Toss around the word osteoporosis and for many of us a classic stereotype of the “little old lady,” comes to mind – a frail and bent elderly woman walking with a cane. But unfortunately, for many women (and men) with undiagnosed and untreated osteoporosis, this image can become a reality and it can happen over a period of time without warning symptoms. To truly understand your risk of developing osteoporosis, it’s important to sort the facts from fiction.
FACT It’s a disorder that leads to thin and weakened bones, making them more prone to fractures. Because there are usually no symptoms until a bone is broken, it is often called a “silent” disease.
FACT According to the Centers for Disease Control, 10 percent of women in their 60s, 27 percent of women in their 70s and 35 percent of women who are 80 and older have the disorder.
FICTION While bones may appear to be as solid as rock, they are actually living tissue. The body is constantly breaking down old bone tissue and replacing it with new bone tissue. Under a microscope, it resembles a honeycomb. But starting at about age 30, the production of new bone tissue begins to slow. When more bone tissue is broken down than is replaced, spaces in the “honeycomb” get bigger and our bones get weaker and more prone to fractures. Because bone loss happens over time, the earlier we take seriously our bone health, the more we can do to fight the onset of osteoporosis.
FACT Osteoporosis strikes at a rate of 1 in 5 men and when they are affected, men are more likely to experience a fracture. Additionally, mortality is greater in men than women for similar fractures.
FICTION Actually, prior to having a fracture, osteoporosis can affect your activity levels due to pain or discomfort, loss of balance, inability to carry out basic skills of daily living and reduced mobility. If you haven’t been diagnosed and haven’t begun treatment to mitigate your advancing bone loss, you are at higher risk of a experiencing a fall or other incident that results in a fracture.
FACT When bones become more porous and soften resulting in fractures, a person can experience the following:
• Chronic pain
• Reduced height and a stooped or hunched posture, especially when osteoporosis affects the bones in the spine
• Limited mobility, which can lead to feelings of isolation or depression
• The need for long-term nursing home care
Also, some 20 percent of seniors with broken hips die within one year, either from complications related to the broken bone itself or the surgery to repair it.
FACT The following put you at higher risk for osteoporosis –
• Gender: Women are at higher risk than men.
• Aging: The older you are, the greater your risk.
• Menopause: Estrogen helps protect bones in younger women, but the reduction of estrogen in post menopausal women results in bone loss.
• Your body frame: Women who are thin and small-boned are at higher risk.
• Ethnicity: While all women are at risk, Caucasian and Asian women are at higher risk, mainly due to differences in bone density.
• Certain medical disorders: Rheumatoid arthritis, type 1 diabetes, early menopause and anorexia are some of the disorders that can affect bone health.
• Medications: Some commonly used medicines can cause loss of bone mass, including:
– Glucocorticoids: used to control diseases like arthritis, asthma and lupus
– Some anti-seizure drugs
– Gonadotropin-releasing hormones, used to treat endometriosis
– Antacids with aluminum, which blocks calcium absorption
– Some cancer treatments
– Too much replacement thyroid hormone for an underactive thyroid
• Family history: If you have a family member who has (or had) osteoporosis, your risk of having it goes up.
• Previous fracture: People who have had a fracture after the age of 50 are at high risk of having another.
FICTION There are tools that can help your physician determine the density of your bones and your risk for fracture. If you are over age 50 you should discuss bone health with your doctor at your next check-up. This conversation should include information about any recent fractures and a fracture risk assessment (such as FRAX®). Depending on your age and risk factors, a bone mineral density test using DXA (dual-energy X-ray absorptiometry) may be recommended.
FICTION There are a number of steps you can take to lower your risk:
• Diet and nutrition: Eat a balanced diet rich in calcium and vitamin D. Even with a proper diet, most women need to boost their calcium and vitamin D intake by taking supplements and spending more time in the sunshine to keep bones strong. To stay healthy, bones also need adequate levels of protein, vitamin K, vitamin C, magnesium and zinc.
• Physical activity: Physical activity strengthens your bones as well as the muscles supporting them. It also improves your balance, which helps prevent falls. Experts recommend weight-bearing activities, like walking, dancing, running and climbing stairs.
• Stop smoking: Cigarette smoke harms your bones and lowers the amount of estrogen in your body.
• Limit caffeine: People who drink a lot of caffeine lose more bone tissue than those who don’t.
• Limit alcohol intake: Alcohol makes it difficult for your body to absorb calcium. Also, if you’re tipsy (or worse) you’re more likely to fall. Experts recommend no more than one drink a day for women.
FACT Medications designed to treat osteoporosis fall into several different categories –
Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:
• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Zoledronic acid (Reclast)
Hormones, such as estrogen, can play a role in osteoporosis prevention and treatment. However, there has been some concern about potential side effects tied to the use of hormone therapy. Current recommendations say to use the lowest dose of hormones for the shortest period of time.
Some hormone-like medications also are approved for preventing and treating osteoporosis, such as raloxifene (Evista).
Denosumab (Prolia, Xgeva) is a newer medication shown to reduce the risk of osteoporotic fracture in women and men.
Teriparatide (Forteo) is typically reserved for men and postmenopausal women who have very low bone density, who have had fractures or whose osteoporosis is caused by steroid medication. Teriparatide has the potential to rebuild bone.
Abaloparatide (Tymlos) is another new osteoporosis medication. Like teriparatide, it has the potential to rebuild bone. In a research trial comparing these two treatments, abaloparatide appeared to be as effective as teriparatide but was less likely to cause an excess of calcium.
Maintaining bone health is a life-long undertaking. The sooner you take heed of your risks and make changes to strengthen your bones the better. While you may not notice symptoms of bone loss over a period of years, that doesn’t mean that osteoporosis, the “silent” disease, isn’t undermining your bone health and ultimately, your overall health and quality of life.