Bad to the Bone: What You Should Know About Osteoporosis

By: Jennifer Hammond, RN, MSN, FNP-C

Many of us are familiar with the sense of alarm that registers when we hear that a loved one has broken their hip. Fractures are accompanied by pain and a change in lifestyle. Independence is compromised while we wait for injured bones to heal. This limitation in mobility may also keep us from participating in social events or activities. So how can we avoid this painful inconvenience?

At Carolina Arthritis Center in Greenville, we strive to provide high quality care to our patients. Screening for osteoporosis is important for women who have reached menopause and for men older than 70 years old. There are also cases in which younger patients should be screened. If you have been on prednisone for longer than a few months or if you have a history of a fracture resulting from a minor impact or injury, then screening for osteoporosis may be right for you.

What Is osteoporosis? Osteoporosis means porous bone. Bones are living tissue, made mostly of collagen and calcium and are constantly changing. Bones are strongest in our late teens and 20s. From our 30s and as we age, some bone cells dissolve while other new bone cells form. In osteoporosis, bone loss surpasses bone growth. When this occurs, bones become more porous and brittle and are more susceptible to fracture.

How common is osteoporosis? Current estimates are that about 10 million Americans have osteoporosis and another 44 million have low bone density putting them at risk for osteoporosis. Some studies estimate that one in two women and one in four men age 50 and older will break a bone due to osteoporosis.

What are risk factors for osteoporosis? Risk factors are divided into those we can change and those we cannot change. By recognizing modifiable risk factors, we can take steps to prevent osteoporosis. Major risk factors include age above 65 for women and 70 for men, being female, having small bone structure, family history of hip fracture in parents, history of fracture after age 50 and certain ethnic groups including non-Hispanic white and Asian ethnicities. Eating disorders such as anorexia nervosa and bulimia, tobacco and alcohol abuse, low calcium and vitamin D intake, sedentary lifestyle, certain medications and some diseases also carry increased risks for developing osteoporosis.

How do I know if I have osteoporosis? Osteoporosis is usually a silent disease, meaning there are no symptoms. The first sign may unfortunately be a broken bone after even a minor injury or sometimes after a hard cough or sneeze in severe cases. A simple and non-invasive test called a bone mineral density, or BMD, test obtained through a DEXA scan helps us determine the strength of your bones. Typically, measurements of the lumbar spine, hip and/or wrist are taken. A t-score of less than -2.5 indicates osteoporosis. Sometimes other factors, like a history of a broken bone after menopause, place one into the osteoporosis category even if the t-score is higher than -2.5. Women should not undergo a DEXA scan if they think they may be pregnant.

How can is osteoporosis treated? There are multiple prescription medications used to treat osteoporosis and treatment is specific to the individual being treated. Common medications are bisphosphonates which include alendronate (Fosamax), risedronate (Actonel) ibandronate (Boniva) and zoledronic acid (Reclast); hormone replacement therapy; teriparatide (Forteo); and denosumab (Prolia). There are also some other less commonly used medications. These medications come in various forms including oral medications, intravenous infusions, injectables and nasal sprays. Hormones may also be administered by patch. It is important that you talk to your healthcare provider about the benefits and risks of these medications to choose which one is right for you.

What if I have osteoporosis? Talk to your physician about options for treatment. If you are on a prescription medication for osteoporosis, we usually repeat the bone density scan every two years to see how well the therapy is working. If you have some unsteadiness, use a walker or cane. Try to get rid of rugs and loose cords in your home as they are often tripping hazards. Place nightlights near walkways or hallways. Make sure the area around your bathtub and toilet are not wet or slippery and use nonskid mats where needed. Wear good, supportive shoes with good grip on the bottom. Avoid walking in socks or wear socks with nonskid bottoms.

How can I prevent osteoporosis? Most women should be getting 1,000-1,2000 milligrams of calcium and 400-1,000 international units of Vitamin D in through diet or supplements every day. Talk to your personal physician about their recommendations before starting any new supplements. Stop smoking. Limit alcohol intake to less than 2 drinks a day. Participate regularly in exercise. Weight bearing exercises are particularly beneficial in strengthening our bones. Try to get in 2 ½ hours a week of exercise. Tai Chi and yoga are excellent sources of exercise to improve balance which may also make us less likely to have falls. Make your home safe to prevent falls. If you or your loved one are interested in being screened for osteoporosis, it would be our pleasure to see you at Carolina Arthritis Center in Greenville. We can be reached for appointments at (252) 321-8474.