Osteoporosis has haunted women since the dawn of history. Egyptian mummies from 4,000 years ago have been found with the telltale dowager’s hump. Most young women today can expect to spend their old age standing as straight and tall as they ever were, thanks to recent dramatic improvements in the diagnosis, prevention, and treatment of osteoporosis.
An early medical pioneer, the eighteenth century English surgeon John Hunter discovered that as new bone is laid down in the body, old bone is destroyed, or reabsorbed. This process is now known as remodeling and was later shown to play a critical role in osteoporosis, though it wasn’t even a recognized disease for more than 100 years after his death.
In the 1830s the French pathologist Jean Georges Chretien Frederic Martin Lobstein noticed that some patients’ bones were riddled with larger than normal holes, and he coined the term osteoporosis (porous bone) to describe such deteriorated human bone. In the 1930s Fuller Albright of Massachusetts General Hospital couldn’t help but ponder what it was about being postmenopausal that made women particularly susceptible to having frail bones.
Somewhere around 1940 he defines postmenopausal osteoporosis and begins treating women with the condition with estrogen. But estrogen therapy can only prevent damage to the skeleton by stemming bone loss. In the 1940s it was virtually impossible to detect the minimal bone loss seen in the early stages of the disease.
Detecting Bone Loss
Fortunately, starting in the 1960s, researchers developed more sensitive devices for detecting bone loss, including densitometers, which can determine bone density by measuring changes in the absorption of energy passing through bones in the hand, spine, hip, or other body part. This technique enables physicians to detect osteoporosis in its early stages, well before fractures occur.
Also in the 1960s Herbert Fleisch discovered compounds known as bisphosphonates that inhibit bone resorption. Other researchers discover that compounds known as selective estrogen receptor modulators (SERMs) can simultaneously block breast tumors and trigger the growth of uterine cells. At that time though, limited funding was available and the seriousness of the disease was not quite recognized or acknowledged.
In 1984, the National Institutes of Health publicized this disease, citing it as a significant threat to health and emphasizing that bone loss could be reduced by estrogen therapy, calcium, good nutrition and exercise. In the 80s and 90s Researchers discovered cytokines that influence the development and activity of osteoclasts.
Such discovery then led to bisphosphonates alendronate and risedronate entering the market as anti-osteoporosis drugs. The selective estrogen receptor modulator drug Raloxifene entered the market as a drug to treat and prevent postmenopausal osteoporosis in 1998. Around this time people were also urged to increase their calcium intake.
Despite its long history, osteoporosis remains a formidable challenge to medicine.
A greater understanding of the variables that influence bone mineralization will allow the development of strategies to determine those at risk of developing osteoporosis. Advances in the management of this disease in the future will most likely come from prevention and selective screening. Awareness and education also play a significant role.