Bone disease damages the skeleton and makes bones weak and prone to fractures. While you may think that weak bones are a natural part of aging, people of all ages can improve their bone health.
Listen to the interview at the link below, or read the transcript that follows.
What is osteoporosis?
Osteoporosis is a weakening of the structure of the bone, and the main concern is it puts people at risk for fracture, because the bone is weak. And, unfortunately it really is very common, and some of the reports out there state that one in two women over age 50 will have some type of fracture in their lifetime, and one in four men. So, I think a lot of times men are forgotten about to be screened for this as well.
What causes osteoporosis?
Osteoporosis is a weakening of the bone. But the cells in the bone are always building and breaking down, so the bone becomes weak when there’s more breakdown. And that can happen over time with age, or certain medications may cause that to happen, after menopause, things of that nature. Particularly after menopause when there’s lack of estrogen around, the cells that break down bone are more active or ramped up. So this is why many times people think about osteoporosis occurring in women after menopause, and those are many people that we screen.
Certainly bone loss can happen in men too, as I mentioned. And certain hormone states could cause that, lack of testosterone, too much parathyroid hormone. If somebody was placed on medication such as Prednisone, or sometimes treatments that are used for cancer, such as for prostate and breast cancer, can also lead to bone loss and increased risk of fracture.
What are the symptoms of osteoporosis?
The biggest problem is there are no symptoms. People don’t know they have it unless they’re screened. And sometimes people don’t find out until they have their first fracture, which is of course what we want to prevent. Some of the things that could be suggested is if somebody had loss of greater than two inches of height since they were younger. That could be suggested of a small fracture in the spine, that perhaps they never knew about. Or, if they had some type of back pain perhaps, that didn’t recall any injury, or seemed out of the ordinary, that may suggest a fracture. But unfortunately there’s just really not any symptoms to know of.
How could somebody have a fracture in their spine and not know about it?
Many times people, they may have just been doing some type of activity, perhaps lifting something, or moving a certain way. They may have had a pain for a short period of time, and then it cleared up, and then they never thought about it again. And then sometimes they’ll have an X-ray down the road and somebody will point out, “Would you look? You actually had a fracture.” And then when we see that we always try to ask the person, “Well gosh, do you remember any incident where this may have happened?” Certainly we ask if they were ever in an accident, so maybe it wasn’t a non-traumatic fracture. But yeah, sometimes the history is tough, and many times people don’t know until they just have an X-ray, or somebody notices height loss.
Who is most at risk, and who do you recommend for screening?
Really the older we get, the more chance for having osteoporosis and breaking something. Again, post-menopausal women are most at risk. So, that’s an important group that should be screened, men also getting older. The recommendations from the National Osteoporosis Foundation are for all women starting at age 65 should be screened, and all men over age 70. Both men and women could be started screening at age 50 if they have other risk factors, such as if they’re on medications that may cause bone loss, or strong family history, smoking, things of that nature.
It’s uncommon for people to have bone loss at a younger age, say under age 50. But sometimes those people warrant screening also. For instance, say if they had a fracture that seemed out of the ordinary, or if they were on any medications that could harm bone, or perhaps a female that didn’t have regular menstrual periods, and could be at risk for bone loss.
What is screening like?
In terms of screening, the best test is called the bone density test, or a DEXA. And, the nice thing about it is, it’s very simple, the person just lies down, it’s a very open machine, it’s not like an MRI. There’s really no prep beforehand, and they take pictures of the spine and hip. And sometimes we’ll take pictures of the wrist as well. And there’s very minimal radiation, you receive more radiation going to the airport. It’s very simple and straight forward.
What is treatment like? Is there a way to cure it?
We do actually have the most medications now that we’ve ever had. Certainly some people can do better with some than others. In terms of the current medications, the main ones we use are from a group called Bisphosphonates.
There’s oral pills that people can take such as Alendronate or Fosamax, where people take them once a week. Sometimes they’re given once a month. We also have injectable medications that are sometimes given in physician offices. There’s an infusion that runs over 15 minutes once a year. There are some injections under the skin every six months. And for people at high risk for fractures, there’s some injectable medications that they take at home daily for two years to really help build bone. Which medication we would choose really also depends upon that person’s risk for fracture.
And, certainly no medication has zero chance of side effects, even aspirin. However, we always weigh the risks and benefits. And many of the things that people worry about in terms of rare side effects are extremely rare, and unfortunately since the risk of fracture is so high, it really is important to be open minded, to think about medication if necessary to prevent a fracture.
Is osteoporosis genetic?
