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Seven years ago, when she was 60, Susan Schaalman Youdovin was jogging in Germany and “tripped over a piece of air,” as she puts it. She broke her left arm—but didn’t even realize what had happened until she visited her doctor several months later. “This [osteoporosis] is a completely asymptomatic disease,” explains Youdovin’s doctor, Beatrice Edwards, a geriatrician who directs the bone health and osteoporosis program at Northwestern’s Feinberg School. Youdovin went on the treatment drugs Actonel and Forteo, and she is now taking Reclast. Today, at 67 years old, 95 pounds, and four feet 11 inches (three inches shorter than when she was younger), Youdovin wears a brace to stay erect. But she feels lucky that modern medicine is paying attention to her ailment.
Bone loss is a major female health issue. Three-quarters of all fractures occur in women, and more than 40 percent of women will suffer at least one fracture at some point in their lives. From age 30 on, both genders lose about 1 percent of bone mass per year, but the rate speeds up for women when they go through menopause. At that point, “the breakdown of bone far exceeds what the bone replacement process can keep up with,” says Murray Favus, the director of the bone program at the U. of C. Medical Center. In all, women typically lose 15 to 20 percent of their bone mass in the decade following menopause—and the loss might even be greater if left untreated.
The consequences can be serious. About a quarter of all postmenopausal women suffer fractures in their vertebrae (though only a third receive medical attention). Hip fractures also pose a big, expensive problem. But breaks in tiny bones can be equally disabling. In a study published this year in the British Medical Journal, Edwards reported that even a simple wrist fracture contributes to functional decline in older women, who run into trouble cooking and cleaning. “Even such a small fracture has an impact on the ability to stay in the community,” says Edwards.
Though medications are available, one problem with osteoporosis is that it often goes undiagnosed. “Bone loss is as common as hypertension,” says Edwards. “But unlike hypertension, it’s only identified in 15 percent of cases.”
Bone density is the standard clinical measure for assessing bone strength, but it only predicts 70 percent of fracture risk. (Women whose mothers had osteoporosis or who have a history of anorexia nervosa, and, as a result, formed less bone mass as teens, are considered particularly susceptible.) At the U. of C. Medical Center, Dr. Tamara Vokes, an endocrinologist, is studying another measure—called radiographic texture analysis—that looks at the pattern of bones. Coarse bone patterns—that is, bones exhibiting a more textured surface—seem to be more durable. “You could think of it as having a scaffolding that’s strong,” says Vokes. She wants to find out if coarseness is dominant and if it varies between genders and among races. “The goal would be to define people who have the greatest fragility and treat them more aggressively,” she says.
HEART DISEASE | FERTILITY | PREGNANCY | BREAST AND OVARIAN CANCER
CERVICAL AND ENDOMETRIAL CANCER | OSTEOPOROSIS
HEADACHES, MULTIPLE SCLEROSIS, AND OTHER NEUROLOGIC DISORDERS | DEPRESSION
EATING DISORDERS | INCONTINENCE | IMMUNE DISORDERS | SLEEP DISORDERS