. However, as ipriflavone can occasionally cause a decrease in white blood cell counts, it should be taken only under the supervision of a doctor. Taking 400 to 800 IU of supplemental vitamin D each day may reduce bone loss in women with osteoporosis, especially if their diet is deficient in vitamin D.⁷ Other evidence suggests that the efficacy of vitamin D may be enhanced when taken with calcium.⁸

Other nutrients are important for bone growth and may help improve the integrity of bone in women with osteoporosis. Preliminary evidence suggests that fish oil, vitamin K, magnesium, vitamin C, zinc, copper, boron, manganese, silicon, and strontium may all play a role in developing healthy bones.⁹ Most of these nutrients can be found in a high-potency multivitamin-multimineral supplement. A physician should be consulted for specific intake recommendations.

In this recent study, primary care physicians in the United States, including family physicians, general practitioners, obstetricians, gynecologists, and internists, were questioned about the age, sex, diagnosis, and treatment of all patients seen during the course of one week. From this information, the researchers determined how many white women over age 60 had received a diagnosis of osteoporosis or fractured spine (a common manifestation of osteoporosis).

The researchers found that the diagnosis of osteoporosis or spinal fracture was extremely uncommon, relative to what has been reported in prior epidemiological studies. Less than 3% of the women studied were identified as having osteoporosis, compared with a national prevalence of almost 30% in women of similar age. The proportion of women diagnosed with osteoporosis increased to just over 4% in women over 80 years of age. The survey also found that more than 45% of women with known osteoporosis were not receiving any treatment for their condition.

References:

1. Gehlbach SH, Fournier M, Bigelow C. Recognition of osteoporosis by primary care physicians. Am J Public Health 2002;92:271–3.
2. Reid IR, Ames RW, Evans MC, et al. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 1995;98:331–5.
3. Ruml LA, Sakhaee K, Peterson R, et al. The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized, placebo-controlled study. Am J Ther 1999;6:303–11.
4. Ohta H, Komukai S, Makita K, et al. Effects of 1-year ipriflavone treatment on lumbar bone mineral density and bone metabolic markers in postmenopausal women with low bone mass. Horm Res 1999;51:178–83.
5. Agnusdei D, Bufalino L. Efficacy of ipriflavone in established osteoporosis and long-term safety. Calcif Tissue Int 1997;61 Suppl 1:S23–S27.
6. Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA 2001;285:1482–8.
7. Dawson-Hughes B, Dallal GE, Krall EA, et al. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 1991;115:505–12.
8. Pfeifer M, Begerow B, Minne HW, et al. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 2000;15:1113–8.
9. Gaby AR. Preventing and Reversing Osteoporosis. Rocklin, CA: Prima Publishing, 1995.

Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of Garlic and Cholesterol: Everything You Need to Know (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice in Westport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.

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