(Don't) Give Me A Break: Osteoporosis and You

By Dr. Shuxin Wang, DO



Osteoporosis and you

Osteoporosis (aa·stee·ow·pr·ow·suhs) literally means "porous bone." The bones become weak as a result of the body losing too much or not creating enough bone.


Unfortunately, weak, thin bones tend to break, and most people with Osteoporosis have no symptoms until they break a bone.


It is estimated that about 10 million Americans suffer from Osteoporosis, and an additional 44 million are at risk for developing it.


Women are two times more likely than men to develop Osteoporosis. Their risk significantly increases in their 50s primarily due to menopause. Half of all women will break a bone in their lifetime due to Osteoporosis.


Weak bones can increase an older person's risk of falling, see the GeriAcademy post Don't Let Falls Get You Down. Think of your bones the way you would the foundation of a house, which bears the entire house's weight, and in this case, your home is your body.


Both women and men build bone at about the same rate and have the most robust bones into their mid-twenties, after which the rate of bone loss changes for women and men.


In Women


From the mid '30s-'40s, bones are generally stable, there is slow bone loss. Around the mid-40s-50s, women start to experience more rapid bone loss, especially during menopause; they can lose about 7% per year. By the mid-50s to late life, women will continue to lose 1-2% of bone yearly.


In Men


After age 30, there is about a 1% bone loss per year, but can lose up to 6% of bone yearly depending on risk factors.


Geriatricians fear Osteoporosis, and they fear falls!

Bone fractures are the most common condition requiring hospitalization for individuals 65 years and older. Some studies estimate that about 1.5 million people annually suffer a bone fracture related to bone disease. Hip, spine, and forearm fractures are the most commonly seen in older adults.


About 20% of older adults who sustain a hip fracture die within the first year, and up to 50% never return to their previous functioning level.


Are you at risk for Osteoporosis?


When it comes to Osteoporosis, some risk factors can be reduced, and some cannot!


Risk factors that can be changed

  1. Poor Nutrition

  2. Little to no physical activity

  3. Rapid unintentional weight loss, or weight less than 127 pounds

  4. Cigarette smoking

  5. Excessive use of alcohol

  6. Air pollution

  7. Stress

Risk Factors that cannot be changed

  1. Older age

  2. Female

  3. White ethnic background

  4. Previous bone break

  5. Family history of Osteoporosis

  6. History of falls

Other Risk factors

  1. Thyroid disease

  2. Chronic liver disease

  3. Hypogonadism- a condition where the body doesn't produce hormones like testosterone.

  4. Chronic steroid use

  5. Vitamin D deficiency

  6. Heart disease

  7. Diabetes mellitus

  8. Dementia

  9. Chronic kidney disease

  10. Rheumatoid arthritis and other inflammatory diseases

Should I get tested for Osteoporosis?


The recommendation is that every woman over the age of 65 should be tested. For men, there is no routine testing.


Additionally, any older adult with the risk factors described above or loss of height by more than 1.5 inches should be tested, regardless of gender.


How do I get tested for Osteoporosis?


The most common test to detect Osteoporosis is called a DEXA scan (dual-energy X-ray absorptiometry). Basically, an x-ray, looking at bone thickness. The spine, hips, and wrists are common test sites. This test is usually repeated every 2 years. Medicare generally covers testing for those that qualify.


Suppose you have already had a fall and sustained a fracture. In that case, you are considered to have the diagnosis of Osteoporosis even without a DEXA scan. You may need to receive treatment to prevent a future fracture. Unfortunately, less than 10% of patients who should be receiving treatment for Osteoporosis after a fracture do so.


Sometimes the result of a bone scan is osteopenia. Osteopenia is low bone composition, not Osteoporosis. It means you are at greater risk of developing Osteoporosis and need to work harder to prevent disease development. It is important that you discuss osteopenia treatment with your health care provider to prevent Osteoporosis.


Preventing Osteoporosis


Start by tackling the risk factors that can be modified. For example, try to quit smoking, decrease alcohol intake, start getting active.


