Author: Laura Gater
A correlation between metatarsal insufficiency fractures and low bone mass in both genders was confirmed in a study by podiatrists at The Ohio State University. Although the study was completed and published in 1999, it is still noteworthy because it has made podiatrists more aware of the potential for osteoporosis as a risk factor for stress fracture.
“There is a relationship between fractures occurring in the metatarsals of the foot and osteoporosis,” said Robert VanCourt, DPM, clinical assistant professor, Department of Orthopaedics, The Ohio State University, Columbus, Ohio. “Until 2002, the main focus of fractures resulting from osteoporosis was on fractures of the hip and vertebra. It has been noted that many patients presenting with insufficiency fractures of the metatarsal bones had early signs of osteoporosis. Insufficiency fractures are different from stress fractures in that they occur without a change in patients’ activities. They occur during a patient’s normal daily activities with no evidence of trauma.”
An estimated 22 million Americans have osteoporosis, which is now recognized as a public health problem since it is associated with high medical expenses, high mortality, and morbidity (Bonjour JP, Ammann, P, Rizzoli R, Importance of preclinical studies in the development of drugs for treatment of osteoporosis: A review related to the 1998 WHO guidelines. Osteoporosis Int.9:379-393, 1999).
The disease is characterized by low bone mass and deterioration of the bone tissue, which causes bone fragility and a resulting increase in fracture risk.
“Osteoporosis is a silent and deadly disease that is often brought to the attention of the patient and physician only after a fracture has occurred. The physicians should recognize the patients at risk of developing this disease of bone and provide appropriate referral for treatment of the systemic affects and cause of the disease and provide appropriate management of the local manifestations of osteoporosis,” explained Dr. VanCourt.
Early Detection and Treatment Are Crucial
If bone quality is abnormal, as a result of osteoporosis or another bone-related metabolic disease, a fracture can occur from normal usage. Since osteoporosis can progress without symptoms for many years, a stress fracture may be the first sign of osteoporosis. If risk factors are present for osteoporosis or other bone disease, then a Bone Mineral Density (BMD) measurement should be obtained. A BMD is a value that is obtained by dividing the bone mineral content of the bone by the area of volume measured. X-rays may be used to assess bone density, but they are not as accurate as actual BMD testing.
Estrogen withdrawal is one major risk factor for osteoporosis, along with impaired metabolism, long-term calcium deficiency, secondary hyperparathyroidism and decreased activity levels. Dr. VanCourt also cited genetic predisposition (those who are small and fair-skinned, of northern European ancestry, have hypermobile joints, or have scoliosis), excessive alcohol intake and cigarette smoking as other risk factors.
The goal of osteoporosis treatment is, obviously, to prevent further bone loss and accelerate the rate of new bone growth. There is no one drug for treatment of patients with established osteoporosis. Drugs that are currently available do not lead to substantial formation of new bone, nor are they universally accepted.
“High caffeine consumption has been proposed as a risk factor for osteoporosis because caffeine increases urinary calcium output. However, the evidence associating high caffeine intake with low bone density is inconsistent,” explained Denise Freeman, DPM, MSE, associate professor at the College of Podiatric Medicine, Des Moines University Foot & Ankle Institute, Des Moines, Iowa. “Some research supports that drinking two or more cups of coffee a day is associated with reduced bone density and that drinking high amounts of coffee is associated with fractures in women. There seems to be no association with reduced bone density and other caffeinated beverages, including tea or soft drinks.”
“Osteoporosis is a potentially devastating disease leading to extensive morbidity and possible mortality. As life expectancy increases, the possibility of more extensive bone loss over time also increases. There is an increase in public awareness of this disease, but many men and women in the population are suffering silently from the disease,” stated Dr. VanCourt.
“There is a very high correlation of patients with insufficiency fractures due to low bone mineral mass,” he continued. “Patients who present with unexplained metatarsal fractures, including men, should be referred for bone density testing.”
© Copyright, peoplemenders.com Inc., 2009. All Rights Reserved.
About the Author
Laura's writing specialties are medical, health and business topics.
Just a few of her published writings: Medical Imaging, 24x7, Podiatry Management, Strategic Healthcare Marketing, Advance for Imaging & Radiation Therapy Professionals, Podiatry Management, RT (Respiratory Therapy),Corrections Forum, Radiologic Technology, For the Record, Plastic Surgery Products, Orthodontic Products, Chiropractic Products, Podiatric Products, and The American Journal of Managed Care (supplement on NSAIDs).
Laura is also the temporary medical producer for several websites, writing news briefs. She has also done healthcare research and reports, provided public relations for several non-profit organizations and taught freelance writing classes.
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