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Osteoporosis is a thinning of the bones to the point of brittleness. Osteopenia is a loss of bone mass and is a precursor to osteoporosis.
Osteoporosis can progress painlessly until a bone fractures – typically in the hip, spine, and wrist. Any bone can be affected, but fractures of the hip and spine are a major concern as they almost always require hospitalization, major surgery, and can impair ability to walk unassisted. Spinal or vertebral fractures also have serious consequences including loss of height, severe back pain, and prolonged or permanent disability.
Most bone mineral content, which strengthens bones, is established in the first 20 to 30 years of life. Adequate levels of calcium and vitamin D are essential in maintaining bone density. Vitamin D helps the body absorb calcium. Because people with cystic fibrosis often have trouble absorbing vitamin D, they are at risk of developing osteoporosis. Other risk factors influencing the onset of osteoporosis include:
Treatment with corticosteroids (which can lead to calcium loss)
Diagnosis of osteoporosis is made through the use of a test called a bone mineral density (BMD). The most common BMD test in use today is called duel energy x-ray absorptiometry. A BMD is completed by lying on a table for several minutes while a small X-ray detector scans in three locations: hip, spine and wrist. The test is safe, painless and accurate, allowing physicians to understand if medications to help strengthen bones are required.
Building strong bones, especially before the age of 30, can be the best defense against developing osteoporosis. A healthy lifestyle, including good nutrition, adequate food intake, and proper supplementation, is critical to keep bones strong. The recommended daily calcium intake is 1000 mg for ages four to eight, 1300 mg for ages nine to 18, and 1000 mg for adults. A glass of milk or cup of yogurt contains approximately 300 mg of calcium. However, the easiest preventative measure is increasing activity. An increase in weight-bearing activity can help gain five percent in bone mass, which reduces a 40 percent lifetime risk in developing osteoporosis, and has the added benefit of maintaining better lung function.
Prevention is best, but some promising treatments for established osteoporosis are available. However, these still need to be properly assessed in CF care. The search for appropriate therapies to cure and prevent osteoporosis in cystic fibrosis is vital.
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