May is National Osteoporosis Awareness & Prevention Month. Fifty-four million Americans have osteoporosis or low bone mass, putting them at risk for broken bones. Osteoporosis-related bone breaks cost patients, their families and the healthcare system $19 billion annually.
When I ask women about what they fear the most about osteoporosis, they answer that it is the curvature of the spine, the so-called “dowager’s hump” as well as the associated loss of height, loss of self-esteem, and the overall feeling that they are old. In truth, osteoporosis is much more than a deformed back – it can lead to serious complications and, in some cases, even death.
What is osteoporosis?
The term osteoporosis simply means porous bone. Porous bone occurs in most of us as we age. It is more common in women than men, although males are by no means immune to developing osteoporosis. Approximately 40 percent of women age 50 and over have osteoporosis while about 10 percent of men do.
Osteoporosis is called a silent disease. This is because early on it does not cause any pain and often has no outward symptoms. Even the dowager’s hump occurs more commonly from changes other than osteoporosis, such as disc disease, or twisting curvature, or scoliosis of the spine.
Osteoporosis becomes a problem when those porous bones weaken to the point that even minor trauma may lead to a broken bone, which in medical jargon we call a fracture. Our perception of fractures is often that of a young child breaking a bone and healing without incidence. However, as we get older, these fractures take on a whole new meaning. The most serious of these fractures are those of the hip, which can lead to loss of independence. This may lead to a more dependent lifestyle, such as moving in with a relative, or even moving into a nursing home. More frightening is that there is a 20 percent increase in the risk of dying in the first year after a hip fracture, or a similar risk over five years in someone with several fractures of the spine.
What can I do to prevent osteoporosis?
Like other “silent” diseases, such as high blood pressure or high cholesterol, where early intervention may prevent the complications (such as stroke and heart disease), there are things we can do to slow the loss of bone and prevent the fractures.
- We can make an effort to change our habits to foster healthy bones. This includes stopping smoking and avoiding excess alcohol. It also means increasing muscle tone to avoid frailty as we age, which leads to the next thing we can do…
- Regular exercise may help by improving our muscle and bone mass, and may also help reduce our risk of falling, which often leads to fractures in elderly people.
- And finally, most broken bones from osteoporosis occur in the home so a little tidying up of clutter, loose cords, low lying tables and improving lighting can reduce the risk of falls.
How do I know if I’m at risk for osteoporosis or bone fractures?
Today, we have techniques to determine whether an individual has weakened bones and is at higher risk for fracturing. This is done using a technique called bone densitometry, which allows us to determine the density of bone, which in turn reflects the strength of bone.
The result reported by the densitometer is your T-score. In some individuals, the density is sufficiently low that treatment is recommended without the need for more information. In other cases, the bone density is intermediate, and we combine that measurement with age, height, weight, sex, and other risk factors – such as smoking history, history of previous broken bones, excess alcohol, and the use of certain medications or diseases associated with fracturing. With this information, we calculate your FRAX, or fracture risk assessment. This is reported as the likelihood of breaking a bone over a period of ten years. If your FRAX is elevated that suggests that treatment could be considered.
Who should be tested?
We recommend that these age groups be tested:
- Women, age 65+;
- Men, age 70+;
- Postmenopausal women with risk factors;
- Men, age 50+ with risk factors; and
- Anyone age 40+ with a broken bone not caused by major trauma.
Are there any medications available?
Along with guiding patients on the appropriate amount of calcium and vitamin D to strengthen their bones, we may also recommend a number of medications that have the ability to enhance bone density and reduce the likelihood of breaking a bone by about half the rate without treatment. Overall, these medications are well tolerated, often available as an inexpensive generic, and have helped thousands of individuals to prevent fractures and live healthy, productive lives.
Learn more about the Osteoporosis Program at the University of Vermont Medical Center.
Edward Leib, MD, a rheumatologist, is medical director of the Osteoporosis Center at the University of Vermont Medical Center, where he is also a professor in the University of Vermont College of Medicine.