Osteoporosis is a disease of bone which results in decreased bone mineral density and a higher risk of fracture. An underdiagnosed and also undertreated disease, the American Osteoporosis Association estimates that over half of the American population aged 50 or over has osteoporosis significant enough to be a fracture risk. While some degree of diminished bone density is naturally expected with aging, patient education and proper diet and exercise, along with medications if indicated, can delay and prevent serious complications of this disease.
Fractures are a significant risk in osteoporosis, and can result in chronic pain, disability, joint deformity and depression, as well as an increase in mortality. Hip fractures not only leave people with an inability to walk without assistance, they are also a major contributor to health care expenditures, hospitalization rates, and death. Preventing them and having good bone health is essential to going into older age with a strong healthy foundation.
Osteoporosis is more common in females than male. The scientific thought for this is that while men lose bone at a linear rate in their lifetimes, women suffer an acute demineralization with the loss of estrogen from menopause, and the bones are suddenly left weaker. Men who lose testosterone rapidly (“male menopause”) suffer this, but at a far lesser severity. Genetic factors also play into the equation.
How does one know that they are either suffering from or prone to severe osteoporosis? The World Health Organization classifies bone mineral density on the basis of a calculation called a T-score, which is the difference in standard deviations between a person’s bone density and that of a younger adult reference population. Bone density testing allows doctors to diagnose osteoporosis before fractures occur and take preventative steps. This is usually accomplished through a DEXA (dual energy X-Ray absorptionometry) scan. The US Preventative Services Task Force recommends this test be done in all women over the age of 65, as well as all those men and women who are at increased risk for fracture or with a genetic history of same.
Some circumstances lead to increased fracture risk that can’t always be controlled but their assessment is critical to proper management. Menopause in women and hypogonadal states (low testosterone in men) are two of those. Coincident diseases such as Cushing syndrome, rheumatoid arthritis, ulcerative colitis, and those entities that cause deceased reabsorption of calcium are among them. Most autoimmune diseases are contributory as well.
Alcohol excess and smoking are two conditions that contribute to osteoporosis that are preventable entities. Proper nutrition with a diet adequate in Vitamin D and calcium are essential. Exercise and avoidance of inactivity are also necessary to promote adequate bone mass and strength. Regular weight bearing exercise and fall prevention are also essential in avoidance of consequences of osteoporosis.
Recommendations for everyone include a daily intake of elemental calcium of at least 1,200mg daily, although too much calcium can also be detrimental if it is retained and not excreted properly. Vitamin D3 in doses of 800-100 IU daily also brings Vitamin D levels into optimal ranges. Most laboratory testing in a routine physical will include calcium and Vitamin D levels. When osteoporosis is significant enough to require prescription medication, biphosphonates, estrogens in women, and other calcium reabsorptive medications are used in successful treatment.
Talking to your doctor is an important first step in evaluating your risk of osteoporosis. Doing everything in your power to promote good bone health with adequate calcium and Vitamin D intake and preventable measures such as smoking cessation and life style modifications such as increased exercise and decreased alcohol intake are key. Bone densitometry and Xray tests are the other component to help decide whether further measures are needed to keep your skeleton healthy and strong into advancing age.