By Mike Falcon, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

October 4, 2002 - Married actors Jill Eikenberry and Michael Tucker played law partners on "L.A. Law." But now the couple has partnered in a more important venture -- fighting osteoporosis.

"I had my first bone mineral density test in 1998, and the result was shocking," says Eikenberry, 55. "I had a T-score of minus 1.8, which meant that I had an 18% bone loss in comparison to a young, normal, healthy woman."

Tucker was not far behind, to his surprise as well. "Like most men, I didn't think a whole lot about bone loss," says Tucker, 57. "After all, I felt fine and nobody can see your bones anyhow, so it wasn't a concern of mine. I just went in with Jill, but when the doctor said I had a risk factor for osteoporosis -- I'm a man under 5'7" -- I took the test too and my T-score came out as a minus 1.4."

But the news got worse.

Last year Eikenberry went in for another bone mineral density test (BMD) and her T-score was -2.9. She had moved out of osteopenia -- or relatively moderate bone density loss -- into true osteoporosis, an all too familiar progression.

Bone is living tissue, with constant "turnover"-- simultaneous tearing down and building up. Osteoporosis is a disease characterized by low bone mass and caused by excessive tearing down. This leads to increased risk of fractures, especially of the hip, spine, and wrist.

According to the National Osteoporosis Foundation (NOF), 10 million in the USA have the disease. An additional 34 million are estimated to have low bone mass, placing them at increased risk for developing osteoporosis.

A serious disease

"It's a serious disease," says Eikenberry, who along with Tucker, are spokespersons for the "Know Yourself to a 'T'" awareness campaign for the NOF. The campaign is sponsored by Merck & Co., Inc., which manufacturers one of the medications used to treat osteoporosis. The campaign includes a public service announcement produced by Spotlight Health featuring Eikenberry and Tucker.

"About one in two Caucasian women will get an osteoporosis-related fracture at some time in life," notes Felicia Cosman, a physician and clinical director of the National Osteoporosis Foundation (NOF). For men, that figure is 25%.

Common osteoporosis-related fractures of the hip and spinal vertebrae are particularly dangerous.

"They have both a great influence on quality of life and longevity," notes Cosman. "There's a 15-20% mortality in the following year for those who break their hips, and 25% of them wind up spending some time in a nursing home as they attempt to recover. But a lot of women just never get complete recovery."

While osteoporosis-related hip fractures usually result from a fall, spinal vertebrae breaks may not be noticed initially. But the results will be: A series of small spinal fractures often results in a permanently stooped posture.

"If osteoporosis goes unchecked it can get to the point where you turn over in bed and break a rib," says Eikenberry. "Osteoporotic bones can break with very little prompting - you can get a break when your husband hugs you or you knock against a piece of furniture."

But loss of bone density mass can often be stopped or even reversed.

"But first you have to find out if you have osteoporosis or osteopenia," says Tucker. "That means getting a bone mass density test and finding out your T-score."

"It's a simple, quick, non-invasive, and utterly painless procedure," says Robert K. Rude, a physician and osteoporosis researcher at Orthopaedic Hospital in Los Angeles. He estimates that nearly 60% of serious fractures and fatalities could be eliminated if people at risk received BMD testing.

The NOF recommends that all women get a BMD test before age 65. Cosman says that in postmenopausal women under 65, a careful review of risk factors with your physician will often prompt earlier testing at menopause. Osteoporosis risk factors include:

• Fracture after age 50 not caused by major trauma
• Advanced age
• A family history of osteoporosis
• Estrogen deficiency as a result of menopause / abnormal absence of menstrual periods
• Low lifetime calcium intake
• Use of corticosteroids and anticonvulsants
• Cigarette smoking or excessive alcohol use
• Anorexia nervosa

Defending your life

The gold standard for BMD testing is a dual-energy X-ray absorptiometry (DEXA) scan that uses ultra-low energy x-rays to measure hip and spine bone density.

The results are given as a T-score, the comparison of the patient's bone mass with that of a healthy young person of the same gender at peak bone mass. The lower or "more negative" the score is, the greater the risk of fracture. The score can also be related as a percentage: -1.5 equates to 15% below normal.

Scores above -1.0 are considered normal. T-scores between -1.0 and -2.5 indicate osteopenia or bone density that is somewhat low, says Rude. Scores below -2.5 reveal osteoporosis.

But treatment "should hopefully begin before someone reaches that stage," he adds. The NOF recommends therapy for women with T-scores below -2.0 and for women with other risk factors when their score is below -1.5.

For some people with modestly low T-scores, lifestyle changes in diet and exercise may be helpful in preventing or slowing the disease.

Diets should include plenty of calcium and vitamin D. Both Eikenberry and Tucker modified their diets to include more leafy greens, vegetables, and fruits. Tucker currently takes supplemental calcium in pill form.

There are also foods which can negatively impact bone loss. "Excess animal protein and salt both result in excreting more calcium," notes Cosman. Caffeine reduces calcium absorption, as can excessive amounts of alcohol.

Weight bearing exercise involves "doing exercise on your feet with the full weight of your body working against gravity at last three times a week," explains Cosman. "Weight training, low-impact aerobics, and yoga impact both bone and muscle, which reduces the risk of falling."

Swimming, cautions Cosman, is not a weight-bearing exercise. While it definitely helps muscle, it does not affect bone mass accretion.

But even a disciplined diet and an ambitious exercise program doesn't guarantee bone health. Various types of medications are used to treat bone loss.

• Estrogens -- These are additional "female hormones" that may help slow or stop degeneration.
• Selective estrogen receptor modulators (SERMs) -- These influence the way estrogens are used.
• Bisphosphonates -- These can strengthen bone weakened by osteoporosis.

"All these drugs may reduce the amount of bone turnover and prevent bone loss, and to some extent increase bone mass," says Cosman, "although that's not a very prominent outcome with all of them."

Eikenberry is currently taking medication, although she doesn't reveal details. "I don't want to influence someone else's decision. What's really important is to look closely at your own risk factors, know your T-score, and talk it over with your doctor. It can literally save your life."

Click here for the National Osteoporosis Foundation web site. For more information about osteoporosis, click here.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 10/30/2002  -  Mike Falcon and Stephen A. Shoop, M.D.