There is a genetic basis to it. The biggest concern is particularly if someone had a parent that fractured their hip, because then that really increases a person’s risk themselves for fractures. One other thing to mention, there is a spectrum of bone loss. So sometimes when people have bone density tests performed, they might be told that they’re in the range of osteopenia, which is some bone loss, but not quite osteoporosis. It’s important because we want to identify it early, and help that person make the best choices to help preserve their bone health, and perhaps not need a medication or be at risk for fracture. So certainly not every person in the range of osteopenia needs treatment necessarily, but it is important to know kind of where you are in terms of bone health.
What are some other common metabolic bone diseases?
Other things that we see in the clinic often are hypoparathyroidism, that’s where the body makes too much parathyroid hormone. Either because of a problem at the gland level, or a response to something else going on in the body. And the most common reason for that is vitamin D deficiency. It’s very easy to become vitamin D deficient at all ages. We certainly don’t have a lot of sun, it’s tough to get enough from food, that can be a problem. We also sometimes see some rare metabolic bone disorders, such as Paget’s disease, or osteogenesis imperfecta, so we cover a lot of different things here.
Do we see a higher incidence of bone diseases in Vermont impacted by vitamin D deficiency?
That’s a good question. Looking at the spreadsheets they give across the country that’s necessarily the case. I mean, certainly it is known areas with higher, like northern latitudes, are more at risk for vitamin D deficiency. Whether or not that actually translated to osteoporosis depends upon other risk factors. But, it’s interesting. In the medical studies, even people that live in warm weather areas such as San Diego, and Miami, even times many people there have vitamin D deficiency because you cover up from the sun of course, and are not outdoors much. So it really is tough to get enough from food.
What can younger people do to take care of their bones?
That’s a great question, and it’s really important because being young, that’s when we really reach our peak bone mass. That kind of builds the reserve to help keep our bones healthy down the road. So, the most important thing is adequate amounts of calcium and vitamin D. Calcium is much easier to get from the diet than vitamin D, so just having a well-rounded diet and regular physical activity. Anything that puts weight bearing on the bones and joints is very helpful to keep the muscles and bones strong. And then also, to avoid excessive amounts of alcohol or caffeine, tobacco, things of that nature.
So, alcohol, caffeine, tobacco can wear your bones down?
Yeah. Tobacco’s not good for many reasons, but yeah. Tobacco definitely not. In terms of alcohol and caffeine, safe amounts, not excessive.
What can older adults do to take care of their bones?
Actually, it’s very similar to what younger adults can do. I mean, we always tell people that it’s very important to maintain adequate amounts of calcium and vitamin D. Protein is also very important for muscle strength. When you think about it, your muscles are what pull on your bones and help keep them strong. And something that’s really important, especially in older people and particularly where we live, is fall prevention.
I know it may sound silly, but really, many fractures happen because people fall. So, just take a look around the homes to make sure that there’s no extra throw rugs, or chords, or going outside on slippery areas, going down stairs. I mean, that really is a big part of it. And, regular weight bearing activity, getting older too is very important. And we want people to be able to maintain their balance, and have strong muscles. So, that’s all a big part of bone healthcare.
What are some good weight bearing activities that an older adult could start doing?
The nice thing is there’s lots of exercise classes around town, that I hear many different people attend that help with strengthening. Some patients perform activities such as yoga, or Pilates, or Tai Chi. It doesn’t have to be anything fancy, you know? Because I mean, many of these people might not necessarily be very athletic per se, but just anything that helps with kind of core posture and balance. Even walking is considered weight bearing.
The most important thing is doing something that’s not going to harm your joints, not do anything excessively. So say for instance, sometimes we send people to physical therapists to help them with weight bearing activities. And things such as jumping jacks are great, because they put impact on your bone. However, you still don’t want to hurt your knees, or do anything that’s going to hurt yourself. So really anything that the person can do safely, that has some type of impact on the bones, is helpful.
Is it a good idea to take vitamins to supplement your diet?
This is a topic that comes up a lot in the medical literature as well. So, a good rough safe number for both is about 1,200 a day. 1,200 milligrams of calcium, or units of vitamin D.
With vitamin D, it’s tough to get enough from food. It’s in fatty fishes, there’s about 100 units in a glass of milk. But you can see where it would be tough to get adequate amounts. So many people do at times need additional vitamin D supplement. In terms of calcium, the recommendations are, it’s better to try to get it from diet than all from supplements, because there were some concerns in medical literature for a while that people that were taking in too much calcium between their diet and supplements were having problems with calcifications of different parts of their body, such as the coronary. So certainly we don’t want that to happen.
The goal with calcium is to aim for about 1,200, but not to go over 2,000 milligrams, and that’s from all sources, diet and supplements. So it’s certainly easy for people that are able to take in dairy or things of that nature, in terms of milk, yogurt, cheese, and also there are a lot of non-dairy types of milk, and other products these days that also contain calcium. And, a lot of times now, different products even outside of the dairy field have calcium fortified in them, such as different orange juice, hot chocolates, green vegetables. So, it is a little easier to get calcium from the diet.