NIH panel issues consensus report on osteoporosis

March 29, 2000
Web posted at: 3:58 p.m. EST (2058 GMT)

By Rhonda Rowland

BETHESDA, Maryland (CNN) -- The National Institutes of Health announced recommendations Wednesday on ways to prevent, diagnose and treat osteoporosis, a disease marked by thin, brittle bones that affects about 10 million people in the United States, most of them women.

The recommendations are intended to help doctors diagnose the disease and decide when to prescribe drugs to treat it. They also give prevention advice in the form of nutrition guidance for children and young adults whose bones are still developing.

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The guidelines were developed by an independent panel that met this week at NIH. The last such conference on the disease took place in 1984.

Osteoporosis defined

The panel members defined the disease as "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture." Bone weakness may result from mineral loss, inadequate bone development during childhood and adolescence, or both. The consequences go beyond fractures to include psychosocial effects resulting from decreased mobility, and a financial impact estimated at $10 to 15 billion annually.

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Osteoporotic fractures affect women more than men, and whites more than non-whites. They are the cause of Dowager's hump, the result of spinal fractures that can leave sufferers unable to stand straight. Hip fractures often lead to permanent disability and death.

"The bone mass attained early in life is perhaps the most important determinant of life-long skeletal health," the report said. It cited good nutrition and calcium intake during youth and young adulthood as important in preventing the disease. The panel said children 3 to 8 years of age should receive 800 mg. per day of calcium; children 9 to 17 should consume 1300 mg. per day, and older adults should get between 1000 and 1500 mg of calcium per day.

The consensus report said anyone with more than one risk factor for osteoporosis should consider undergoing a bone-density measurement. Exercise, calcium, vitamin D, hormone-replacement therapy, selective estrogen-receptor molecules such as Raloxifene, and learning to prevent falls can all reduce a person's risk of fracture.

More research needed

The panel called for more research into ways to increase peak bone mass during youth, investigation into the effects of a deficiency of calcium and vitamin D during youth, and study of genetic factors that lead to osteoporosis. Also, research is needed into treatments for osteoporosis caused by drugs prescribed for other ailments, more accurate data regarding ethnicity and osteoporosis risk, ways to improve quality of life in osteoporosis patients and better ways to identify people at risk for the disease.

"There is an urgent need for a randomized clinical trial of combination therapy," they said.

Osteoporosis was once thought to be an inevitable part of aging, but that view has changed as progress has been made against the disease.

In 1984, treatments for osteoporosis were limited to calcium, vitamin D, supplemental estrogen and fluorides. Fluoride treatment was halted after it was found ineffective. Estrogen remains effective, but can increase breast cancer risk.

Drug treatments available

Since the 1980s, the Food and Drug Administration has approved several osteoporosis drugs. Alendronate, or Fosomax, can reduce the incidence of fractures of the spine, arm and leg, but it irritates the esophagus in 10 percent of patients. Risedronate, or Actonel, is as effective as Fosomax in preventing fractures but without the same side effects. Another option, raloxifene, or Evista, prevents spinal fractures, but there is no evidence it prevents other fractures.

The new medications do not necessarily build bone, so they don't help women who've already suffered a fracture. Researchers are hoping other agents now under study will form bone.

The panel said the biggest barrier to treatment is awareness. Only one third of spinal fractures are detected.

"Twice as many spine fractures, a half million a year, go undetected and show up as height loss or chronic back pain," said Dr. Nelson Watts, an endocrinologist at Emory University School of Medicine. "Patients who have that first-time fracture need to be treated."

Spinal x-rays and bone biopsies used to be the only way for doctors to measure bone mass. But x-rays cannot detect less than a 20-percent decrease in bone density, and biopsy required specialized equipment and expert analysis.

In the late 1980s, bone densitometry emerged as an effective screening tool. It's easy to do and requires only low doses of radiation.

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Osteoporosis and men
June 18, 1999
Osteoporosis: You can prevent it
June 2, 1999

National Osteoporosis Foundation
The Foundation for Osteoporosis Research and Education

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