By Autumn Barrett, PA-C – Sheridan Memorial Hospital Internal Medicine
October 2019
Your body, like mine and everyone else we know, certainly wasn’t made to last eternity… obviously. However, there are steps that can be taken to help with the nicks and pains that come up as we get older. Being proactive about osteoporosis can certainly help with that pain later in life.
The basic definition of osteoporosis (“porous bone”) is the decrease in bone density and bone quality. Bones are active tissue, which means they constantly break down and rebuild themselves. Up until about the third decade of life, the body is building bone faster than it is breaking it down; then this slowly declines after about age 35. With osteoporosis, however, the regeneration of new bone does not keep up with the rate at which bone is breaking down. Over time, bone quality and strength degenerates. Bones become weak and brittle, leaving individuals more susceptible to a fracture (broken bone.) In fact, when osteoporosis is present, a fracture can occur without a major fall or trauma, sometimes just by sneezing, coughing or carrying groceries.
Osteoporosis affects men and women in all ethnicities, but some individuals are at increased risk:
Unchangeable Risk Factors
- Gender: more common in women than men
- Ethnicity: more common in White and Asian populations, less common among Black and Hispanic
- Thin, small-framed body structure
- Age
- Family history
Other Risk Factors
- Hormones: lack of estrogen or being menopausal for women and lack of testosterone for men
- Untreated thyroid disease
- History of bariatric surgery
- Eating disorders, for example anorexia
- Medications: long-term use of oral corticosteroids (i.e. Prednisone)
- Smoking
- Excessive alcohol use, more than 2 alcoholic beverages per day
- Sedentary lifestyle
Fractures commonly occur in the spine, hips and wrists. Generally speaking, there are no obvious signs or symptoms associated with osteoporosis until a painful fracture occurs. However, osteoporosis can be found as part of a preventative health screen. Routine screening typically begins around age 60-65 for women and 70 for men unless other risk factors are present. So, if you have increased risk for osteoporosis, it is important to talk to your primary care provider to see if screening should be considered earlier.
The most common test for detecting bone loss or diagnosing osteoporosis is a DEXA scan or bone density test. The scan consists of a low-radiation x-ray, most often to the spine and hip area. (DEXA scans are available at Sheridan Memorial Hospital by order from a medical provider.)
There are a number of medications used in the treatment of osteoporosis. Bisphosphonates such as Fosamax (Alendronate), Actonel (Risedronate), and Boniva (Ibandronate) are the most common. In the usual five-year treatment plan, these medications help stop bone breakdown, thereby increasing bone density. Side effects may include abdominal distress (pain, nausea, diarrhea, ulcers) and on rare occasions osteonecrosis of the jaw (rare but serious condition when cells in the jaw bone die). Depending on the medication chosen, risk of fracture can be reduced by 30-50%. Medications in this class can be taken orally or given by IV infusion.
Another medication used for treatment of osteoporosis is denosumab (Prolia). This injection stops bone breakdown. Fracture reduction with this medication can be up to 70%. It is administered every 6 months by subcutaneous injection, which ideally may alleviate gastrointestinal side effects often seen with oral options. Osteonecrosis of the jaw still remains a possible side effect.
In select cases, hormone therapy may also be considered.
To prevent osteoporosis, it is important to maintain a healthy and nutritious diet with adequate amounts of calcium, vitamin D and protein. Vitamin D is necessary to help the body absorb calcium from the diet. 1200-1500mg of calcium is recommended (from dairy products or supplementation if necessary) and 800-1000IU of vitamin D3 per day. Individual recommendations may vary. Weight-bearing activities such as walking and resistance training (weight lifting) are important to delay osteoporosis. 30 minutes of physical activity on most days of the week is ideal. Avoidance of smoking and minimal alcohol use will help prevent the development of osteoporosis. Also, chronic use of ibuprofen or naproxen can contribute to bone loss over time, so use these medications sparingly.
Please review your risk factors for osteoporosis with your primary care provider. It is an important part of preventative health maintenance for your long-term benefit.