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Osteoporosis: Risks, Treatment and Prevention

Osteoporosis: Risks, Treatment and Prevention

Osteoporosis: Risks, Treatment and Prevention

Osteoporosis Explained

As we age, the topic of bone health becomes increasingly important to our overall wellness. Osteoporosis is one of the most common conditions related to our bone health. A widespread bone disease that disrupts an individual’s balance and makes it nearly impossible to live life to the fullest, osteoporosis is especially common among older adults.

It is characterized by a deterioration of bone structure, which results in a loss of bone mass and density. Fragility fractures are common due to the bone weakening and usually happen with little to no trauma, or at least with minimal impact. The hip (especially the femoral neck), wrist, upper arm, vertebral bodies of the thoracic and lumbar spine, ribs, and even parts of the knee joint, such as the tibial plateau, are the best-known locations for these fractures.

What are some of the risk factors for developing osteoporosis?

There are a number of risk factors for developing osteoporosis. Race, age, and gender all impact the chances of this condition occurring. Scientists report that postmenopausal Asian and White women are the most vulnerable; others indicate Caucasian postmenopausal women over 50-55 as perhaps the ones with the highest number of risk factors.

A family history of bone-related conditions, such as either parent having a hip fracture, is another significant risk factor. Low body weight (body mass index less than 20), smoking, daily alcohol intake, and use of certain medications, such as daily steroids for three months or longer or certain medications used to treat breast cancer (aromatase inhibitors), also increase the risk.

Additionally, there are a number of medical conditions, such as rheumatoid arthritis, type 1 diabetes, hyperparathyroidism and hyperthyroidism, vitamin D deficiency, and celiac disease, that are associated with low bone mass and an increased risk of fractures.

Diagnosis and Screening for Osteoporosis

Early diagnosis and screening are essential for effective management and the prevention of severe complications of osteoporosis.

Types of screening for osteoporosis

The gold standard for osteoporosis screening is the DXA scan (Dual-Energy X-ray Absorptiometry), commonly referred to as a bone density test. This radiology study measures bone mineral density (BMD) and is a quick, non-invasive procedure with minimal radiation exposure—approximately 1/100th the radiation of a chest X-ray. Primary care providers or gynecologists typically order this test, especially for women post-menopause.

In addition to the DXA scan, other radiologic methods can assess bone density:

  • Heel Ultrasound: This method uses sound waves to measure bone density in the heel. It’s a portable and less expensive option, although it’s less accurate than DXA.
  • CT scanning (quantitative computed tomography): It provides detailed images and can measure bone density, particularly in the spine.
  • Spine and hip X-rays: While not primarily used for screening, they are valuable in identifying fractures that indicate osteoporosis.

Who should be screened, and when?

Screening guidelines vary based on age, gender, and risk factors.

    • Women aged 65 and older: All women in this age group should undergo a DXA scan at least once to screen for osteoporosis.
    • Women aged 45–65: Those with risk factors, such as a family history of osteoporosis, low body weight, smoking, excessive alcohol consumption, or previous fractures, should consider bone density testing.
    • Men aged 70 and older: According to the National Osteoporosis Foundation, men in this age group should also be screened for osteoporosis.
    • Men aged 50–69: Men with risk factors similar to those in women should consider screening.

Additional screening tools

The FRAX (Fracture Risk Assessment Tool) is an online calculator that estimates an individual’s 10-year probability of sustaining a fracture. It incorporates clinical risk factors and, optionally, BMD values. This tool is particularly useful for determining whether bone density testing is necessary. For individuals with a 10-year fracture risk above 9.3%, the testing is recommended. For those with a global fracture risk above 20% or a hip fracture risk above 3%, treatment is typically advised.

Are there things women can do to prevent osteoporosis?

The short answer is “Yes!”. There are things we can’t control, such as family history or the pathologies we were born with. But for most women, it’s possible to reduce the risk of facing osteoporosis. First, consider dietary habits. Consuming adequate calcium and vitamin D is essential. Adults typically need 1200–1500 mg of calcium per day. Dairy products like milk, cheese, and yogurt are rich sources of calcium. A typical dairy serving (1 cup of milk, 6 oz yogurt, ½ cup of cottage cheese, or one ounce of cheese) has roughly 300 mg of calcium. Check here for more information about the calcium content of various foods.

For those who are lactose intolerant or vegan, alternatives such as fortified plant-based milks (almond, soy, or rice milk), leafy green vegetables (kale, bok choy, broccoli), almonds, and tofu are excellent options.

Keep in mind that while obtaining calcium from food is preferred, supplements can be useful, especially for those with dietary restrictions. It’s important to choose calcium supplements wisely and not exceed recommended doses to avoid potential negative effects such as kidney stones.

Lifestyle habits such as quitting smoking and moving more, especially if you have a sedentary job, should also be considered. Walking, jogging, dancing, or climbing stairs are all wonderful options. Strong core and back muscles are a great combo for a healthier spine.

Since a lack of estrogen is the most common cause of declining bone mass in women, menopausal hormone therapy (MHT) can especially help prevent the condition in women who have premature menopause (before the age of 45) and who should receive hormone replacement.

What are the treatment options?

Lifestyle changes, such as weight-bearing exercise, quitting smoking, and consuming adequate calcium and vitamin D, are the first steps to preventing osteoporosis. Once it has developed, though, your doctor should perform a series of blood tests to check for medical conditions that cause osteoporosis and correct any issues that can be addressed. If bone density testing shows low bone mass, then medication management may be warranted.

Bisphosphonates (such as alendronate, risedronate, and zoledronic acid) have been the mainstay of osteoporosis treatment for many years. These medications can reduce fracture risk by half and are important to help prevent fractures, particularly after the first fracture has occurred, as fracture risk is significantly higher then. There are several other families of medications that have been shown to be helpful, such as selective estrogen receptor modifiers, rank ligand inhibitors, and parathyroid hormone. They come in various forms, ranging from daily pills to daily injections, semiannual shots, and yearly infusions. Your doctor can help you decide which treatment is best for you.

Ongoing research and advancements in medical science have led to the development of new treatment options. Evenity is one of the newest medications to treat osteoporosis. It is important to consult with your doctor to stay informed about the latest developments in technology.

Your physician will help you choose a suitable treatment approach for your specific needs and circumstances.

Eileen West, MD, FACP, NCMP, CCD

Leading the way in women's healthcare is renowned board-certified internal medicine doctor Dr. Eileen West. She has over 20 years of experience and is recognized for her expertise in menopause, osteoporosis, and cardiovascular disease prevention. Her excellence-driven compassionate approach, which is associated with the American College of Physicians, improves the lives of her patients by putting a strong emphasis on their overall well-being.

Location: Fairfax, Virginia

Areas of Expertise: Women's Health, Menopause Management, Cardiovascular Disease Prevention, Osteoporosis Diagnosis and Treatment.

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