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. However, fractures of the hip and spine are a major concern as they almost always require hospitalization and major surgery and can impair your 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 (strengthens bones) is established in the first 20-30 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 poor childhood nutrition, chronic infections, delayed puberty, diabetes, reduced exercise or weight-bearing activities, and treatment with corticosteroids (which can lead to calcium loss).
All people with cystic fibrosis are at risk for osteoporosis, especially those with a more severe disease and low body weight. Studies show approximately 80% of people waiting for a lung transplant have reduced bone mineral content, and most attending adult CF clinics have a significant deficiency in bone mineralization. They are at risk of a bone fracture from relatively minimal trauma.
There is good news! 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 vitamins and supplements, is critical to keep bones strong. The recommended daily calcium intake is 800 mg for ages 4-8, 1300 mg for ages 9-18 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 5% in bone mass, which reduces a 40% 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 CF is vital.
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