Osteoporosis: Prevention is Key to a Better Quality of Life
One out of every two women age 50 and older in the United States will suffer from osteoporosis or low bone mass—about 44 million people—and many of them won’t even know it until a life-changing fracture occurs.
For comparison, 12.6 million suffer from coronary heart disease and 16 million from prediabetes, according to the U.S. Department of Health and Human Services.
“We hear about other diseases far more often than we hear about osteoporosis,” said Dr. Renu Joshi, a 15-year endocrinology specialist at PinnacleHealth System. “At the rate we see osteoporosis cases increasing, it will only get worse.”
Osteoporosis is a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes or deficiency of calcium or vitamin D. A less severe loss of bone tissue is called osteopenia.
A bone density scan, or DEXA scan, is the only way to diagnose osteoporosis or osteopenia, Joshi said. Because there are no symptoms related to either illness, many people don’t realize they have it until they’ve suffered a fracture—putting them at a point beyond prevention, she said.
While some people believe osteoporosis causes them to fall, resulting in a broken bone, it’s usually an unknown fracture, often very small, that goes undetected and causes the fall, resulting in worse injuries, Joshi said.
Doctors are able to suggest an early DEXA scan if someone is on steroids, has thyroid issues or has suffered from cancer, or is on any medications to treat cancer, she said. This is especially true for women who have gone through menopause, have a family history of osteoporosis, or have a very thin frame.
The DEXA scan is a low-level X-ray that rates bone density on a scale. The scan can measure the bone density of the entire skeleton, as well as specific points that are more likely to break, such as the hip, spine, and wrist.
The T-score indicates a patient’s bone density versus that of a healthy individual. A score above -1 is considered normal. A score between -1 and -2.5 is classified as osteopenia, and a score below -2.5 indicates osteoporosis.
When someone is diagnosed with a low bone density, their bodies are either having issues losing too much bone mineral or not making enough, Joshi said. In about 80 percent of cases, she said, the patient is losing too much bone tissue. Lab tests can help determine which one the patient’s body needs the most help combating.
After someone is diagnosed, they might be put on medications to help them reverse the affects of osteopenia or osteoporosis. There are three types of medications that help do that.
The first are medications that work to prevent bone loss, giving the body time to catch up on creating new bone minerals. The most common oral medications are bisphosphonates, which include Fosamax and Actonel. These treatments are taken orally, either once a week or once a month. These medications also require that a patient not lie down for 30 minutes after taking one, and they can cause an upset stomach or heartburn, Joshi said.
Injectable bisphosphonates are an alternative for people who might not want to take the oral medication because of the side effects. Boniva is administered once every three months, and Reclast is given once a year.
The only medication for increasing bone density instead of preventing its loss is Forteo, a daily injection that can be taken for two years.
“Not all of these medications work for everyone, so it’s important that people understand they might not respond to each of these,” Joshi said.
While many people will need treatments the rest of their lives, some of these medications cannot be given longer than seven to 10 years because they cause spontaneous fractures in the femur, Joshi said.
Because treatments aren’t perfect, the best thing people can do is work on prevention, she said.
Kirsten Ditzler, a physical therapist for Lancaster Health Campus in the women’s health department and an expert on osteoporosis, said many people don’t realize how easy it can be to prevent this disease.
The average woman should have 1,000 to 1,200 milligrams of calcium each day, supplemented with 800 units of vitamin D to help the body absorb the calcium. While the highest amounts of calcium are commonly found in dairy products, she said, many leafy greens also provide a good amount of the mineral.
Aside from diet, weight-bearing exercises are the best way to build the muscles that support and protect bones, Ditzler said.
“There is no gold-standard exercise that I can recommend for anybody that is the absolute best,” she said. “There is no research that says one exercise is the No. 1 way to prevent osteoporosis. But what we do know is that walking is one of the easiest weight-bearing exercises that just about everyone can do.”
There is no specific speed or distance required for those who want to start walking to prevent osteoporosis, she said, but most people who start will find improvements in their spine and hips—where osteoporosis seems to hit the hardest.
For patients who already have been diagnosed with osteoporosis, Ditzler said, they want to avoid any extreme bending, rotating, or twisting that can put compression and torque on the spine, leading to compression fractures.
While many patients are willing to go to their doctors and get medications for osteoporosis, they don’t want to take what Ditzler calls the “e-pill”—her prescription for exercise.
“A lot of people don’t want to hear that they have to exercise because they don’t want to have to do any work,” she said. “But the proper exercise can mean you might be able to live at home longer or suffer with fewer fractures.”
Many of the exercises Ditzler recommends are easy, she said, even including some that patients can do before they get out of bed in the morning.
Inactivity can be one of the hardest things on the spine, Ditzler said. Adding more activity doesn’t have to mean spending hours at the gym or doing a daily workout video. For some people, it’s simply walking instead of driving to their mailboxes each day.
As a fulltime physical therapist with two daughters at home, Ditzler understands it can be tough to fit in time to exercise. She recommends people do leg lifts or knee kicks while brushing their teeth or cooking dinner to squeeze in a few minutes of activity.
“Every little thing you do adds up,” Ditzler said. “Doing one small thing today can save you from a broken bone or a broken hip that lands you in a nursing home. Taking better care of yourself today means you can do the things you love longer.” BW