National Osteoporosis Month: Prevention and Treatment Options for Brittle Bones
"Sticks and stones may break my bones, but words can never harm me."
Despite that familiar childhood chant, there actually is a word that threatens broken bones: osteoporosis. Derived from the Greek words for bone (osteon) and passage (poros), osteoporosis is a disease in which the bones become progressively more porous and brittle and more likely to break.
"In younger people, the body makes more bone than it breaks down," says Dr. Ranjana Sharma, a family medicine specialist with the Washington Township Medical Foundation. "As we age, there is less bone formation and bone breaks down more rapidly. Development of osteoporosis, which is defined as very low bone mass, is a process that takes many years, including a stage called osteopenia, in which the bone density is lower than normal but not as severe as osteoporosis."
According to the National Institutes of Health, there are approximately 1.5 million bone fractures in the U.S. each year due to osteoporosis, primarily of the hip or vertebrae in the spine. Other common osteoporosis-related fractures occur in the wrists and forearm. Complications from such fractures can cause significant health problems. The National Osteoporosis Foundation (NOF) reports that 24 percent of hip-fracture patients over age 50 die in the year following the fracture.
"Osteoporosis is a 'silent' problem," Dr. Sharma explains. "It has no early symptoms and people often aren't aware they have osteoporosis until they suffer a fragility fracture. That's why it is important for people to learn more about osteoporosis and take steps to decrease their risk factors."
Osteoporosis is more common in older women who are postmenopausal and in men over age 70, but it also can affect younger men and women. Dr. Sharma notes that in addition to advancing age there are other risk factors that can't be changed, such as:
- A history of previous bone fractures.
- A family history of osteoporosis.
- Northern European ancestry.
- Existence of certain medical conditions including rheumatoid arthritis, hypothyroidism and Lupus.
"The good news is that there are numerous things we can do to reduce risk factors for osteoporosis," Dr. Sharma says. "For example, it's important have an adequate intake of calcium - between 1,000 and 1,500 milligrams per day - and 800 to 1,000 international units (IU) of vitamin-D to help the body absorb calcium. Dairy foods such as milk, yogurt and cheese are great sources of calcium, and 15 to 20 minutes of sun exposure each day should supply your need for vitamin-D. People who are unable to get enough of these nutrients from natural sources should consult their doctor about supplements."
Dr. Sharma also recommends lifestyle changes to help reduce the risk of osteoporosis:
- Getting 30 to 45 minutes of weight-bearing exercise at least three to four times per week.
- Avoiding excessive alcohol consumption.
- Stopping smoking.
"Certain medications, including anti-seizure drugs, or prolonged use of corticosteroids such as prednisone also may contribute to osteoporosis," she adds. "If you need to take these medications, you may want to ask your doctor about whether it is possible to reduce your dosage. People who are extremely underweight also should consult their doctor about ways to gain weight, since low weight can be a risk factor."
Dr. Sharma encourages people to follow the guidelines for bone-density screenings established by the NOF - beginning at age 65 for all women, at age 70 for all men, and at age 50 for any adult who has had a bone fracture.
"Your doctor may recommend screenings earlier if you have a medical condition such as rheumatoid arthritis or if you have used steroids for a prolonged period," she adds. "Earlier screening also might be warranted for younger post-menopausal women who are very petite."
The "gold standard" for bone-density testing is dual-energy X-ray absorptiometry (DEXA). DEXA screening is generally performed on the hip and spine, where bone loss can be detected in the early stages.
"There are other ways to screen for bone-density loss, including a 'quantitative' CT scan," Dr. Sharma says. "The CT scan, however, has the drawback of involving more radiation. Ultrasound also can be good for screening, but it is used on the heel bone, and it is not as accurate. If an ultrasound indicates low bone density, the physician generally would follow up with DEXA screening."
For people diagnosed with osteoporosis, there are medications that can be used for treatment along with the above-mentioned lifestyle changes.
"These medications - known as bisphosphonates - decrease the rate of bone breakdown," Dr. Sharma explains. "They can be taken orally on a daily, weekly or monthly basis and should be taken in the morning with plenty of water at least a half hour before eating anything. For some patients who experience adverse side effects such a stomach upset or reflux from the oral medications, we can give the medication intravenously in the doctor's office either once every three months or once a year."
If bone-density screening indicates osteopenia, as opposed to osteoporosis, the physician may use a web-based fracture risk assessment tool called FRAX to help determine whether the patient might benefit from osteoporosis medicine. The FRAX score estimates the patient's chance of breaking a hip as well as the risk of fractures to the spine, forearm or shoulder. The NOF recommends that people with a 3 percent or greater chance of breaking a hip in the next 10 years or a 20 percent or greater chance of breaking another major bone in the next 10 years be treated with bisphosphonates.
"These medications can have other side effects besides digestive upsets," Dr. Sharma cautions. "For example, they can affect kidney function and may cause vision problems. In rare cases, they may cause decaying of the jaw called osteonecrosis or a fracture of the femur, which is the thighbone. As with any other medication, it's always important to discuss any unusual side effects of osteoporosis medications with your doctor."
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For more information about Washington Township Medical Foundation and its more than 60 board-certified physicians with expertise in a broad range of medical specialties - from neurosurgery to pediatrics - visit www.mywtmf.com.