Screening and treatment can decrease severity of osteoporosis

03/31/2014 9:46 PM

08/08/2014 10:23 AM

Most people have heard the word osteoporosis and are aware that women are more prone to getting it, particularly as they age. What they might not know is what a diagnosis of osteoporosis really means – how to manage it or possibly even how to prevent its onset altogether.

What is osteoporosis?: Osteoporosis is a state of compromised bone strength – low bone density and bone quality – which leads to an increased risk of fracture. People with osteoporosis can break bones with minimal or no trauma. The most common fractures are in the wrist, hip and vertebra, but any bone can be affected.

How common is osteoporosis?: One in three women between the age of 60 and 70 has osteoporosis; 70 percent over the age of 80 have it.

What is the economic burden of osteoporosis?: Seventy percent of nursing home admissions are related to osteoporosis. Treatment and loss of productivity from osteoporotic fractures costs $14 billion per year. Costs of hip fracture and rehabilitation are similar to costs of a stroke.

What are the dangers of fracture?: In addition to the pain, downtime and expense of breaking bones, fractures can lead to chronic pain, diminished quality of life and loss of independence. Fractures, particularly among the elderly, can increase risk of death due to the body being physically compromised and susceptible to other illnesses.

What are the symptoms of osteoporosis?: Osteoporosis does not cause any pain. Often the first symptom is breaking a bone. That’s why it is important to be screened for osteoporosis so it can be prevented and treated at earlier stage.

How is it diagnosed?: Osteoporosis is diagnosed by DXA scan (a special kind of x-ray) that measures bone density at the hip and lumbar spine and occasionally, in certain medical conditions, the forearm. It compares the bone density with a 30-year-old of the same gender and same ethnicity and assigns a T score (standard deviation ratio). A T score of minus 2.5 at one or more sites is classified as osteoporosis. A T score between minus 1 and minus 2.5 is classified as low bone mass, or osteopenia, which is a pre-osteoporosis state.

Who should have DXA scan?: The National Osteoporosis Foundation recommends screening with DXA in women age 65 or older and men age 70 or older and at an earlier age for those with any risk factors or if there is a history of fracture after age 50.

Risk factors for osteoporosis: Peak bone density is achieved by age 30. Slow bone loss begins at age 40 in both men and women at a rate of about 0.3 to 0.5 percent per year with accelerated loss up to 3 to 5 percent per year in women in the first few years after menopause.

In addition to aging, risk factors include:

• Being post-menopausal
• Certain medications
• Thyroid and other endocrine disorders
• Smoking
• Alcohol
• Excess caffeine and soda consumption
• Family history of osteoporosis
• Lifelong low calcium intake
• Thin body stature (less than 127 pounds)
• Lack of physical exercise, or being sedentary or bedridden
• Kidney and liver disease
• Rheumatoid arthritis
• Prolonged use of prednisone

How can osteoporosis be prevented?

• Perform weight-bearing exercise such as walking at least 30 minutes daily. Cycling and swimming are not considered weight-bearing exercises.
• Eat a diet rich in calcium and vitamin D and take supplements if necessary.
• Limit coffee to two cups per day, soda to one to two per week and alcohol to one to two drinks per day.
• Avoid smoking.

What is the treatment for osteoporosis?: Choice of treatment will depend on the severity of osteoporosis, presence or absence of history of fracture and other medical conditions. Medications are available to help slow down the bone loss or promote bone formation.

Medicines that slow down bone loss include bisphosphonate drugs and Denusomab. Bisphosphonate drugs are available both orally and intravenously. Denusomab is given by injection every 6 months.

Teriparatide, the only medication that can promote bone formation, is taken daily by injection for two years. This is generally reserved for people with severe osteoporosis, or who have already had fractures.

While on treatment, bone density test should be performed every one to two years to monitor the response to treatment. Your doctor will advise you to exercise, take calcium and vitamin D supplements, and may recommend certain lab tests to rule out other causes for bone loss.

Talk with your doctor today if you think you have risk factors for osteoporosis.

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