Here is a little quiz to test your knowledge about osteoporosis:
- Developing osteoporosis as you age is inevitable
True___ False___ - Osteoporosis only affects women
True___ False___ - Osteoporosis is annoying, but not serious
True___ False___ - Osteoporosis is painful
True___ False___ - Osteoporosis is not treatable
True___ False___
The answer to all these questions is “false.” How did you do?
What is osteoporosis?
Osteoporosis is a bone disorder characterized by low bone mass. The most common risk factor for developing osteoporosis is advancing age. The older one gets, the greater the risk. It is not, however, an inevitable part of aging. About 12%-15% of the population over age 50 in this country has osteoporosis. And one in two women and one in four men over age 50 will eventually have an osteoporosis-related fracture.
With osteoporosis, bones become fragile and more likely to break (fracture). It is a silent disorder–you do not know you have it until you get a fracture. Only then do you get pain.
Osteoporosis is defined by the bone mineral density, or BMD, which is most commonly measured by the use of a DEXA (Dual Energy Xray Absorptiometry) bone density scan.
As the illustration here reveals, osteoporotic bone is more porous and less dense than healthy bone. The result is bone that is fragile, and more vulnerable to breaks. In fact, osteoporosis contributes to more than 1.5 million bone fractures a year. Spinal, wrist, and hip fractures are most common, with hip fractures being the most serious of all.
Bone density results
The way bone density results are reported can be confusing. You will hear about T and Z scores. Each of these scores is reported from minus 5 (lowest bone density) to plus 5 (highest bone density). The T score compares your bone density to a young adult whose bone density is at its maximum. It shows approximately how much bone you have lost over the years since you were at peak bone mass. The Z score compares your bone density to someone of your age, race, and gender.
A normal BMD result will have a T score greater than -1.0. Osteopenia (slightly low bone mass) is defined as a T score between -1.0 and -2.5. And osteoporosis is defined as a T score less than -2.5.
A low Z score is different. That suggests that you may have another problem that is adversely affecting your bones. Your bone loss is out of the expected range for someone of your age, race, and gender. So your thin bones are not just the result of advancing age. There is probably an additional reason your bones are thinning. Therefore, if your Z score is low, doctors often will look for “secondary” causes of bone loss. Secondary causes of osteoporosis include certain drugs, endocrine disorders, and gastrointestinal diseases such as celiac disease and inflammatory bowel disease.
Who gets Osteoporosis?
It is estimated that more than 10 million people in this country have osteoporosis. Both men and women can get osteoporosis, although it is more common in women. The older you are, the greater the risk of developing thin bones. All races and ethnic groups are susceptible, although not equally. Non-Hispanic white and Asian women are most at risk.
Other risk factors for developing osteoporosis include family history, low body weight, smoking, Vitamin D deficiency, estrogen deficiency in women or testosterone deficiency in men, alcoholism, inadequate physical activity, lifelong low calcium intake, and dementia.
Why worry?
In this country alone, about 1.5 million fractures every year are related to osteoporosis. These in turn can lead to long hospitalizations, surgery, disability, and even death from complications. Osteoporosis is a very common problem, and potentially a very serious one.
Prevention:
We don’t know how to completely stop all bone loss. But there are many things to do to help prevent it, including:
- Make sure you get enough calcium every day. Calcium is needed to help maintain bone health. The usual recommended amount is 1000-1500 mg/day. Check with your doctor about the right amount for you.
- Get enough vitamin D, which is also needed to keep your bones healthy. There are two sources of vitamin D: sunlight and foods or vitamins fortified with vitamin D. The usual suggested dose is 400-1000 units a day.
- Exercise regularly. Weight-bearing exercise like walking helps build bone mass and strength.
- Live a healthy lifestyle. Don’t smoke. And limit your alcohol intake.
- Talk with your doctor about whether you need medication to help prevent loss of bone.
If you have osteoporosis, you can be treated. Treatment programs begin by emphasizing basic prevention including exercise, smoking cessation, and calcium and vitamin D supplements. Medications to slow bone loss and build new bone are often recommended as well. Talk with your doctor about these. They might include bisphosphonates (including alendronate/Fosamax, and risedronate/Actonel), estrogens (such as Premarin) and selective estrogen receptor modulators (SERMS) such as raloxifene/Evista. Others include testosterone for men, calcitonin, and parathyroid hormone (Forteo).
Conclusion
Now that you know about osteoporosis, think about prevention and treatment. Prevention should begin early and continue throughout your life. Exercise, don’t smoke, cut back on alcohol, and get adequate calcium and vitamin D each day to reduce your risk of osteoporosis. Talk with your doctor about when to get a bone density test, and whether or not you need specific treatment.
