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August 14, 2020

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Weekend doctor: Osteoporosis - What is it?

Who is at risk? How can it be prevented?

By Leah Eiden, MD
Family Medicine
Bluffton Primary Care

If anyone has ever told you to “Go out there and break a leg,” hopefully you didn’t think they were advising you to fall and fracture, but realized they were using an idiom to wish you good luck during a performance.

Your family doctor does not want you to break a leg, hip or any of your bones. In fact, we would like to help you prevent fractures if at all possible. Thus, our interest in osteoporosis.

What is osteoporosis? Osteoporosis is defined as bones that are more fragile than they should be and are at higher risk of fracturing. (By the way, in medical discussion, the words "fracture" and "break" are synonymous.) In between normal bones and osteoporosis is a condition called osteopenia, which is bones that are weaker and more fragile than normal, but not weak or fragile enough to be classified in the osteoporosis category.

Think of this as "pre-osteoporosis," like "pre-diabetes." Osteoporosis and osteopenia are very common, occurring in approximately 53 million American men and women. Each year in the US, there are approximately two million fractures that are “fragility fractures,” felt to be caused by osteoporosis.

Besides causing pain, these fractures often cause significant disability and sometimes even death. The statistics say that approximately 50 percent of patients with hip fractures will permanently lose their ability to walk without assistance and that 25 percent will require long-term care. There is a 20 percent increase in the chance of dying over the five years after a hip fracture or vertebral fracture than what would have been expected without the fracture.

Who is at risk for osteoporosis? Osteoporosis is found more often in older adults and more often in women than in men. Long term use of steroids increases the risk of osteoporosis, as does a deficiency of vitamin D.

How is osteoporosis diagnosed? The most common way to assess for osteoporosis is a DXA scan, an X-Ray test that measures bone density at the hip and the spine. Bone strength can also be assessed by ultrasound, and this screening is sometimes offered at community health fairs.

How can osteoporosis be prevented? The most effective way to prevent osteoporosis is to get enough calcium when you are building bone during adolescence. Teenage girls should pay attention to their calcium intake, trying to get around 1300mg of calcium per day, either in diet or by taking a calcium supplement. A simple way to think of this is that during adolescence, you are depositing into your "bone bank." After about age 30, you reach your peak bone density. The hardness of your bones plateaus for a while and gradually decreases later in life. The stronger your bones are at their peak, the less likely that you will develop osteoporosis. Be sure to encourage the young ladies in your life to take in adequate amounts of calcium; it will make a difference for their health when they reach their "golden years."

Even if you are older than 30 and no longer actively increasing bone density, adequate calcium and vitamin D intake can decrease your chances of developing osteoporosis. Adults under 50 years of age should get 1000mg calcium and 400-800IU vitamin D each day, and those over 50 should get 1200mg calcium and 800-1000IU vitamin D on a daily basis. The National Osteoporosis Foundation has good information on how to achieve this intake with diet and supplements.

In addition to calcium and vitamin D, weight-bearing exercise helps prevent osteoporosis. The most common weight-bearing exercise would be walking. Exercises like swimming and biking, while great for muscle strengthening and cardiovascular health, do not strengthen bones.

Prescription medications are available for people whose bone density test results and risk factors indicate a high risk of osteoporosis. Decisions about prescription medications are best made in consultation with your physician or provider.

How is osteoporosis treated? The treatment for osteoporosis is focused on preventing fractures. It follows and builds on the recommendations for preventing osteoporosis discussed above, including calcium and vitamin D intake, weight-bearing exercise and prescription medications. Medications used to treat osteoporosis come in several forms: pills taken daily or weekly or monthly, a yearly IV medication, or injections given daily or every six months. The medications vary in effectiveness, cost and side effect profiles, so it is important to discuss an individualized treatment plan with your physician.

Another very important piece of avoiding fractures is fall prevention. Exercising for balance and strength, removing fall hazards from the home and avoiding medications and substances which cause dizziness or decrease alertness are all ways to minimize the chance of falling.

Who should be screened for osteoporosis? There is some variation in recommendations among the various medical societies, but in general, normal risk women should have a bone density test at age 65. If the test is normal, they may not need additional testing. For those with osteopenia, bone density testing should be performed every 2-3 years to evaluate for worsening bone density and progression to osteoporosis. For those with osteoporosis, the frequency of follow up bone density tests to monitor response to treatment can be individualized based on what treatments are being used and what information is needed. The decision to do bone density testing for men is typically made based on the presence of specific conditions that put them at higher risk of osteoporosis.

Just as is the case with so many diseases, with osteoporosis, "an ounce of prevention is worth a pound of cure." A healthy diet and routine exercise are so important, and it is never too late to make positive changes. From this family doctor, I'm hoping you stay strong, enjoy good health and never "break a leg!"