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Preventing and Treating Osteoporosis Can Save Your Life

Tony Makhlouf, MD News

Health concerns for aging adults tend to focus on heart disease and cancer. These are truly important issues to monitor, but—particularly for women—it is critical to keep bone health in mind too.

Osteoporosis—a loss of bone tissue that can make the bones brittle and fragile—is not, itself, fatal. It can, however, lead to dangerous consequences when a weakened bone breaks. For example, the mortality rate (the chance of dying) after a hip fracture is 50 percent. It is not the break that is fatal but the results of an inability to get up and move around. One of the dangers in this case is deep vein thrombosis, an extremely serious condition that creates blood clots that can block veins in the lungs.

Death is not the only risk of osteoporosis. Someone who is laid up for a long time after a major bone fracture can feel isolated and alone, which may eventually manifest as physical illness. In addition, they may experience severe financial stress, sometimes leading to a loss of their home or their life savings. For these reasons, it is important to make sure you’re keeping track of your bone health.

Women with no risk factors for osteoporosis should have an initial screening at age 65 then every two years after that. There are no screening recommendations for men who don’t have risk factors, but men with significant loss of height, diagnosed with low testosterone or taking hormonal therapy for prostate cancer should be tested.

Screening should begin at menopause for women with any of these risk factors:

  • Smoking
  • Excessive alcohol consumption
  • Family history of osteoporosis or a hip fracture in an older relative
  • Caucasian or Asian descent
  • Low body weight—body mass index (BMI) less than 20
  • Long-term use of steroids
  • Chronic inflammatory disease, such as rheumatoid arthritis or lupus

Because our bodies continue to lose bone mass as we age, it is important for women to talk with their physician about follow-up testing every two years after their initial test—even if the result of the first test was normal.

A bone density scan is the most prevalent and practical way for your physician to learn about the health of your bones. Also known as a DEXA scan, this procedure uses X-rays to measure the mass of bone tissue. The test can result in three possible diagnoses: normal, osteopenia and osteoporosis.

Osteopenia can be thought of as “pre-osteoporosis.” It is a condition in which there is bone tissue loss that is not severe enough to be considered osteoporosis. The diagnosis of osteopenia is a wake-up call—a chance to halt the progression toward osteoporosis.

If you are diagnosed with osteopenia, you’ll likely be counseled to take two important steps. The first is to take 2000 international units (IU) of Vitamin D every day for the rest your life. This is a good idea, incidentally, for all women after menopause. More than 50 percent of women get inadequate amounts of Vitamin D. Combined with bone loss after menopause, the risk of developing osteoporosis increases.

The other recommendation for osteopenia patients is to regularly do weight-bearing exercise—bicep curls, squatting and similar moves that strengthen bones. It is important to note that, while walking is an excellent exercise for overall health, it does not put enough stress on the bones to help with osteopenia.

Treatment for osteoporosis includes Vitamin D and weight-bearing exercise but adds prescription medication to prevent further bone loss and/or build bone tissue. A family of medications called bisphosphonates (including the drug Fosamax) has been the go-to treatment for many years. However, there can be unpleasant side-effects from these drugs, such as stomach upset, heartburn and joint pain. More recently, a twice-a-year injectable alternative called Prolia has gained popularity among physicians and patients, as its side effects are much less significant.

Your physician may also recommend teriparatide (Forteo), which helps to build bone and, therefore, can be particularly helpful with patients who have suffered a bone fracture.

If you’re an older woman and have not yet talked with your primary care physician about bone density screening, please make it a priority to do so soon. Strong bones can literally be a lifesaver.

Tony Makhlouf, MD, is a board-certified rheumatologist with the Arthritis and Rheumatology Center in Moorpark and is a member of the Simi Valley Hospital medical staff.