What is Osteoporosis?
Osteoporosis is a disorder of the bones resulting in decreased bone strength. In most, but not all, cases this loss occurs as we get older. It is accompanied by a loss of bone structure, which leads to weakening of bones and weak bones are prone to fractures.
Osteoporosis is a risk factor for fracture just like high blood pressure is a risk factor for stroke. Fractures present a sense of urgency as they signify increased risk of subsequent fracture.
A majority of fractures occur in patients with low bone density (osteopenia: A step prior to osteoporosis) rather than osteoporosis simply because of a large number of individuals in this category.
How will you know if you have Osteoporosis?
Broken bones in people over the age of 50 can be the first sign of osteopenia or osteoporosis, a silent disease that may be diagnosed only after you break a bone. This could occur following a minimal trauma like sneezing, bumping into furniture or with no trauma at all. Broken bones from serious falls or accidents are often related to osteoporosis.
Why should you know about it?
Almost 54 million Americans have osteopenia or osteoporosis. This means that half of all adults age 50 and older are at risk of breaking a bone. About 1 in 2 women and up to 1 in 4 men over age 50 will have an osteoporosis-related fracture.
For women, the incidence is greater than that of heart attack, stroke and breast cancer combined. A man is more likely to break a bone due to osteoporosis than he is to get prostate cancer.
Is it Serious?
Yes. 24% of hip fracture patients age 50 and over die in the year following the fracture. Six months after a hip fracture, only 15% of patients can walk across a room unaided. Every year, of nearly 300,000 hip fracture patients, one-quarter end up in nursing homes and half never regain the previous function.
Can you prevent it?
Yes. Building strong bones during childhood and adolescence can help prevent osteoporosis later in life. Peak bone mass is typically achieved between 18-25 years of age. The more bone you have at that time, the less likely you are to get osteoporosis later in life. Ensuring recommended daily calcium and vitamin D intake, regular weight-bearing and muscle-strengthening exercises, smoking cessation and minimizing alcohol consumption are important components of preventing as well as managing this disease.
How is it diagnosed?
Bone density test using hip and spine DEXA (Dual-energy x-ray absorptiometry). It is a simple, painless test that uses very little radiation. You are exposed to 10-15 times more radiation flying in a plane roundtrip between New York and San Francisco. Osteopenia is diagnosed if T scores are between -1.0 and -2.5 and Osteoporosis if T score <= -2.5. In patients <50 years of age, Z scores are used for diagnosis.
Should you be screened?
You should have a DEXA scan if you are a woman above the age of 65 or a man above the age of 70. If you’ve had a fracture after the age of 45 speak to your provider about your risks and whether you need to be tested. Personal history of fracture, family history of osteoporosis, celiac disease, smoking, alcohol >3 drinks/day place you at an increased risk for a fracture.
Is it treatable?
Yes. In fact, the whole idea is to prevent fractures. We have oral as well as injectable medications. Talk to your healthcare provider about an osteoporosis treatment plan that includes taking an osteoporosis medicine that works best for you. Even after you have had a fracture, there are effective treatments available to decrease the risk of further fractures. In order for your medicine to work, it’s important to exercise regularly and make sure you get the recommended amount of calcium and vitamin D every day from foods and/or supplements.
Talk to your healthcare provider today about osteoporosis!
Cosman F, J De Beur S, LeBoff MS et al. Osteoporosis Int DOI 10.1007/s00198-014-2794-2. Facts courtesy National Osteoporosis Foundation
Dr. Mahajan is a board-certified physician in internal medicine and rheumatology and a member of Harrington Physician Services. She earned her medical degree at Kasturba Medical College, Mangalore-Karnataka, India and completed her residency at Mount Sinai Hospital, Bronx, New York. Dr. Mahajan also completed a fellowship at the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Maryland.