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Osteoporosis Up Close and Personal: An Osteopathic Perspective

E-mail: DOCMABY{at}msn.com

Of all the chronic disabling diseases that threaten us as we age, osteoporosis is the one I relate to and fear most, perhaps because I am a woman whose great-grandmother sustained a hip fracture that shortened her life expectancy. Or, perhaps it is because I am aware of the rapid bone loss I will be facing when I enter menopause. But even more so, I believe it is because of my training in osteopathic medicine. Osteopathic medicine is founded on three principles: the principle of the body unity, the principle of the healing power of nature, and the principle of structure and function interrelationship.

It is in this last category of the interrelationship of structure and function that the principle of osteopathic medicine is proven microscopically and grossly in osteoporosis. Microscopically, the structure is altered when the increase in bone turnover leads to microarchitectural deterioration and defects in bone quality that predispose patients to an increased risk of fracture. Grossly, when patients sustain fractures, the gross structure of the bone is altered, leading to a dramatic loss of function. For example, 50% of hip fracture survivors are permanently incapacitated, requiring assistance with activities of daily living, though they were previously independent.¹

In the early 1990s, the US Food and Drug Administration-approved pharmacologic therapy for osteoporosis was limited to injectable calcitonin and estrogen. By 2002, the arsenal against osteoporosis had multiplied with the approval of calcitonin-salmon nasal spray, raloxifene hydrochloride, risedronate sodium, alendronate sodium, and teriparatide (a synthetic form of parathyroid hormone). Then came the Women's Health Initiative study results published in July 2002, removing estrogen—one of the therapeutic modalities we had grown most familiar with—from our armamentarium.

In this JAOA Supplement, James R. Shoemaker, DO, and Frederick T. Murphy, DO, and their coauthors summarize the symposium titled "What Is Going on With Hormone Replacement and How to Deal With the Osteoporosis Fallout," presented at the 40th Annual Convention of the American College of Osteopathic Family Physicians. Doctors Shoemaker and Klemes review the three pivotal studies on estrogen that have altered not only our approach to the use of estrogen in our offices but also the hormone's package labeling. The article by Dr Murphy et al addresses the options that remain available to us, highlighting their respective safety, speed of action, and efficacy. Additionally, Dr Murphy and associates remind us when managing osteoporosis, we must treat the whole patient—not merely dispense prescriptions—and counsel patients on nutrition, lifestyle habits, and falls reduction.

As recent literature has shown, we underrecognize and undertreat our osteoporotic patients—even those with hip fracture, "a group at very high risk for additional fragility fractures."² Therefore, I would like to reemphasize the National Osteoporosis Foundation (NOF) guidelines for diagnosis as presented by Dr Murphy et al. The NOF recommends bone mineral density testing in the following:

• all women aged 65 years and older regardless of risk factors;
  
• younger postmenopausal women with one or more risk factors (other than being white, postmenopausal, and female); and
  
• postmenopausal women who present with fractures (to confirm diagnosis and determine disease severity).
  

For more information, contact the NOF at www.nof.org.

	Footnotes

 
Dr Maby is the director of the Medical House Call Program at North General Hospital in Harlem, NY, and she is a clinical assistant professor in the Department of Medicine at the New York College of Osteopathic Medicine of New York University of Technology in Old Westbury, NY.

Dr Maby has received past grant support from Merck & Co, Inc, and she is a consultant to Eli Lilly and Company, Novartis, and Procter & Gamble Pharmaceuticals. She is also on the speakers bureau of Eli Lilly and Company and Novartis.

	References

Top References

 
1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med.1993; 94:646 -650.[Medline]

2. Harrington JT, Broy SM, Derosa AM, Licata AA, Shewmon DA. Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum.2002; 47:651 -654.[Medline]

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