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Stop Osteoporosis in Its Tracks
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Good self-care and a new diagnostic tool can help keep your bones strong
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By Natasha Persaud
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May 2008
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 | | Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation |
If you are over age 50, the odds are your bones are weakening. In fact, one in two women and one in four men eventually break a bone due to bone loss from osteoporosis. The National Osteoporosis Foundation (NOF) released updated treatment guidelines in 2008 that promise to reduce the incidence of bone fractures—and the pain and disability that result. Here, Felicia Cosman, M.D., clinical director of the NOF, explains how their efforts—together with yours—can help you stave off osteoporosis.
"Typically, no," Dr. Cosman says. "A person may feel no pain or discomfort, yet bones have been thinning silently for years. Often, it's only when a fracture occurs that osteoporosis is diagnosed.” Bone fractures commonly occur in the hip, spine, wrist, shoulder and arm--although any bone in the body may break.
"It's important to be proactive and review your personal risk factors for osteoporosis with a doctor," she says. Risk factors include being over age 50, being thin or small or having a mother, father or sibling who experienced bone fractures. The NOF offers a helpful list of questions to ask your healthcare provider.
"During menopause, around age 50, is a great time for a woman to ask about osteoporosis prevention,” Dr. Cosman says. “A woman's estrogen levels are declining during that time, and she loses some of her natural protection against bone damage. A man may want to discuss his risks for osteoporosis during a routine doctor visit, such as to review blood pressure, cholesterol or an EKG.”
The NOF recommends that all women get screened for osteoporosis with a bone density test by age 65, and all men by age 70. Women who may be at high risk for fractures should be screened starting at age 60, according to the U.S. Preventive Services Task Force.
"Many people think that only people of European descent are at risk for this disease, but that's certainly not the case. Caucasians and Asians both have a very high risk of osteoporosis and fractures, but so do non-black Hispanics; African Americans also carry a substantial risk. By no means should any ethnic group believe they are protected."
The NOF provides specific, helpful information for women in various ethnic groups, men and teenagers. Check out the NOF’s bone tool kit, and print the sections most appropriate to you.
"Our mission is to educate consumers and health-care professionals about osteoporosis prevention, risk factors, diagnosis and treatment,” says Dr. Cosman. “To reach that goal, we've started an awareness campaign that includes five key ways to promote stronger bones:
- Eat nutritiously. Make sure you're getting enough calcium (from foods such as dairy products, calcium-fortified foods, almonds and certain green vegetables) and vitamin D (from fatty fish and fortified foods). Supplements are often needed to get enough vitamin D.
- Do weight-bearing exercises, such as walking, jogging, playing tennis and dancing, two to three times per week, and engage in strength training (weight machines, free weights, Pilates or yoga) twice a week.
- Avoid smoking and excessive alcohol.
- Talk to your doctor about bone health.
- Get a bone density test, and take medication if your doctor recommends it.
"A person with osteopenia has a lower bone mass than average as compared to the optimal peak bone density of a healthy young adult of the same sex, and therefore is at greater risk of developing osteoporosis,” says Dr. Cosman. “The condition is diagnosed with a bone mineral density test. Someone with osteopenia needs to be monitored by a doctor, but not every patient will require treatment."
"Vitamin D is vital to many organs of the body, and it's critically important for bone health," Dr. Cosman explains. "Supplements may contain D2, a plant-based vitamin, also called ergocalciferol, and/or D3, an animal-based product, that's also known as cholecalciferol. Adults age 50 and over need 800 to 1,000 International Units (IU) of vitamin D daily."
What about food and other sources? "Very few foods naturally contain vitamin D, so most people won't get enough from diet," says Dr. Cosman. "Although fatty fish is a major source, unless you eat all the fat layers of the fish, you're not ingesting all of its vitamin D. Some foods, such as certain varieties of milk and citrus juices, are fortified with vitamin D.
"The human body has a remarkable ability to produce vitamin D from sunlight," she says, "but those of us who live in the United States mostly don't get enough sunlight exposure due to a temperate climate and our use of sunscreens and sun-protective clothing."
"An exciting new tool from the World Health Organization is helping doctors identify which osteopenia patients will likely benefit from medication. FRAX™ is a mathematical tool that estimates the likelihood of a person to break a bone over a period of 10 years due to low bone mass (osteopenia) or untreated osteoporosis.”
