Dr. Lynn Kohlmeier believes osteoporosis is a problem that not only wont go away in the near future, its going to get worse.


Kohlmeier, an endocrinologist with the Spokane Osteoporosis Center, at Deaconess Medical Center, is on a mission to educate, test, and treat residents in the Inland Northwest who likely are at risk for the diease, but dont realize it. She says osteoporosis, characterized by an accelerated loss of bone mass and fractures, is a silent disease because there are no outward signs or pain associated with the loss of bone mass that the disease causes. Aging baby boomers, more women experiencing menopause, poor diet, and sedentary lifestyles are just a few of the reasons for Kohlmeiers alarm.


There will be more osteoporosis cases for thousands of reasons, such as people not getting enough calcium, or not getting enough exercise. Its going to get worse, she warns. We can make a difference at every stage. Its never too late, and its never too early.


Osteoporosis can cause bones to become very brittle and to fracture easily. The bones that are most likely to break are the hip, spine, and wrist. Those fractures take longer to heal than in someone who doesnt have the disease, and sometimes require surgery, such as to replace a hip.


The cause of the disease generally is attributed to calcium loss, which makes the bones porous. Bones break down as part of the natural aging process because the body cant produce new bone as quickly as it could when it was younger.


Women are much more susceptible to the disease with the onset of menopause, when a womans ovaries stop producing the hormone estrogen, which protects against bone loss.


The National Osteoporosis Foundation estimates that 10 million people in the U.S. who have osteoporosis and an additional 34 million people have low bone mass. Of those who have the disease, 8 million are women.


Efforts to combat the disease have met with some successes, but also difficult setbacks.


In February, the federal government stopped a study examining the effects of hormone-replacement therapy because the therapy hadnt produced a reduction in heart disease and had increased the risk of stroke. Earlier, the government halted a study that monitored estrogen and progestin in healthy, menopausal women because the hormone replacements appeared to increase the risk of breast cancer, heart disease, blood clots, and stroke. That led many women to stop taking hormone replacements, Kohlmeier says.


Because a lot of women are coming off estrogen, they need a bone density test within six months, says Kohlmeier. I am very concerned about the risk of bone lost (when women come) off of estrogen.


She warns that many nonprescription hormone replacements dont prevent osteoporosis.


Over-the-counter estrogen and other natural forms of estrogen may help menopausal symptoms, but they likely will not prevent bone loss, says Kohlmeier.


Osteoporosis occurs most often in post-menopausal women, who have a 40 percent chance of developing the disease, and the consequences can be dire. The Osteoporosis Foundation estimates the disease causes 1.5 million fractures a year, and a recent national study found that an average of 24 percent of hip-fracture patients over the age of 50 die within a year after suffering a fracture.


The most recently available local data along these lines, gathered by the Spokane Regional Health District, showed that in 1999 there were 940 hip fractures in Spokane for every 100,000 people21 percent higher than the state average of 743 hip fractures for every 100,000 residents.


We dont know why that is, says Kohlmeier.


In addition to hip fractures, osteoporosis victims can suffer from compression fractures of the spine. Those fractures change the alignment of the spine, often resulting in reduced height or poor posture. That can cause a myriad of problems, including chronic pain, impaired balance, and decreased lung function.


If a person has two spinal fractures, their risk for another fracture within a year increases 25 percent, says Kohlmeier. They dont think about their risk of fracturing again, but its there.


The cost of osteoporosis is quite substantial. Its estimated that the national direct expenditures at hospitals and nursing homes caused by the disease and associated fractures were $17 billion in 2001, according to the National Osteoporosis Foundation.


Battling osteoporosis


Theres no cure for osteoporosis, but several drugs are believed to either prevent or slow the progression of the disease and in some cases strengthen weakened bone.


The Spokane Osteoporosis Center is enrolled in several national studies that measure the effectiveness and tolerance of drug therapies over extended periods.


Two prescription medications, Actonel and Fosamax, are being compared in a two-study that has more than two dozen people participating, Kohlmeier says. Those drugs are believed to increase bone density and make bones stronger and reduce fractures, Kohlmeier says.


Another prescription drug Spokane-area osteoporosis sufferers are using is Forteo, which is whats known as a parathyroid hormone and is designed to improve bone quality, Forteo is not part of the study. Those patients who have the worst symptoms of osteoporosis often are prescribed the drug, Kohlmeier says.


Bone quality generally refers to bone structure and damage bones already have suffered. Forteo is injected into the body daily and can be taken for only two years under FDA guidelines. The prescription costs about $600 a month.


We are seeing great results with Forteo, and predict it is improving bone quality as well as bone density, says Kohlmeier. After two years (of being on Forteo), patients will go back to other therapies such as Fosamax and Actonel.


Evista, another prescription drug, is a designer estrogen that helps build bone, and it has shown signs of being safer for the heart and breast than estrogen, Kohlmeier asserts.


In addition to drug therapies, Kohlmeier says, exercise, a proper calcium-rich diet, and vitamin D are the best ways to combat the disease. Just spending 15 minutes in direct sunlight every day can be beneficial, she says.


Getting tested


Osteoporosis risk factors include being thin or small, early menopause, eating disorders, smoking, excessive alcohol intake, sedentary lifestyle, previous fractures, and taking steroid medications. Post-menopausal women who arent on estrogen replacement and people over the age of 65 also have a higher risk of getting the disease.


A bone-density test can help determine if a person has osteoporosis or could develop it later. The test is similar to an X-ray. Technicians can test the hip, spine, or heel.


There are 20 bone-density testing machines in the Spokane area. Five years ago, there were only five, says Kohlmeier. Despite the availability, people are not getting tested enough.


The Osteoporosis Resource & Screening Center, in the Deaconess Health and Education Center at 910 W. Fifth, offers free bone-density tests on Mondays and Thursdays between 9 a.m. and noon and between 3 p.m. and 5 p.m. Kohlmeier recommends that people over age 65 have the test, which is done on the heel with ultrasound. The test only takes about a minute. Kohlmeier says Valley Hospital will begin offering such free tests in late October.


Kolhmeier says the heel test is important, although, its not a sufficient replacement for hip and spine tests, which are comparable in their reliability.


The heel test is a one-time test, she says. You cant compare heel tests. But it helps pick up people that might not realize they are at risk.


Osteoporosis patients should try to have regular tests performed at the same location as their initial tests because bone-density tests are not easily comparable when done on different machines because of the way the machines have been calibrated, says Kohlmeier.


The Spokane Osteoporosis Center also focuses on bone-density tests on people who have had hip placements. Kohlmeier says the center can test the bone density around metal, which she says is difficult to do. All of the hip replacements she has seen have metal parts. She believes its paramount that patients who have suffered fractures receive routine bone-density tests.


Of all hip-replacement fractures, only about 15 percent of the people take a bone-density test or get treatment, Kohlmeier says. Once theyve had the fracture, they think they wont have another one. Its important to continue seeking medical therapy for osteoporosis and prevent falls.


Some believe that bone microarchitecture or structure degrades as the disease progresses. Major scientific strides could be made in understanding and repairing bones within the next five years as imaging technology improves, giving doctors a better idea of how to improve bone quality, Kohlmeier says.


I believe virtual bone biopsies will be available in the future, says Kohlmeier. We cant clinically measure bone quality yet.


Kohlmeier teaches a series of prevention and education classes about osteoporosis to people in the community. She also trains technicians, who perform bone density tests.