MONTCLAIR, NJ - Osteoporosis occurs when the creation of old bone does not keep up with the removal of new bone.  As a result, the bones become weak, brittle and fracture easily.

Osteoporosis affects men and women of all races. The National Osteoporosis Foundation states, “A woman’s risk of breaking a hip due to osteoporosis is equivalent to her risk of breast, ovarian and uterine cancer combined.  And a man age 50 or older is more likely to break a bone due to osteoporosis than he is to get prostate cancer.” Unfortunately, osteoporosis often is not diagnosed until after a fracture.  Fractures commonly occur in the hip and spine.

Here are some interesting statistics about osteoporosis:

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1 in 2 women and 1 in 4 men age 50 and older will break a bone due to osteoporosis.

54 million Americans have osteoporosis and low bone mass

Each year approximately 80,000 men will have a hip fracture

Men are more likely than women to die within 1 year after a hip fracture

RISK FACTORS

There are many risk factors for developing osteoporosis.  Some are modifiable and some are not. Some Non-Modifiable risk factors include:

Sex-Women are at higher risk of developing osteoporosis than men

Age- As we age our risk for osteoporosis increases

Race- People of Caucasian or Asian decent are at higher risk of developing osteoporosis

Family History- The risk of osteoporosis increases in those with siblings or parents with a history of hip fractures due to osteoporosis

Body Mass Index- Those with a low body weight have low bone mass

Some Modifiable risk factors include:

Hormone Levels- Sex hormone levels change as we age.  In Women, Estrogen decreases during menopause and during cancer treatments. Testosterone levels in Men decrease as they age and treatments for prostate cancer decrease testosterone levels.  High levels of thyroid hormone also play a role in bone loss.  The overactivity of other glands such as the parathyroid and adrenal glands can also lead to osteoporosis.

Dietary Factors- Low calcium intake decreases bone density and cause early bone loss leading to an increased for fractures.  People with eating disorders such as Anorexia have low food intake which decreases the amount of calcium ingested.

Gastrointestinal Surgery- When the size of the stomach is reduced, the amount of surface area to absorb calcium and other nutrients decreases.

Medications- Long term use of steroids interferes with bone rebuilding. Some other medications that can lead to bone loss include some anti-seizure medications, antidepressants, gastric reflux medications (proton pump inhibitors), cancer medications and transplant anti-rejection medications.

Lifestyle- Those who live a sedentary lifestyle (lack of weight bearing exercise) are at increased risk for developing osteoporosis.  Excessive alcohol intake (more than 2 drinks per day) and tobacco use also lead to bone loss.

SIGNS AND SYMPTOMS

As stated earlier, osteoporosis usually is not diagnosed until after a fracture occurs.  The most common areas affected are the spine (vertebrae) and hip. 

Signs of a Back (vertebral) fracture:

Acute localized pain after a fall or minor trauma, the pain may be sharp, nagging or dull and is exacerbated by movement. 

Gradual loss of height.  A person loses 2-3cm of height after each vertebral compression fracture leading to a progressive curving of the spine causing a hunched forward posture (kyphosis)

Signs of a Hip Fracture:

Pain in the groin, buttock, anterior thigh, medial thigh, medial knee during weight bearing or attempted weight bearing after a fall or minor trauma.

Decreased hip range of motion.

Pain on palpation of the affected area.

Difficulty with balance.

DIAGNOSIS

A Bone Mineral Density Measurement- Dual Energy X ray Absorptiometry (DEXA) scan is used to diagnose osteoporosis. The bone density is measured by a machine using low levels of x rays to determine the proportion of minerals in your bones.  The patient lies on a padded table as the scanner passes over their hip, wrist and spine.  All women 65 years of age and older and all men 70 years of age and older regardless of risk factors should have a DEXA scan to screen for osteoporosis.  Those at risk for osteoporosis include younger post-menopausal women with risks for fracture, adults with hip or vertebral compression fractures and adults with conditions associated with low bone mass or bone loss.  Adults taking medications associated with low bone mass or bone loss, anyone being considered for osteoporosis treatment and anyone taking osteoporosis treatment should have a DEXA scan.

TREATMENT

There are several treatments for the management of osteoporosis. 

Bisphosphonates

The most commonly prescribed medications for osteoporosis. This class of drugs work by preventing the breakdown of bone.

Alendronate (Fosamax)

Risedronate (Actonel)

Zolendronic Acid (Reclast)

Ibandronate (Boniva)

Hormone Related Therapy-

Raloxifen (Evista) is a treatment for women that mimics estrogen’s maintenance of bone density without some of the risks.  Raloxifen decreases the risk of some types of breast cancer but can cause hot flashes and increased risk for blood clots.

Less common osteoporosis medications

These are used if the more common medications are not well tolerated and include:

Teriparatide (Forteo)- This medication is similar to parathyroid hormone and works by stimulating new bone growth.  Forteo is an injection under the skin daily and can only be given for up to 2 years. 

Denosumab (Prolia)- Prolia targets a different step in bone remodeling than bisphosphonates.  It is an injection under the skin given every 6 months and side effects include back and muscle pain. You must discuss with your doctor which treatment is best for you.

PREVENTION

If you have not been diagnosed with Osteoporosis there are some steps you can take to decrease your risk of developing it later in life. 

Smoking cessation and decreasing alcohol intake can reduce your risk of osteoporosis. 

Practicing fall prevention by wearing low healed, non-slip shoes; keeping rooms brightly lit; checking for electrical cords, area rugs and slippery surfaces and removing them; placing grab bars inside and outside the shower/tub. 

Changes in your diet can also help keep your bones strong and healthy. 

Increasing Calcium intake has been shown to be protective against osteoporosis.

Men and Women 18-50 y/o should be consuming 1000mg of calcium daily

Women 50y/o and older should be consuming 1200mg calcium daily

Men 70y/o and older should be consuming 1200mg calcium daily

Foods that are rich in calcium include: dark green, leafy vegetables; canned salmon/sardines with bones; soy products; calcium fortified cereals and orange juice

Calcium supplements are also available but those who are older than 50 should not consume more than 2000mg calcium daily.

You should consult with your doctor regarding which level of calcium supplementation is right for you because too much calcium can actually increase your risk of heart disease and kidney stones.

Increasing your Vitamin D intake is also a great way to improve your bone health. Vitamin D is needed to help the body absorb calcium. Sunlight actually activates vitamin D in your body.  Vitamin D supplements are also available. You can consult with your doctor to check for low vitamin D levels and to assess your need for additional supplementation.

Let’s not forget about Exercise.  Exercise is an excellent way to build strong bones and to slow bone loss.  You should combine strength training exercises with weight bearing exercises to achieve a good result. Walking, jogging, running, stair climbing, skipping rope and skiing are all excellent weight bearing exercises.  Please remember swimming, cycling and exercising on machines such as ellipticals are good cardiovascular exercise but are low impact and not as helpful in improving bone health.

REFERENCES

www.mayoclinic.org/diseases-conditions/osteoporosis/basics/definition/con-20019924

National Osteoporosis Foundation http://nof.org

National Institutes of Health: Osteoporosis and Related Bone Diseases, National Resource Center

www.medicinenet.com- Osteoporosis slide show: Are your bones at risk

 

About the Author

Monique Hamilton, MD, practices Internal Medicine with HackensackUMC Mountainside. For more information, visit www.mountainsidedocs.com