By Morgan A. McLaughlin
When most people hear the word "osteoporosis," they immediately think of a condition found only among older populations. After all, it seems that at some point we've all been warned that an elderly relative could "fall and break a hip," but in reality, it's not just that age group who should be concerned about their bone health. Find out what changes you should make today to decrease your risk of osteoporosis and its complications – and try to heal any damage that's already done.
Invisible Disease, Visible Dangers
Osteoporosis means "porous bones" and is a disease characterized by loss of bone mass and the inability to rebuild bone tissue. This can lead to an increase in broken bones, even from low-impact accidents like bumping into a piece of furniture or tripping over a step. While any of these breaks could lead to major complications, broken hips are especially dangerous for older individuals with osteoporosis. Bone mass loss and the related injuries can seriously impact lifespan and quality of life.
"People misunderstand how important osteoporosis is," says Dr. Hayes Wilson, Chief of Rheumatology at Piedmont Hospital. According to Dr. Wilson, 20 percent of older adults who sustain an osteoporosis-related hip bone break will die within a year of that injury, and 50 percent die within two years. Additionally, 50 percent of those who break a hip due to osteoporosis will lose their independence.
Are You At Risk?
While aging (65+) is a primary risk factor, these other groups are at higher risk for osteoporosis as well:
- White or Asian individuals
- People of smaller stature
- People with a family history (especially in the maternal line) of osteoporosis or fractures
- People deficient in calcium and vitamin D
Certain medications or treatments for other health problems can also increase risk. "Long-time steroid use, some seizure medications, long-time anticoagulant use, some stomach acid medications and some medications used for diabetes also are associated with a higher risk of developing osteoporosis," says Dr. Michael Crowe, board-certified OB/GYN with Glenridge Northside Gynecology. Proton pump inhibitors like Nexium, Prilosec and Prevacid can interfere with calcium absorption and increase the risk of bone mass loss. Dr. Wilson cites dietary restrictions (such as dairy allergies or diseases like celiac), eating disorders like anorexia, Crohn's-related bowel resection and certain lifestyle factors like smoking and heavy alcohol use as additional risk factors.
Early Prevention for Best Bone Health
Osteoporosis is a prime example of an ounce of prevention being worth a pound of cure. Good bone health begins with a balanced diet and sufficient calcium intake in childhood and the teen years. Weight-bearing exercise from the teen years onward also helps build and maintain bone density.
Dr. Tom Price, an assistant professor of geriatric medicine and gerontology and a physician with Emory Geriatric at Emory Saint Joseph's Hospital, says adequate calcium and vitamin D intake are critical. He recommends daily supplementation of 1200 mg of calcium and 800 IUs of vitamin D. Add these to your routine as early as possible, Dr. Price stresses, ideally before the first signs of bone density loss. Once bone loss is detected, the most effective period of osteoporosis prevention is already behind you. By then, he says, the "horse is already out of the barn, and you're chasing it with calcium."
Another key factor is magnesium, which many people are deficient in. Dr. Tasneem Bhatia from the Atlanta Center for Holistic and Integrative Medicine says, "Calcium and magnesium need to be in a two-to-one ratio for best absorption." Her practice recommends 400 mg of chelated magnesium (a more easily absorbed form) daily.
Diagnosis: Easy and Safe
But how can you tell if your bones are losing density? It's not exactly like noticing a gray hair or tired feet. Thankfully, diagnosis is a very simple process. Bone densitometry (also called DEXA or DXA) scans are the most reliable and most common means of detecting osteoporosis. This advanced X-ray technology is non-invasive – no IVs or other prep required – and typically involves scanning the lower spine, hips and pelvis area. Results will indicate normal bone mass, low bone mass (osteopenia) or osteoporosis.
DEXA scans are recommended for postmenopausal women over 65 and for men over 70, though scans may be recommended earlier for those with more risk factors. Because of the increased risk for osteoporosis in women, most women should consider having a DEXA scan every two years. Referrals for this scan often come from your OB/GYN and can, in many cases, be performed at the same location and in the same visit as a mammogram.
Treating Osteopenia and Osteoporosis
Once low bone mass has been detected, most care providers will immediately prescribe calcium (1200 mg) and vitamin D (2000 IUs) supplements. Vitamin B-12 supplementation, particularly in men, can also help with retaining bone mass. Lifestyle changes, such as smoking cessation and beginning weight-bearing exercise, are also prescribed at this point.
If nutritional supplementation and lifestyle changes do not indicate improvement, the next step is medication, typically bisphosphonates such as Fosamax, Boniva or Actonel. Bisphosphonates may be prescribed for a period as long as five to 10 years, though they can be difficult for some people to take. Bisphosphonates can cause heartburn and must be taken orally, twice a week, and within 30 minutes of taking them, the patient cannot lie down, eat or drink anything other than water, or take other medications.
For those who can't take bisphosphonates or for whom bisphosphonates are not working, a daily injectable medication like Forteo, or a newer, twice-yearly injectable medication like Prolia may be a better option. These medications also carry certain risks, however, and your health care provider will work with you to determine which course of treatment will be the safest and most effective for your individual needs.
Whether you are above the age of 65 or still in your 20s, you can still take steps to improve your bone health. Prevention, early diagnosis and good, evidence-based care can keep you on your feet and improve your overall quality of life.
Tasneem Bhatia, MD, Atlanta Center for Holistic and Integrative Medicine – www.atlantaholisticmedicine.com
Michael E. Crowe, MD, Glenridge Northside Gynecology – www.glenridgenorthsidegynecology.com
National Osteoporosis Foundation – www.nof.org
Thomas Price, MD, Emory Geriatric at Emory Saint Joseph's Hospital – www.emoryhealthcare.org/saint-josephs-hospital-atlanta
Hayes Wilson, MD, Piedmont Hospital – www.piedmontrheumatologyconsultants.com