Managing Your Menopause Type^® Educational Class

Session Three - Your Risks of Disease

Osteoporosis

Osteoporosis is a condition that affects postmenopausal women at an alarming rate. There is a decrease in bone mass and decreased bone density with enlarged spaces in the bone making them more porous and fragile. Osteoporosis can cause an increased risk for fractures of the wrist, the spine and the hip in women. Hip fractures are the most devastating consequence of osteoporosis. About 50% of women who have had a hip fracture are subsequently unable to walk without assistance and 25% require permanent long-term care. As many as 20 to 25% of women who fracture their hip will die within the first year after the fracture.

Osteoporosis is a “silent disease” - a disease without symptoms. You do not feel osteoporosis, you feel the consequences of it. Women who develop osteoporosis may not know they have it until they have a fractured bone. The vertebrae (spinal bones) may collapse and cause severe back pain, or there may be no pain at first - only a loss of height. When you see a postmenopausal woman who has said she is "shorter", or has the "Dowagers hump" (kyphosis) or a stooped posture, you are seeing the effects of osteoporosis. Osteoporosis can also result in tooth loss, due to bone loss in the jaw.

There are a number of bone study tests available. These tests can be used to evaluate the risk for developing osteoporosis, or the degree of osteoporosis, if it is already present.

Bone Study Tests fall in two major categories:

Bone Densitometry: tests that measure the actual density of the bone using radiography
(X-rays) or ultrasound.

There are many different ways to measure how dense, or how strong, your bones are. Typically, when you go to a healthcare professional for bone densitometry you will be tested with one of the following methods.

Dual Energy X-ray Absorptiometry (DEXA) - a special type of X-ray

Single Energy X-ray Absorptiometry (SXA) - a special type of X-ray

Quantitative Computed Tomography (QCT) - similar to a CAT scan

Radiographic Absorptiometry - a special type of X-ray

Radiogrammy - a special type of X-ray

Conventional Radiographic Reading - a regular X-ray

Quantitative Ultrasound - many different types of machines that use ultrasound instead of type of X-ray

Biochemical Markers: Lab tests that measure the metabolism of bone and how fast it is being broken down or rebuilt. These lab tests measure the rate of the bone formation (building) or bone resorption (breaking down and absorbing) by measuring substances in your serum (blood) or urine.

To fully understand how we can learn about your bones by testing blood and urine, it is important to know basic bone metabolism.

Bones consist of living tissue as well as mineral deposits, such as calcium, phosphorus, fluoride, magnesium, iron, zinc, copper, manganese, etc. Like all living tissues, bone needs nourishment to stay strong and healthy. Bone is constantly being broken down and being rebuilt in a process called remodeling. Remodeling has two parts to it.

First, there is bone resorption, in which bone is being broken down and re-absorbed back into the blood. Bone resorption is accomplished by certain bone cells called osteoclasts. An easy way to remember what osteoclasts do is "osteoclasts clear away bone".

Next, there is bone formation, in which new bone is being formed. Bone formation is accomplished by certain bone cells called osteoblasts. An easy way to remember what osteoblasts do is "osteoblasts build bone".

Normal bone remodeling tells a lot about how healthy your bones are. Measuring bone formation (osteoblast activity) and bone resorption (osteoclast activity) can determine your risk for osteoporosis.

Bone Formation Lab Tests that measure osteoblast activity include:

Total Alkaline Phosphatase - a blood test

Bone Specific Alkaline Phosphatase - a blood test

Osteocalcin - a blood test

Procollagen type 1 carboxy-terminal propeptide (P1CP) - a blood test

Procollagen type 1 amino-terminal propeptide (P1NP) - a blood test

Bone Resorption Lab Tests that measure osteoclast activity.

C-Telopeptide (crosslaps, CTx) – blood or urine

N-Telopeptide of type 1 collagen (NTx) - blood or urine

Pyridinium (Pyd) - urine

Deoxypyridinium (D-Pyd) – urine

Hydroxyproline ) – urine

Tartrate-Resistant Acid Phosphatase (TRAP) – blood or urine

In the clinical setting, physicians and other healthcare professionals will use bone densitometry to determine the degree of bone loss that has already occurred and blood or urine tests to determine if the bone loss is continuing, and the rate of bone loss.

An ideal way to measure bone loss is to evaluate urinary levels of both pyridinium (Pyd) and deoxypyridinium (D-Pyd). If both of these are elevated, it strongly suggests that there is an increased rate of bone loss taking place. Therapies to preserve bone should be started under such circumstances. Because this is a urine test, and does not require blood draw, follow-up testing is easier.

Other tests may be ordered for a more in depth osteoporosis evaluation work-up if necessary such as Vitamin D levels, calcitonin or other hormones that can affect bone health, including estradiol, progesterone and testosterone.

What this means to you

Knowing your risk for osteoporosis will allow you to make choices to decrease those risks.

As noted, an ideal way to measure bone loss is to evaluate urinary levels of both pyridinium (Pyd) and deoxypyridinium (D-Pyd).

In addition to weight bearing exercise such as walking, and a healthy diet, postmenopausal women should also take 1,000 to 1,500 mg of calcium a day, as well as 400 to 800 I.U. of Vitamin D a day. Consider using microcrystalline hydroxyapatite concentrate (MCHC) as your source of calcium supplementation. MCHC is a complex crystalline compound derived from bone of free-range cattle. It is composed primarily of calcium, phosphorus, delicate organic factors and protein matrix, and a full spectrum of trace minerals that naturally comprise healthy bone.

A follow-up urinary levels pyridinium (Pyd) and deoxypyridinium (D-Pyd) should be done after you have been on a healthy bone program for a few months.

What's Next?

Learn how to determine your risk for heart diseases, and what you can do to prevent and even reverse these life-threatening diseases.

The Managing Your Menopause Type® Educational Class is provided to the public without charge. This information is provided for education purposes only, and is not intended to prescribe treatment. Consult a physician, pharmacist or other healthcare professional regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.