Bartecchi: How are my bones?
Not a common question, but an important one.
Harvard Health defines osteoporosis as a disorder in which bones become thinner and lose their strength. Individuals with osteoporosis are at higher risk for breaking bones. Osteoporosis is the most common type of bone disease. Estimates suggest that about 20% of American women over age 50 have osteoporosis. According to Penn Medicine, as the body ages, calcium and phosphate may be resorbed back into the body from the bones, making the bone tissue weaker, which can result in brittle, fragile bones that are more prone to fracture, even without injury.
Unfortunately, the majority of the highest risk women and even men who have fractures are not diagnosed and do not undergo approved therapies for osteoporosis.
The NIH notes that osteoporosis is a “silent” disease because you usually don’t have symptoms and you may not even know that you have the disease until you break a bone. Some suggestions of osteoporosis include loss of height, low back or neck pain due to vertebral fractures or a stooped posture.
Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone, but most often in bones of the hip, vertebrae in the spine and in the wrist.
According to Penn Medicine, there are a number of risk factors for osteoporosis. A partial list includes the following:
Post-menopausal state (and possibly low testosterone in males)
Being confined to bed (prolonged immobility)
Chronic problems such as rheumatoid arthritis, kidney disease and eating disorders
Taking steroid medicine daily for more than 3 months or some anti-seizure medications
Long term use of certain GI medicines, psychiatric or diabetes medicines
Hyperparathyroidism
White women with a family history of osteoporosis
Absence of menstrual periods for long periods of time
Smoking or drinking large amounts of alcohol
History of hormone treatment for cancers
Low body weight
If there is any suspicion of osteoporosis, bone mineral density testing (DEXA scan) measures how much bone a person has. A Fracture Risk Assessment Tool (FRAX) can help doctors predict a patient’s fracture risk, according to Dr. Licata, an endocrinologist at the Cleveland Clinic, who also mentions a newer tool to predict fracture risk – the Trabecular Bone Scan. Blood and urine tests can be useful in determining if osteoporosis might be due to a medical condition rather than the usual bone loss problems seen with age, etc.
Once a diagnosis of osteoporosis is made or suspected, a variety of older and many new medications are available for effectively treating the patient’s problem and avoiding or managing complications. At some point, a bone specialist or endocrinologist might prove valuable.
As part of treatment, as well as for prevention, adequate calcium and vitamin D is important along with a nutritious diet. Staying physically active by taking part in weight bearing exercises such as walking, is important. Smoking should be avoided and alcohol consumed only in moderation. Counselling for evaluation and prevention of falls, when appropriate, may also be important.
Estrogen replacement was the standard of practice to prevent bone loss in newly menopausal women. However, the large, prospective Women’s Health Initiative showed a reduction in overall fractures with use of estrogen alone and estrogen-progesterone combinations in older postmenopausal women, but the benefit of fracture reduction did not outweigh the increased risk of strokes and breast cancer, even in women at higher risk of fracture. Thus, hormone replacement is not currently recommended for either prevention or treatment of osteoporosis in postmenopausal women.
Failure to address bone health can be debilitating or even lethal for some individuals.
Dr. Carl E. Bartecchi, MD, is a Pueblo physician and clinical professor of medicine at the University of Colorado School of Medicine.
This article originally appeared on The Pueblo Chieftain: Bartecchi: How are my bones?