May is National Osteoporosis Month

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According to Dr. Prabhat Pokhrel, osteoporosis is a loss of bone mass or bone mineral density (BMD). About ten million Americans are affected by osteoporosis which in turn leads to bone fracture with minimal or even no obvious trauma. Normally, older bone tissues are replaced by new bone tissue throughout one’s life. Every ten years, a bone is replaced by a new bone. Decrease in the rate of new bone formation and/or increase in the rate of bone destruction leads to osteoporosis, which can be classified as primary or secondary.

Who is at risk?

Osteoporosis is most common in post-menopausal women. Despite being common, it is underdiagnosed and undertreated. Primary osteoporosis is related to aging, decrease in function of ovaries or testes. Secondary osteoporosis is related to certain chronic medical conditions such as hyperthyroidism, hyperparathyroidism, diabetes and chronic liver disease. In addition, risk can be increased by regular alcohol use, diet low in calcium and vitamin D, or long-term use of medications such as steroid hormone, thyroid hormone (in high doses), certain anti-cancer medications and antidepressants (to name a few) and lack of regular exercise.

Symptoms

Unfortunately, osteoporosis does not have any specific symptoms. Therefore, it may go undetected for many years until fracture occurs or a positive screening by a healthcare provider. Bones commonly fractured in people with osteoporosis are vertebrae, hip and forearm. Vertebral fracture may be asymptomatic and should be suspected if there is pain over the vertebrae (broken area) after coughing, sneezing or lifting. Loss of height is another symptom, but again, not specific to osteoporosis. 

Screening and Diagnosis

Screening for average risk in post-menopausal women is recommended to begin at age 65. Screening guidelines for men vary in their recommendations. Men and women with increased risk factors should be screened earlier than the recommended age. Screening and diagnosis are done by assessing BMD using dual-energy x-ray absorptiometry (DEXA). Lower-than-normal bone density could mean osteopenia (bone is heading toward becoming osteoporosis) or osteoporosis. Your physician may suspect or diagnose osteoporosis based on clinical findings such as vertebral compression fracture and fragility fracture (bone fracture with minimal injury).

Prevention and Treatment

Regular weight-bearing, aerobic, resistance and balance exercises combined with a healthy diet are extremely important to maintain bone health and reduce risk of fracture. Daily intake of calcium (1,200mg) and vitamin D (2,000IU) is appropriate for treatment of osteoporosis. Depending on BMD, bone-specific medications may be prescribed. With appropriate use, those medications have been shown to reduce risk of spine and hip fractures. Your physician should be able to discuss with you to determine what type of treatment, with or without medication and for how long, is best for you.

Can bone loss be reversed?

Appropriate drug therapy combined with a healthy lifestyle may reverse or slow down bone loss. It takes about 3-5 years of drug therapy and healthy lifestyle to determine whether drugs should be continued further or can be temporarily discontinued. Quitting cigarette smoking, reducing body weight to normal for age, gender and height and cutting down caffeine intake can positively affect risk.

Are supplements effective?

Vitamin D and calcium are the most researched bone health supplements. More rigorous clinical research is necessary to assess effects of soybeans (Isoflavones), vitamin B12, folic acid and omega-3 fatty acids on bone health. There is not enough data to recommend for or against the use of these supplements to treat or prevent osteoporosis.

If you are in an at-risk category, ask your physician if you need osteoporosis screening.

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