What is Osteoporosis?

Osteoporosis is a weakening of the bones that occurs naturally with age. When the bones become weak, they are more fragile and therefore, more susceptible to fracture. By the early 20s, most bone development has been completed. After that time, bones naturally become less dense over time (more fragile) which means they can fracture more easily. Sometimes bones can fracture after a fall or sometimes by just a cough or sneeze.

Why is osteoporosis important?
Osteoporosis is important because it is a major risk factor for fracture. Fracture, especially in the elderly, is associated with a high morbidity and mortality. The following data, taken directly from the National Osteoporosis Foundation, includes:

In 2005, osteoporosis was associated with 2 million fractures, and it is estimated to increase to 3 million fractures by 2025. The risk of a woman getting a hip fracture is equal to the combined risk of getting uterine, ovarian, and breast cancer. Approximately one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. The rate of hip fractures is 2-3 times higher in women than men. However, the one-year mortality following a hip fracture is nearly twice as high for men as for women. An average of 24% of hip fracture in patients above the age of 50 die in the year following their fracture.

Who can develop osteoporosis?
Both men and women can develop osteoporosis. Bones reach their peak bone mass in the early 20s. After that time, the density of our bones slowly decreases. Most commonly, osteoporosis is associated with women who are of menopause age. As the body’s natural production of estrogen decreases in menopause, the bones become more weak. In the first five to seven years after menopause, women can lose up to twenty percent of their bone mass. In men, a testosterone deficiency, also known as ‘male menopause,’ can cause osteoporosis. Medications can contribute to osteoporosis such as chronic use of proton pump inhibitors, which are commonly used to treat heartburn and ulcers. Chronic use of steroids, such as Prednisone, can also contribute to osteoporosis.

Other risk factors for developing osteoporosis include but are not limited to: a family history of osteoporosis or fracture, low body weight (less than 127 pounds for women), ethnicities such as Caucasian, Asian, and Hispanic/Latino, missing menstrual periods for extended periods of time, low vitamin D, smoking, and excessive alcohol use.

How do I know if I have osteoporosis?
Osteoporosis is silent, meaning there are no symptoms of osteoporosis except for fracture. If you fracture a bone that is out of proportion to the trauma, then you should be tested for osteoporosis. Women in menopause should be screened for osteoporosis.

How do I get tested for Osteoporosis?
Testing for osteoporosis is simple. It is a fairly quick radiology test that is called a DXA (Dual Energy Xray Absorpitiometry). A DXA measures the bone density of your hips and low back. Medicare allows a DXA to be performed every other year.

How do I interpret the results of my DXA?
Usually, the DXA evaluates the bone density of the hips and low back. If you are a pre-menopausal woman, then you must look at the Z-score when evaluating your test. If you are a woman in menopause or if you are a man, then you must look at the T-score to evaluate your exam. The T-score is a standard deviation comparison between the densities of your bones now with the density of your presumed ‘peak’ bone mass when you were in your 20s. Therefore, a T-score above -1.0 (one standard deviation below the mean woman in her 20s), is considered normal. A T-score between -1.0 and -2.5 is in the osteopenic range. A T-score below -2.5 is considered osteoporosis.

What are the recommendations for Osteopenia and Osteoporosis?
Recommendations on whether to use prescription medication to treat osteoporosis is based on results of the DXA and the evaluation of a patient’s T-score, FRAX score, and whether a patient has sustained a fracture out of proportion to a traumatic fall. There are many different medications available to treat osteoporosis. A thorough evaluation of the severity of osteoporosis, risk factors, and a person’s overall medical profile are important in determining the appropriate medical intervention.

What about calcium and vitamin D?
All women regardless of their bone density should take calcium 1200mg/day and vitamin D 800 IU/day. Because vitamin D has been found to be an independent factor in fracture reduction, women with osteopenia or osteoporosis should maintain a vitamin D level above 50. Often, supplementation with vitamin D above 800 IU/day is needed to reach this goal.