“Most people take their bones for granted,” observes Donna Shoupe, M.D., professor of obstetrics and gynecology at the Keck School of Medicine of USC. “They forget that this internal structure holds them up.”
If you’re guilty of giving short shrift to your skeleton, then today—World Osteoporosis Day—is an ideal date to not only give a nod of thanks to the 206 bones that literally shape your life, but to also learn more about osteoporosis.
Osteoporosis Weakens Bones
According to the National Osteoporosis Foundation (NOF), osteoporosis is characterized by low bone mass and structural deterioration of bone tissue—a combination that can cause bones to be fragile and thus more susceptible to fractures, especially of the hip, spine and wrist.
Of the estimated 10 million Americans who currently suffer from osteoporosis, eight million are women and two million are men.
Commenting on the disease’s decidedly XX leanings, Robert Rude, M.D., professor of medicine at the Keck School of Medicine of USC, explains, “Women have a much higher incidence of osteoporosis because not only do they acquire less bone mass than men during their lifetimes, but menopause is accompanied by a sharp drop in estrogen and an acceleration of bone loss.”
Prevention is Paramount
While declining bone density is a natural process of aging, this process need not culminate in a diagnosis of osteoporosis. Prevention is paramount to avoiding such an outcome.
From a prevention perspective, calcium is a cornerstone component. “An adequate intake of calcium is 1,000 milligrams daily for those under 50, and 1,200 milligrams a day for those 50 and older,” Rude says.
Equally important is vitamin D, which plays a major role in calcium absorption and bone health. NOF recommends a daily allowance of 400 to 800 international units (IU) per day for adults under 50, and 800 to 1,000 IU daily for adults 50 and older.
Exercise is another prime prevention weapon. Weight-bearing and muscle-strengthening exercises are especially beneficial for bones. Shoupe suggests walking, jogging, and lifting weights. “Going down stairs is particularly good,” she explains, “because you’re putting weight on your hips.”
When to Schedule a Screening
“All postmenopausal women should be screened,” advises Rude. “NOF recommends that the first screening be done at age 65.” There are exceptions, however, as Shoupe notes: “If a woman is under 65, postmenopausal, and has at least one risk factor, then she should be screened before 65.” According to NOF, men should first be screened at age 70; earlier, if they have one or more risk factors.
Risk factors include:
• family history of osteoporosis
• low body weight
• history of broken bones
• low calcium intake
• low vitamin D intake
• inactive lifestyle
• high caffeine intake
• high salt intake
• alcohol abuse
• overactive thyroid gland
• significant loss of height
Bone Mineral Density Test
A bone mineral density (BMD) test is used to diagnose osteoporosis. A BMD test uses a special machine featuring dual energy x-ray absorptiometry that measures bone density in various sites on the body. These measurements are then translated into what are called T-scores. According to parameters established by the World Health Organization in 1992, T-scores are categorized as follows (the closer the negative number is to zero, the healthier the bone):
• T-score of –1 or above = normal bone mass
• T-score between –1 and –2.5 = low bone mass but not considered osteoporosis
• T-score at or below –2.5 = patient has osteoporosis
Although there’s no current cure for osteoporosis, it unquestionably can be treated, and an expansive menu of medications is available.
Severity of the disease drives which pharmacologic therapy is the best fit. For example, teriparatide—sold under the brand name Forteo—is for those at high risk for fracture. As Rude explains, “This is a daily injection for people with advanced osteoporosis.”
Those who aren’t at an advanced stage, as well as those in the low-bone-mass category, are usually prescribed one of several medications classified as bisphosphonates. Brand-name bisphosphonates, which are generally taken once a week or once a month, include Actonel, Boniva, and Fosamax. Reclast is also a bisphosphonate, but it comes in the form of an annual, intravenous infusion.
“I would estimate that about 10 percent experience gastrointestinal upset, but most patients do well on bisphosphonates,” observes Rude. Rare cases of jaw disease also have been reported.
Another treatment option is a daily nasal spray—calcitonin—marketed under the brand names Fortical® and Miacalcin. Estrogen/hormone therapy additionally can be considered but, says Shoupe, “in low doses and only for prevention.”
If you’d like to calculate your risk of sustaining a broken bone within the next decade, two online tools are now available:
• WHO Fracture Risk Assessment tool
• Fracture Risk Calculator