By Mindy Ewert, PA-C, DC
May is National Osteoporosis Month, and I wanted to take this opportunity to share the basics on osteoporosis. Osteoporosis is a common bone disease where the bone becomes too thin due to too much bone loss or too little bone building, increasing the risk of fracture. The numbers may surprise you: 50% of women over 50 years old and 25% of men over 50 years will break a bone because of osteoporosis.
Fractures caused by osteoporosis affect both quality and quantity of life. Half of those people who fracture a hip will never regain full function, which can affect one’s ability to walk and remain independent, and 25% of those who fracture a hip die within one year of the fracture. Spinal fractures can cause permanent deformities of the back, reduce lung function, and lead to chronic pain and disability.
Osteoporosis is an issue that becomes more common as we age. Due to loss of estrogen and testosterone, there is an acceleration of bone loss that contributes to a steady decline of bone density over time. This bone loss is heightened during the time of menopause for women. Osteoporosis can occur in middle-aged adults and occasionally teens due to other medical conditions that contribute to excessive bone loss. Most commonly, these include early menopause (before 45 years old), diabetes, hyper or hypothyroidism, eating disorders, chronic kidney or liver disease, celiac disease, and rheumatoid arthritis.
Medical procedures that contribute to osteoporosis include weight loss surgeries like gastric bypass, hormone-blocking treatments for breast and prostate cancer, and complete hysterectomies at a young age. Medications that commonly contribute to osteoporosis include steroids, antidepressants, and heartburn medications. We diagnose osteoporosis traditionally with a bone density scan (also called a DXA scan). This is a non-invasive, 10-minute test where the patient lies on a table and has their hips and back scanned. This generates a report indicating the bone density in these areas and calculates the likelihood of a fracture based on bone density.
We utilize the bone density test, along with the patient’s fracture history, to determine the level of bone loss, the risk of fracture, and the need for treatment. This test is traditionally done on women starting at 65 years old and men starting at 70 years old as part of a health screening to check for the degree of bone loss that occurs with aging. It is common to have this test done at a younger age if there is a history of a fracture or there is a concern for bone loss based on a patient’s medical history.
It is very important to consider getting a DXA scan if you are over 50 years old and have broken a bone, especially if the break occurred with a fall, a minor injury, or without a clear injury. When patients have osteoporosis, we repeat this scan every 1-2 years to monitor bone loss and treatment efficacy. When patients have osteoporosis, we utilize medication to either slow the bone thinning or boost the bone building in order to stabilize the bone and prevent future fractures. The medications come as pills, shots, or infusions and are chosen based on what is safe and appropriate for each patient. The medications are generally well-tolerated, and with follow-up visits and repeat scans, we ensure that whichever treatment is chosen is both safe and effective.
In addition to the medication, we also encourage patients to take adequate amounts of calcium and Vitamin D eat a diet includes foods that are rich in bone-building vitamins and minerals such as dairy and dark leafy green vegetables, exercise regularly with weight-bearing or resistance exercise, avoid smoking, avoid excessive alcohol or caffeine intake, keep thyroid disorders and diabetes under good control, and make efforts to reduce falls.
Osteoporosis is a disease that is significantly under diagnosed and under treated. I encourage you to inquire with your healthcare provider if a bone density scan is appropriate for you. The Healthy Bones Center at Tulsa Bone and Joint is a dedicated osteoporosis clinic that can conveniently schedule a bone density scan and follow-up consultation with a healthcare professional immediately following the scan. Call 918-392-1489 to schedule or for further inquiries.