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Osteoporosis: Q+A with Dr. West

Osteoporosis: Q+A with Dr. West


Osteoporosis: Q+A with Dr. West

What exactly is osteoporosis?

Osteoporosis is a condition of the bones which often occurs with aging. It is defined as a disruption of the microarchitectural structure of bone which leads to a loss of bone mass and strength, and makes a person susceptible to fractures. Fragility fractures, as they are known, occur most often at the hip (especially the femoral neck), the vertebral bodies of the thoracic and lumbar spine, the wrist, the upper arm, and even ribs and parts of the knee joint (tibial plateau 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, especially Caucasian women over age 65 and men over age 70 are perhaps the greatest risk factors. Having a family history, such as either parent with a history of hip fracture, is another significant risk factor. Low body weight (body mass index less than 20), current 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 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 which are associated with low bone mass and an increased risk of fractures.

What type of screening is there for osteoporosis?

The gold standard for screening for osteoporosis is the DXA scan, or “bone density test.” This radiology study, which takes a few minutes and has only 1/100th the radiation of a chest xray, can be ordered by your primary care provider or gynecologist. Most women don’t need this test until after they go through menopause.
There are also other radiologic methods, such as a heel ultrasound, and CT scanning, which may be used to determine bone density. Spine and hip x-rays can also be very useful in identifying fractures associated with osteoporosis.

Who should be screened and when?

All women over the age of 65 should be screened once for osteoporosis. Any women between 45-65 with the above mentioned risk factors might also benefit from a bone density test. According to the National Osteoporosis Foundation, men aged 70 and over should also be screened for osteoporosis. There is an online tool known as FRAX (Fracture Risk Assessment calculator) which can also be helpful to determine whether a bone density test should be done. For those with a fracture risk above 9.3%, bone density testing is indicated. For those with a global fracture risk above 20% or hip fracture risk above 3%, treatment is usually warranted.

Are there things women can do to prevent osteoporosis?

First, smokers should quit smoking. Consuming adequate calcium and Vitamin D are important. Often, enough calcium (1200-1500 mg daily) can be consumed in the diet, and obtaining calcium naturally is preferred to taking large supplement doses. For those who are sensitive to lactose or have a gluten sensitivity, supplements can help one to reach the recommended daily amount. Vitamin D is converted by the skin and sunshine to its active form in the body, when exposed to sunlight without wearing sun block. Generally, most of us need Vitamin D supplementation (about 800 ius daily) to reach the daily recommended amount. Weight bearing exercise (such as walking, jogging, dancing or climbing stairs) is very important to maintaining strong bones. Strengthening exercises for the core and paraspinous muscles can be beneficial in maintaining a strong and healthy spine. Osteoporosis is most often a disease seen in women with estrogen deficiency, so replacing estrogen in those who go through premature menopause (before age 45) can also be helpful for prevention.

What are some of the treatments?

Lifestyle changes, such as lots of weight-bearing exercise, quitting smoking, consuming adequate calcium and Vitamin D, are the first step to preventing osteoporosis. Once it has developed though, your doctor should perform a series of blood tests to check for medical conditions which cause osteoporosis, and correct any issues which can be addressed. If bone density testing shows low bone mass, then medication management may be warranted. The bisphosphonates (such as alendronate, risedronate, 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 the first fracture, and particularly after the first fracture has occurred, because fracture risk is significantly higher then. There are several other families of medications which 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.

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Eileen West, MD about 12 hrs ago
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The scenario plays out like this… you’re sitting at home watching reruns of Friends when your vision blurs. Minutes later your head feels like it's set in a vice, and someone is cranking the lever. With your head throbbing, the nausea kicks in. After making a bathroom stop (goodbye lunch), you climb into bed and pull the covers over your face, lying still in the dark. Can you relate? This is called migraine, and sadly this illness is all too common. ● Approximately 39 million people in the US and 1 billion people worldwide have migraines ● Most people with migraine have 1 to 2 attacks per month which can extend from 4 hours to 3 days ● 36 billion is spent each year on healthcare and loss of productivity due to migraines Add onto those staggering stats this surprise—WOMEN are at greatest risk. Studies show that 8 out of 10 people with migraine are females. While research isn’t fully conclusive as to why, the data points to women’s hormone levels changing. ➡️ If you are battling migraines, please know that you do not need to suffer alone. At Eileen West, MD, and Associates, we are here to help you find the right treatment to prevent migraines and make them less painful. You have a life to lead. We’re here to help you on that journey and provide exceptional care. ⭐️ June is National Migraine & Headache Awareness Month. Share your migraine questions below… We’d love to help. #youdeservebetter #msmedicine #fairfaxphysician #conciergemedicine #lifestylemedicine #doctorsofinstagram #femalephysician #womenshealth #fairfaxdoctor #fairfax #fairfaxva #fxva #dc #washington #loveVA #fairfaxcounty #virginia #northernvirginia #nova #dcarea #dmv #va #nham

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Eileen West, MDabout 2 days ago
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IT’S SELF-CARE SUNDAY. We’re back this week to focus on the importance of self-care and giving you tips on how to practically care for the physical, mental, emotional, & social parts of you. Today’s self-care tip is simple but necessary: Find Ways To Relax Our American society prides itself on doing, doing, doing. Here’s the truth - busy doesn’t equal beneficial. We need a balance of work, play, and rest. Your mind, body, and emotions need periods of relaxation in order to refuel. Here are 10 Ways You Can Relax: ● Meditate ● Do Yoga ● Get a massage ● Take a nature walk or hike ● Journal ● Swim ● Listen to calming music ● Sit in the sun ● Color ● Read a book Self-care isn’t selfish, it is essential. Your brain and body need downtime. Do yourself a favor & RELAX. ➡️ What is your favorite way to relax? Tell us in the comments. #youdeservebetter #msmedicine #fairfaxphysician #conciergemedicine #lifestylemedicine #doctorsofinstagram #femalephysician #womenshealth #fairfax

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Eileen West, MDabout 6 days ago
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More than 80% of women experience hot flashes during menopause. Hot flashes can occur during the day or night and have a range of severity. If you fall into the category of moderate to severe, here are 6 tips to help you find relief: 1. Keep the temperature in your home cool. 2. Reduce stress with yoga, tai chi, meditation, biofeedback, acupuncture & massage. 3. Eliminate hot drinks, hot foods, alcohol, caffeine, and cigarette smoking 4. Wear light, breathable clothing during the day and to bed. 5. Sleep with cooling products, including sprays, gels, and a cool-fabric pillow. Use layered bedding that can be easily removed during the night. Cool down with a bedside fan. 6. When a hot flash is starting, try “paced respiration”—slow, deep, abdominal breathing, in through your nose and out through your mouth. Breathe only 5 to 7 times per minute, much more slowly than usual. ➡️ There are some prescription treatments to help with menopausal symptoms. Talk with your primary care doctor to discuss the best path for you. If you currently are seeking a provider, we are here to advocate for your total wellbeing and provide knowledgeable and personal care. Please reach out to schedule an appointment and learn more about how we can help! References: The North American Menopause Society (mnflashes.pdf), Stat from National Library of Medicine #youdeservebetter #msmedicine #fairfaxphysician #conciergemedicine #lifestylemedicine #doctorsofinstagram #femalephysician #womenshealth #fairfaxdoctor #fairfax #fairfaxva #fxva #dc #washington #loveVA #fairfaxcounty #virginia #northernvirginia #nova #dcarea #dmv #va #menopause

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