Next, ensure you are taking enough vitamin D and Calcium. The FDA recommends that older adults take 800 units of vitamin D3 daily. Vitamin D has been shown to maintain bone health and prevent falls in older adults. When Vitamin D is combined with Calcium it has been shown to reduce the risk of fracture.


A daily Vitamin D supplement at the recommended dose is safe to take. Additionally, foods that contain Vitamin D include Milk, yogurt, sardines, tuna, leafy greens, beans, liver, eggs, and certain mushrooms.


The daily recommended dose of Calcium is about 1200 mg. This includes the Calcium you eat in your diet, and take as a pill. Keep in mind if you eat enough calcium-rich foods, you should not take an additional supplement. See the table below.


Too much Calcium is not safe, check out the the GeriAcademy blog on Vitamins and Herbs which discusses safety of Calcium and Vitamin D.



For example, if you eat a cup of yogurt and drink a glass of milk daily, then you would need an additional 500-600 mg of Calcium that day. This could include taking a supplement, or other foods that contain Calcium.


What if I have Osteoporosis? What are some treatment options?


There are two types of Osteoporosis medications. One type prevents bones from breaking down, and the other helps the body build bones. Some of these medications can be taken by mouth, injected with varying frequency including daily, monthly to yearly. It is crucial to talk to your health care provider about what type of treatment is best for you.


Treatments for Osteoporosis, just like all other medicines, have side effects but are generally well-tolerated. It is crucial to have an evaluation for treatment options.


Getting active!


Exercise helps to prevent and treat Osteoporosis by strengthening bones and the muscles that support your bones. The best type of exercise includes a combination of strength, balance and flexibility. The National Institute on Aging has a free book that can be downloaded through the their site called Workout to Go. Consult with your primary care provider before starting any exercise program to prevent hurting yourself.


Summary


I hope you enjoyed reading about Osteoporosis by Dr. Shuxin Wang. See other posts on the GeriAcademy blog, listen to my podcast and follow me on social media.



Dr. Wang is currently a Geriatric Fellow at Carolinas Health Care System Blue Ridge. Her training prior to fellowship was in Internal Medicine. She has had experience working as a hospitalist caring for older adults.


References


Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 4, The Frequency of Bone Disease. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45515/


Riggs BL, Melton LJ 3rd. The worldwide problem of Osteoporosis: Insights afforded by epidemiology. Bone. 1995 Nov;17(5 Suppl):505S–511S


Benson M, Sharafsaleh G, McCourt L, Combs A,. Suboptimal Treatment of Osteoporotic Fragility Fractures Linked to Provider Understanding of Current Guidelines, (2020), Paper Abstract. J Am Geriatr Soc, 68: S1-S385. doi:10.1111/jgs.16431


Chrischilles EA, Butler CD, Davis CS, Wallace RB. A model of lifetime osteoporosis impact. Arch Intern Med. 1991 Oct;151(10):2026–32


Marshall K, Sharafsaleh G, Give us a break! Evaluating rates of Osteoporosis Treatment Following Fragility Hip Fractures in a Community Health Setting. (2019), paper Abstract. J Am Geriatr Soc, 67: S1-384. doi:org/10.1111/jgs.15898


Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on Osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:2029-2049. Published 2018 Nov 6. doi:10.2147/TCRM.S138000


Rabenda V, Vanoverloop J, Fabri V, Mertens R, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY. Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am. 2008 Oct;90(10):2142-8. doi: 10.2106/JBJS.G.00864. PMID: 18829912


Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6-14. doi:10.1177/2151458510378105


Thanapluetiwong, Saran MDa; Chewcharat, Api MDb; Takkavatakarn, Kullaya MDb; Praditpornsilpa, Kearkiat MDb; Eiam-Ong, Somchai MDb; Susantitaphong, Paweena MD, PhDb,c,∗ Vitamin D supplement on prevention of fall and fracture, Medicine: August 21, 2020 - Volume 99 - Issue 34 - p e21506 doi: 10.1097/MD.0000000000021506