Osteoporosis is a major health concern in the United States. Nearly 44 million Americans suffer from the condition that reduces bone density and increases the risk of fractures. In fact, half of women over 65 have been diagnosed with the condition — and while it is more common in women, it also occurs in men as well.
Osteoporosis is what's known as a silent disease, which means there may not be any obvious symptoms before a bone fracture. The first symptom is generally a fracture. With some, patients may not be able to recall when they began to have pain. This is especially common in spinal fractures.
Some of the most common osteoporosis-related fractures are found in the hip, wrist, shoulder and spine. They are usually the result of a low-impact incident.
Predisposing factors for osteoporosis include gender, age, ethnicity and family history. Other things that can predispose you to osteoporosis are not getting enough vitamin D, inactivity, smoking, malnutrition and excess alcohol consumption.
Some common conditions that may contribute to osteoporosis include diabetes, celiac disease/colitis, rheumatoid arthritis and kidney disease. Certain medications like anticonvulsants, steroids or proton pump inhibitors may also increase the likelihood of developing the condition.
Bone density testing should be done in all women over 60 and all men over 70. The most common way of diagnosing osteoporosis is through bone densitometry, also known as a bones density test. This is a low-radiation test that combines X-ray and computer software that analyzes the X-ray to come up with an estimated bone density. Screening can also be done using a heel scan. During this test you would place your heel in an ultrasound device called a bone densitometer, which then measures the bone mineral density of your heel.
Though osteoporosis cannot be reversed, there are a variety of ways you can manage the condition.
- Bisphosphonates work to slow bone loss. Some of these medications include Boniva and Fosamax and can be taken orally or intravenously.
- Calcitonin is a hormone that is derived from salmon and is taken as a nasal spray. It's been shown to be very effective in patients who have osteoporosis-related back pain.
- Estrogen hormone therapy can reduce the risk of fractures; it is prescribed by gynecologists.
- Estrogen agonists provide many of the same benefits of hormone replacement therapy but without the dangerous side effects.
- Parathyroid hormone is used to stimulate bone forming cells and there's a thought that the quality of the bone created may be better than in some other medications like bisphosphonates. This is a daily injection for two years and used for more severe cases of osteoporosis.
- RANKL (receptor activator of nuclear kappa ligand) is similar to bisphosonates and given to patients as injections twice a year.
All of medications have potential side effects, so it's important to talk to your doctor about the risks before you begin any treatment. The duration of the treatment varies depending on the medication, but none exceeds five years. If you are on medication for osteoporosis, you should have bone density screenings every two years.
In addition to medication, physical therapy can improve balance and coordination to help prevent falls. Physical therapy usually just consists of general conditioning and strength training. If you have been diagnosed with osteoporosis, you should also assess your living environment for safety. Make sure you don't have any tripping hazards like loose rugs or exposed cords, get rid of step stools and be aware of any small pets that could trip you.
There are ways to prevent osteoporosis. Limit your alcohol intake, don't smoke, make sure to exercise, take 1,200 mg of calcium a day and avoid falls.
—John Williams, M.D., Orthopedic Surgeon, for Coordinated Health