We hear a lot about osteoporosis, especially after we’ve reached a “certain age,” but what is it exactly, and is it serious?
Osteoporosis is a condition that happens when our bones become more porous and brittle and less dense, making them weaker and more prone to fractures. Approximately 10 million Americans have osteoporosis and another 44 million have low bone density, meaning approximately 54 million over-50 adults are at risk of a bone break. Osteoporosis is often called a silent disease because it may have no symptoms until a fracture. While the condition itself isn’t life-threatening, its impacts can be devastating, with hip and spine fractures being the most serious complications.
In many cases, fractures happen from a fall, but osteoporosis-related fractures can also occur without any fall. Sometimes the bones of the spine can deteriorate to the point of crumbling, causing a “compression fracture,” or a wrist fracture may occur without any obvious cause.
The bare bones of the matter – risk factors
“There are multiple osteoporosis risk factors, some that are avoidable and some that aren’t,” explains Mary Mulcahey, MD, director of the Tulane Women’s Sports Medicine program. “It can affect both men and women, but is most common in women after menopause because of the drop in estrogen, the hormone that normally helps protect and preserve bone strength. In fact, one in two women over 50 will have an osteoporosis-related break.”
Unavoidable risk factors
- Being female
- Caucasian or Asian race
- Family history
- Menopause or hysterectomy
- Small body frame
- Chronic or long-term steroid use (such as prednisone or cortisone)
- Some medical conditions – For example, hyperthyroidism (overactive thyroid gland) or too much medication for hypothyroidism (underactive thyroid gland)
Avoidable risk factors
- Low body weight
- Excessive drinking
- Eating disorders
- Low calcium or Vitamin D
- Sedentary lifestyle
A feeling in your bones – symptoms
Unfortunately, there are often no symptoms with early bone loss. Sometimes people don’t know they have osteoporosis until they break a bone. In other cases, people with osteoporosis may experience back pain from collapsed or fractured vertebrae. Other possible signs:
- Loss in height
- Stooped or hunched over posture
- A break that occurs much more easily than expected
Is it time? – when to be tested
“If you have any of the risk factors, you should definitely ask your doctor about osteoporosis testing, if you haven’t already,” stresses Mulcahey. “One of the issues with osteoporosis is that it doesn’t fall neatly within one specialty, so I always encourage patients to be their own advocate and ask their doctor, whether primary care, ObGyn, endocrinologist, or their orthopedist.”
According to National Osteoporosis Foundation guidelines, a bone density test is appropriate for:
- Women 65 or older, or under 65 with risk factors
- Men 70 or older, or under 70 with risk factors
- Anyone over 50 with a break or fracture
- Menopausal women with any of the risk factors
- Back pain that may signal a spine fracture or bone weakening
- If you lose ½ inch or more during a single year
The view from the back – diagnosis
Osteoporosis is diagnosed through a special X-ray, called a DEXA (dual energy x-ray absorptiometry) scan that measures your bone mineral density (BMD). A DEXA scan, which measures your hip and spine bone mass, is the only test that can diagnose osteoporosis before you break a bone.
Understanding the test results
Bone density results are reported out as a T score, a measure that compares your bone density to that of a healthy 30-year-old. Your doctor will look at the T score to determine if you have normal bone density, low bone density (also called osteopenia), or osteoporosis. World Health Organization (WHO) guidelines are:
- Normal bone density: A T score of -1.0 or above
- Low bone density or osteopenia: A T-score between -1.0 and -2.5
- Osteoporosis: A T-score of -2.5 or below
Putting the brakes on breaks – prevention and management
It’s never too early to think about bone health – building strong bones as a child or adolescence can help prevent osteoporosis later – and alternately, it’s never too late to work on your bone health, regardless of your age. About half of osteoporosis repeat fractures can be prevented with appropriate treatment – a combination of lifestyle steps and osteoporosis medicines.
Talk regularly with your doctor about risk and whether you should be tested.
Make sure you’re getting the vitamin D and calcium you need every day. (your doctor can advise you on appropriate amounts)
Eat a healthy diet and exercise regularly – it’s a potent blend that can help slow or stop bone mass loss. Aim for 30 to 40 minutes of exercise three to four times a week, with a mix of weight-bearing and muscle strengthening activities.
Avoid tobacco and heavy drinking.
Building bones – treatment
Osteoporosis treatment depends on each individual and the stage of the condition. Medicines will generally fall in one of two categories bone protecting/preserving, or bone building. Your doctor can help you understand what each medicine does and the best one for you.
Tulane Health System offers bone health expertise across our spectrum of physician specialties. We are also prepared in case of osteoporosis-related emergencies or fractures with two ERs located in the New Orleans metro area.