What You Need to Know About Osteoporosis
Heart disease and diabetes have taken front and center stage for media attention these days. But osteoporosis should be right up there, too. With more than 10 million Americans affected and another 34 million close behind (at risk), the costs of treating associated fractures is in the billions of dollars. What can be done about this problem? Two experts in bone health bring us up-to-date on the prevention, diagnosis, and treatment of osteoporosis. Recommendations for screening, monitoring, and managing this condition are presented.
What exactly is osteoporosis? Simply stated, it is decreased bone density. But that might not mean anything to you. Does the phrase brittle bones help? Because that is quite literally what osteoporosis is. To understand this a bit more from a biologic point of view, consider that bone strength comes from two things: bone density and bone quality. Bone density refers to how many bone cells are present in a square inch. That measure also reflects how close together the bone cells are.
But density isn't the only component of bone strength. There's also bone quality. Bone quality reflects the health of the bone cells present. Quality of the collagen cells that make up bone, thickness of the bone, and architecture of the bone all make up this entity we call bone quality. Bone quality reflects the condition of the supportive structure of bone.
Bone loss occurs in a predictable fashion with aging. Women are affected more often before men around the time of menopause when the menstrual cycle stops and the woman can no longer get pregnant or give birth to children. A significant reduction in the hormone estrogen at that time contributes to the development of osteoporosis. But men are also affected -- about 10 years later than women as age-related changes cause microarchitectural deterioration. In both men and women, the bone becomes fragile. Fractures can occur without trauma or injury. These are called fragility fractures.
The risk of fracture, loss of independence, and even death associated with osteoporosis is what makes the prevention of this condition so important. It's not just quantity of life; it's also quality of life that's at stake. So what can be done? First of all, build up the bones in the early years of life. That's the equivalent of putting money in the bone bank, so-to-speak. Getting enough calcium, good nutrition, and exercise in childhood and the teen years increases peak bone mass, an essential ingredient in strong, healthy bones to last a lifetime.
Recent studies have shown that vitamin D is as important as calcium for bone health. Without it, the body doesn't absorb and process the calcium needed to support bone health. How do we get vitamin D? How much is needed? Sunshine is one way to boost vitamin D levels in the body. But many people don't get out much. And many people live far enough north that the sunrays aren't strong enough to really benefit. Then there's the risk of skin cancer with too much sun exposure. Using sun block decreases the absorption needed to produce vitamin D.
Experts recommend taking vitamin D supplements to make sure everyone is getting enough vitamin D. How much to take depends on your age, ethnic background (light versus dark skin), risk factors, body mass index, and general health. Each person should consult with his or her doctor to find out what's best. At the same time, your doctor will counsel you about reducing your risks by not smoking, losing weight if you are overweight, and reducing consumption of alcohol and caffeine. Weight-bearing exercises and resistance training are both osteoporosis-preventive.
Hopefully, you won't find out you have osteoporosis because of a sudden bone fracture. So, how can you find out if you have osteopenia (bone mineral density is lower than normal but not osteoporotic yet) or osteoporosis? You can get tested. Not everyone needs to be tested. If you are a peri-menopausal or menopausal woman of any age or a male age 50 or older, testing for bone density is a good idea. There are several different ways to be tested. Again, your doctor will advise you as to what's best for you given your own characteristics and risk factors.
The most commonly used measure of bone density is the DXA scan (Dual-energy X-ray absorption). The National Osteoporosis Foundation (NOF) advises all women 65 and older and men 70 years old and older to have a DXA test done. Anyone with other risk factors will also be advised by their doctor when it's time to be tested. FRAX (fracture risk assessment tool) analysis can determine your 10-year risk of fracture if you have osteopenia.
The FRAX is a questionnaire that asks about age, sex, height and weight, history of fractures, current health, and lifestyle choices (smoking, drinking). Once the answers are completed, a score is calculated that gives your 10-year probability of fracture. Anyone with high risk of fractures should get busy and reduce or eliminate any risk factors that can be changed. There's not much you can do about your age or gender (male or female). But your lifestyle choices can be drastically modified to reduce the risk of bone loss and fragility fractures.
What else can you do if your DXA scan or FRAX analysis shows there's a problem? Get enough daily calcium, vitamin D, and exercise. Your doctor will advise you if you need medications called bisphosphonates known to slow bone loss. Stay in regular contact with your physician. You may need to be monitored to make sure you are getting the results you need. Nonresponse is a fancy way to say you are still losing bone, in danger of fracture, or already had a fracture despite treatment. Patient compliance (cooperation, following recommended suggestions) with treatment is an important way to ensure success. Lack of compliance is often a hidden risk factor.
If you are doing everything you've been told to do to stop bone loss but the DXA scan shows continued progression of the disease, then your physician will do some more testing to see if there's some other reason for the problem. Most people are very successful in turning around the negative effects of osteoporosis and prevent fractures that can be so devastating.
Susan B. Broy, MD, and Amanda Kay Myers, MD. Identifying and Managing Osteoporosis: An Update. In The Journal of Musculoskeletal Medicine. January 2010. Vol. 27. No. 1. Pp. 11-19.