What to do now to prevent bone loss from osteoporosis

It’s known as a silent disease that affects more than 12 million Americans.

Osteoporosis, a condition that causes a decrease in bone mass and quality, can often go undetected until you suffer a broken bone. It’s important to note that osteoporosis is a chronic condition like hypertension and requires lifelong attention and management.

What is osteoporosis and why do we care about it?

Osteoporosis is a skeletal disorder that increases the risk for fracture. Osteoporosis affects the entire skeleton rather than a single bone or a few bones.

The bones become weaker so that a fall, cough, or sneeze can cause a fracture. Women have a higher risk of osteoporosis compared to men and usually occurs after menopause.

How osteoporosis affects your life

Hip and spine bones are the most susceptible to fractures. Fractures can lead to pain, shortened height, negative body image and spinal deformities, including kyphosis (slumped-over posture).

These fractures can also greatly affect your lifestyle, leading to a loss of…

• mobility (e.g., a permanent need to use a cane, walker or wheelchair)
• independence (e.g., moving into a nursing home)
• participation in favorite activities

Fractures can also shorten your life.

Who is at risk for osteoporosis?

The following risk factors can increase your chances of developing osteoporosis:

• A small, thin build
• Family history of osteoporosis
• Taking certain medicines, like prednisone (and other steroids) and hormonal medications for certain cancers
• White or Asian race
• Existing diagnosis of low bone density
• Reaching menopause before age 45
• Smoking
• Heavy drinking
• Having had an eating disorder, such as anorexia
• Low calcium in your diet or a vitamin D deficiency
• Older age
• Inactivity/sedentary lifestyle

You can lower the risk factors that are within your control by exercising (balance training, weight-bearing, strength training), taking an adequate amount of calcium and vitamin D, quitting smoking and drinking alcohol in moderation.

How do you know if you have osteoporosis?

There are three ways to diagnose osteoporosis:

1 DXA (dual-energy X-ray absorptiometry) scan

This measures bone mineral density (BMD) using low dose X-rays. The bone density is assigned a “T-score” based on the difference between your bone mineral density and average bone density of young adults. We categorize the T-score into normal (-1.0 or greater); “low bone density,” or osteopenia (T-score <1.0); or osteoporosis (T-score -2.5 or lower). Scans are commonly repeated at two-year intervals.

2 Noting certain types of fractures

If you’ve had a fracture of the hip, spine or forearm, you’re considered to have “clinical osteoporosis.”

Fractures beget more fractures. If you’ve already fallen and broken a bone, the risk of another break increases two to five times more. If you’ve lost 1 ½ inches or more in height compared to when you were a young adult, X-rays of the spine can also be ordered to look for spine fracture.

3 Using the fracture risk assessment tool (FRAX)

You can complete a FRAX assessment, which estimates your chance of breaking a bone in the next 10 years. FRAX is especially useful for those with osteopenia to determine whether you’re at high risk for fracture and when to consider starting medications.

How is osteoporosis treated?

The good news is there are many FDA-approved medications coupled with physical therapy and lifestyle adjustments that can reduce the risk of fracture, from oral medications to injections.

Oral medications pose a risk of unpleasant gastrointestinal side effects, though they can often be prevented by closely following medication instructions.

If the oral medications cause too many side effects for someone, alternatives include intravenous infusions (given once a year) and a variety of subcutaneous injections.

You may have heard of serious side effects with some osteoporosis medications, such as “osteonecrosis of the jaw” or “atypical femur fracture.” Fortunately, these are rare side effects, and we limit the risk by pausing some osteoporosis medications with a “drug holiday” after a few years on treatment. I always tell patients that if they live long enough, chances are good that the “holiday” will end at some point, and they should return to osteoporosis medication.

What kind of doctor treats osteoporosis?

Primary care doctors handle the majority of care for osteoporosis. They can order tests and determine your risks.

Some people also see a bone health specialist (commonly an endocrinologist or rheumatologist) for osteoporosis treatment.

As an endocrinologist, I see patients who have the greatest risk for future fracture. These include people who have had a recent fracture within the past couple of years and therefore have a bigger risk for future fracture. We'll see these patients in Ohio State’s High-Risk Osteoporosis Clinic, evaluate them and consider starting a medication — commonly ones by injection — and ensure adequate intake of calcium, vitamin D and exercise, and refer to physical therapy as appropriate.