What is Osteoporosis?

Julio Defillo Draiby, MD

Osteoporosis is a disease of the skeleton. It involves a loss of bone mass and deterioration of bone tissue. This leads to weak bones, which increases your chance of a fracture.

When people have osteoporosis, they may experience any of the following:

  • loss of height
  • back pain
  • stooped posture
  • problems with balance and walking

Identifying osteoporosis

Because loss of height may indicate osteoporosis, it is important that your height is monitored. Also, be sure to mention to your provider if you are experiencing back pain so you can be checked for compression fractures.

Osteoporosis can be identified through an exam called a bone density scan. It is recommended that women start these at age 65 and men at age 70. It is important to note that post-menopausal women can lose up to 20% bone mass in the next five to seven years, before reaching age 65. For men between ages 50 and 69, with certain risk factors, there may be a benefit to having a bone density scan as well. The scan will give us a baseline for your bone density. The results of your scan will determine your bone density:  normal; low, but not in the range for osteoporosis (osteopenia); or  osteoporosis. It is interesting to know that at least half of all bone fractures occur in those who are diagnosed in the osteopenia range.

Sometimes, osteoporosis is not spotted until someone experiences what is known as a “fragility fracture.” These bone fractures are caused by a fall from standing height or lower. That is why bone density scans are so important – they may be the only way to detect osteoporosis before any type of fracture.

Scan frequency

How often you should have scans depends on risk factors and results from prior scans. The scan is typically repeated every two to five years, with individuals at higher risk having scans more often.

If a bone density scan indicates you have osteopenia, your primary care provider will evaluate you for fracture risk. A common instrument that is used is the fracture risk assessment tool or “FRAX” score. The FRAX tool was developed to evaluate the fracture risk of individual patients. It is based on patient models that integrate the clinical risk factors and bone density at the femoral neck.

The results of this instrument indicate your probability of hip fracture and of a major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture) over the next 10 years. Depending on the results, a decision can be made to start medications that halt the progression of bone weakness hence preventing osteoporotic fractures.

The cause

We reach peak bone mass in our 30s. At that point, new bone growth starts to be slower than bone loss. That can translate into deteriorating bone health, which causes the disease over years. Unfortunately, the reason for the changes in what we call bone dynamic equilibrium is unclear.

Who is most at risk?

There are some individuals who are at higher risk for osteoporosis. They include:

  • those above age 65
  • post-menopausal women usually age 50 and above
  • lean individuals – less than 127 pounds or a body mass index (BMI) less than 20
  • those who smoke
  • individuals who have a family or personal history of fracture (genetic predisposition)
  • those who are inactive or lead a sedentary lifestyle
  • alcohol drinkers – more than 3 drinks per day for men/more than 2 for women
  • those with low dietary calcium and vitamin D
  • rheumatoid arthritis patients
  • individuals taking glucocorticoid medications

No matter their risk factors, all women above 65 and men above 70 should have a bone density scan. Women who are over 50 with more than one risk factor should also schedule a scan.

How is it treated?

If you have been diagnosed with osteoporosis or osteopenia with high risk for fractures, your provider may prescribe medications that can help. There are several types of medications, such as bisphosphonates (alendronate), RANKL inhibitors (denosumab), anabolic agents (teriparatide), or others.

Preventing bone loss

Each of us should try to recognize and change behaviors that could deteriorate our bone health. You can start at any life stage, using healthy bone behaviors. Exercise, nutritional changes, and making sure you are not at risk for falls are effective preventive interventions. Avoid habits that can make bones weaker, like drinking too much alcohol and smoking.

I advise my patients to do the following:

  1. Exercise: To affect bone mass, exercise should be performed at least twice a week for a minimum of 30 minutes. Make sure to include:
    • regular weight-bearing exercises, like stair climbing, tennis, and brisk walks – an elliptical or a bike may not be enough
    • regular muscle-strengthening exercises
    • weight training and other resistive exercises, such as yoga, Pilates, and boot camp programs
  2. Balance training: Take part in a regular balance training exercise, or the practice of tai chi.
  3. Eat well: Make healthy choices in your diet, including foods like lean proteins, healthy fats, and plenty of fruits, vegetables, and nuts. Be sure you are getting enough vitamin D and calcium. If you think there are issues in your diet, discuss it with your primary care provider or a nutritionist. For many, the American diet is rich in calcium, so many of us do not need to supplement our diet. However, vitamin D levels are insufficient in many, and supplements may be needed.

If you think you may be at risk for osteoporosis, we can help. Visit our website for more information. 

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