According to Dr. Cosman, the tool goes beyond a bone mineral density test by assessing a person's other risks: "A total of nine clinical factors are included in the tool, based on such information as a person's age, gender, height, weight, history of fracture, family history of fracture, smoking status and more data. The tool is even helpful without bone density test results."
FRAX can suggest your overall risk of having a major fracture and your risk of a hip fracture, which can be particularly debilitating. "If your risk of having a major osteoporotic fracture over 10 years is 20 percent or higher, or your risk of hip fracture is 3 percent or higher, then you need treatment," Dr. Cosman says.
The tool is available online to all doctors at http://www.shef.ac.uk/FRAX/ In the future, the tool may be added to bone density machines.
"There is no single type of health-care provider or medical specialty that focuses on osteoporosis," Dr. Cosman says. "Many primary-care doctors—including internists, family practitioners, gynecologists, geriatricians and others are capable of treating mild osteoporosis cases. For people who require special care, it's reasonable to be referred to a specialist, such as an endocrinologist or rheumatologist. These include patients who have very low bone mass or previous fractures, or those not responding to treatment."
To help you locate a health-care provider that treats osteoporosis, the NOF has developed the Professional Partner's Network® (PPN) directory. You can also call them at (800) 231-4222. (Note: The directory does not necessarily include all professionals in any geographic area, nor does it make judgments about the quality of care.)
Another good option, suggests Dr. Cosman: “Contact your nearest academic medical center (such as a hospital affiliated with a university), which may have an osteoporosis program.”
Yes; taking corticosteroids (such as prednisone, cortisone, prednisolone and dexamethasone) for weeks to months can damage your bones. These medications are common treatments for a number of chronic conditions, including asthma, rheumatoid arthritis, Crohn's disease, lupus and other diseases of the lungs, kidneys and liver.
Other medications can cause bone loss when used for a long period of time, including aluminum-containing antacids; certain antiseizure drugs, such as phenytoin and barbiturates; gonadotropin-releasing hormone drugs for endometriosis, excessive thyroid hormone and certain cancer treatments. According to Dr. Cosman, “There might also be a risk if you are taking regular proton pump inhibitors (Prilosec, Nexium, Prevacid, Aciphex), certain diabetes drugs (Avandia and Actos) or even SSRIs for depression (Prozac, etc.).” If you take any of these drugs, don’t simply stop using them. Discuss your concerns with your doctor.
"People taking bisphosphonates may experience upper gastrointestinal irritation and a small number may feel muscle, bone and joint pain. These side effects usually cease when the medication is stopped.
"There has been a lot of news in the media about osteonecrosis of the jaw, which is death of bone tissue in the jaw with ulcerated gum tissue above the affected bone. Despite the news, the condition is extremely rare among people treated for osteoporosis because the dosage of bisphosphonates is relatively low. Moreover, osteonecrosis is treatable and reversible with therapy.
"To put it in perspective, it's more risky not to take medication to treat your osteoporosis: Most people who break a hip never really get back to where they were prior to having a fracture. Women with such fractures face a 15 to 20 percent increased risk of dying the year after the break. A person with a vertebral fracture in the spine may suffer deformities, back pain and more. There's also the chance of loss of life. Preventing fractures in the first place is the goal."
"We measure success by whether a person on therapy experiences a bone fracture. That said, even if someone does have a fracture, perhaps he or she would have had several more bone fractures without treatment.
"A person's bones go through what’s called remodeling throughout life—at any one time, a little bit of bone in the body is being taken away and a little bit is being formed. Beginning after age 30, more bone is removed than is formed. Osteoporosis medications slow down the remodeling process to help correct the imbalance.
"If you're taking osteoporosis medication, your doctor may suggest having a bone density test every one to two years to determine if your condition has stabilized. Your doctor may also suggest other tests that assess bone health."
"If you have osteoporosis, your bone health will need to be monitored for the remainder of your lifetime. You may take medication for a long time—but not necessarily the same one. For a number of reasons, your doctor may decide to switch your medication, particularly if new medications become available."
To learn more about beating osteoporosis, visit NOF's awareness campaign.
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