Osteoporosis

OSTEOPOROSIS

Osteoporosis is a progressive loss of bone density. This loss of structural content means bones are thinner and more fragile. In severe cases, a hug from a grandchild or simply opening a window may cause a fracture.

Over 1.3 million fractures occur yearly in the United States. About half of all menopausal women are at risk for disease and fracturing. While the loss of estrogen puts menopausal women at risk, many other factors can also increase anyone’s risk for thin bones.

During the patient’s teens and twenties, one is building bone density. After about age 30, one sees a plateau and then a decline in bone mass. This happens in both men and women. Losing about 1% of bone yearly seems miniscule, but after 20 years, it represents a significant bone loss.

Fracturing may occur in any bone, but the areas of most concern have been the spine, hip and forearm. While fractures rarely are a cause of death directly, they cause other major problems. Rounding of the back, or “dowager’s hump,” may occur after multiple crush fractures of spinal vertebrae bones. These patients cannot stand upright and may not fully expand their lungs. They will have difficulty reaching upwards as well. Hip fractures may result in being bedridden for weeks or months. This in turn may increase the risk of blood clots or aspiration pneumonia, which could be deadly. Many of these patients never regain their independence, and reside in a nursing home. Forearm fractures are often quite painful.

Causes of osteoporosis may include being menopausal, being a female, being of slender build, and sometimes a family history may be a factor. Some risks are nutritional, such as a lack of calcium, or vitamin D. Being a couch potato or prolonged immobilization may thin bones. Prolonged use of certain medications such as Prednisone or some anti-seizure medications may thin bones. Smoking and alcohol may increase risk as well.

Environmentally, poorly lit homes, loos throw rugs or extension cords are a trip and fall hazard. A nightlight and good eyesight helps minimize the risk of falling.

Testing for bone density is most commonly done using a DEXA scan, which uses very low dose x-rays (about 1/10 of a chest x-ray) to measure bone calcium content. Scans of the hip, lumbar, spine and sometimes the forearm are commonly done. Follow up scans done in 1–2 years may help determine if efforts to build bone density have helped. QCT or quantitative CT scan is also done, but traditionally it involves much more radiation than the DEXA, and cannot measure hip density. It is much less commonly used than DEXA.

Other tests such as heel ultrasound, heel DEXA or finger DEXA are helpful in screening, but are not generally used for follow up assessment as your doctor retests your bones to see if therapies have improved your bones.

Therapies for building bones may include nutrition, exercise, medication and possibly removing any offending factor causing thin bones. Calcium, Vitamin D, and a balanced diet will provide building blocks needed to build bones. They are often not enough, and medications are often required.

Medications may include the following:

  • Risedronate, Alendronate, Zoledronic acid, and Ibandronate are the bisphosphonates. They are non-hormonal, and are probably the most commonly used medications to build bones.
  • Estrogens have fallen out of favor as the first line treatment for bones loss due to potential complications of therapy. Some patients may still use estrogens in certain specific cases.
  • Parathyroid hormone is taken as a daily injection, and is unique in that it may directly activate bone building cells.
  • Raloxifene is unique in having some of the bone building benefits of estrogen, but it is not a hormone

While nutrition such as calcium and Vitamin D, and weight bearing exercise may be appropriate for most patients, only after a careful analysis of your risk for bone loss, your bone density and any fracture history will your doctor make a recommendation for medication. Regardless, we recommend all individuals seek a doctor’s opinion before embarking upon any course of therapy for thin bones.