Are you concerned about osteoporosis? Have you had a bone density test? Do you have questions about therapy for osteoporosis? Let me know!
Diana Post, M.D., is an Assistant Professor of Medicine at Harvard Medical School and a practicing internist at Brigham and Women's Hospital in Boston, MA. She is also a rheumatologist.
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Comments: 14
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Very informative. Thanks.
Perhaps I should clarify --- it isn't the osteoporosis itself which is painful, but the fractures which can result from the thin bones. If you have osteoporosis, then you definitely should consider some type of treatment to try and reverse the process.
Bisphosphonates are a class of medicines used to treat osteoporosis as well as other problems including high blood calcium problems and some types of cancer. Actonel is one of the bisphosphonate drugs. It is generally well tolerated, and has been shown to reduce the risk of fracture of bone. Osteonecrosis of the jaw (what you call "jaw death") has been described in people taking chronic bisphosphonates. Most cases have been in cancer patients getting intravenous bisphosphonates, but rare cases have been noted in people taking the medicines by mouth for osteoporosis. But the risk is very very low. And, if you have osteoporosis, the risk of bone fractures with subsequent pain, disability and other complications, is quite high. So I would certainly consider taking the medication, although there are never any guarantees. I think you need to weigh the risks of taking the medicine (very very low) versus not taking the medicine, and then decide. Or else talk with your doctor about other options for treatment of osteoporosis. These might include estrogens, SERMS, or parathyroid hormone. But don't ignore the problem. And remember basic prevention - exercise, smoking cessation, and calcium and vitamin D supplements.
Good luck!
I am 57, and the things that tend to challenge health at my age have happened for me. According to AARP, many women like me throw themselves into exercise, as I have done. I highly recommend this, especially yoga, though you need to find a gentle instructor to begin with.
Tai chi is helpful for some as well. Both can help with flexibility and balance, which in turn help with fall-prevention. The research on flexibility and fall-prevention is Japanese. A woman I used to do tai chi with perplexed her health care provider by actually measuring out as taller than an earlier appointment had recorded. Probably this had to do with posture, which is increasing in interest in the personal-training arena.
Boot-camp yoga is highly popular where I live, and I confess to an acquired fondness for it. If you have the least tendency to obsessiveness, the downside of exercise is that it can be highly addictive. It generates a lot of the feel-good chemistry that you can try to take a pill for if you are not subject to side-effect issues (I am). This is where the risk of over-doing and injury come in with exercise, and why it can be helpful to have friend- and family- support to call you on it if you are getting carried away.
I worked for a certificate in fitness technology through the community college. This was stressful, and I don't think I would recommend it for that reason--way to much seat time, alternated with a temptation to overdo the strength and cardio training.
Joining a gym or community center and finding others to help with goals would be a better choice for most people, I now think.
I cannot take pain meds as my parents did because of side effects. Exercise is what I have to do to increase circulation and to deal with inflammation. Diet is also important. I am struggling to get enough omega-3' fatty acids. The efficacy of omega-3's in helping with mood regulation is also something anybody good at Googling can research. Also, sweating is enormously important for skin health, at least for me. It keeps my skin supple and smooth. Good skin protects the whole body, including bones, from possible entry of infectious agents.
Skin health is a thing to be careful about if you choose exercise as a prime way to maintain bone health.
When people supplement with calcium, be very careful. Your magnesium levels can go wacky, and if you are a low-blood pressure kind of person, this can be a problem. I am speaking from personal experience on this one.
If you are going to work out hard, watch out for all your electrolytes. Fitness places sell a lot of sports drinks because some people learn this the hard way, I guess.
Cheers,
Hope your bone scan results are good-- you certainly deserve it! It is amazing how much you are doing to help yourself stay healthy. You are right that people can "go overboard", so we all should start exercise programs slowly, and progress at a reasonable pace. As we age, injuries are common and we seem to take longer to heal.
Your advice about electrolytes is also good - drinking only plain water if you are exercising strenuously for more than an hour is not a good plan. That is when sports drinks are a good idea.
Best of luck staying healthy and keeping your bones healthy as well.
Fosamax does has side effects, and might not be the best choice if you have Barrett's. And maybe your bone density it not yet bad enough to need medications. But you should talk with your doctor about this again, and if necessary, ask for a consultation with an osteoporosis specialist. Perhaps you will choose to focus on diet,calcium and vitamin D supplementation and weight-bearing exercise, and then get your bone density rechecked. Also, there are many other options for treatment besides fosamax if you do need to be treated.
Just don't ignore it now- it might get worse.