Your skeleton plays an important role in your body. Our bones protect our organs and provide the structure and support we need to stand, walk and so much else. While they’re considerably strong, bones are not indestructible. In fact, some diseases can weaken your bones, making them more prone to fracture. Osteoporosis is one disease that weakens bones.
Marcia Woodburn, AGACNP-C, is an adult-gerontology acute care nurse practitioner who sees patients at Banner – University Medicine Orthopedics Clinic in Tucson. She specializes in osteoporosis screening and treatment, and she is an ambassador with the National Osteoporosis Foundation. Now, she’s taking the time to explain to us what osteoporosis is and what it can do to our bones without the proper care.
What is osteoporosis?
Woodburn explains that osteoporosis translates to “porous bone” and is a pain-free thinning of the bone. As the bone thins, or becomes more porous, the risk of fracture increases. And, while there are risk factors that may suggest osteoporosis, there are no obvious symptoms.
“Unless you are monitored by your provider with scheduled DXA scans, you may not know you have osteoporosis until you fall and fracture,” Woodburn said.
Osteoporosis is also expensive, with estimated costs of $52 billion in 2018 impacting patients, their families and health-care systems. Woodburn also notes that experts believe these costs will reach $87 billion by 2040, with osteoporosis responsible for 3.2 million fractures annually.
If those numbers aren’t shocking enough, Woodburn points out the National Osteoporosis Foundation has even more surprising statistics:
- There are approximately 300,000 hip fractures—a potentially devastating fracture—every year in the U.S.
- 25% of people suffering a hip fracture will die the first year following the injury.
- 25% with a hip fracture will never return home.
- The remaining 50% of people who suffer a hip fracture never regain prior function.
- Only 15% of the patients who do regain prior function are able to walk across a room without an assistive device after 6 months.
Woodburn says there are many causes for osteoporosis, and often multiple factors contribute to poor bone health.
“The most well publicized population who develop osteoporosis is postmenopausal women,” Woodburn said. “However, they are not the only group affected.”
According to Woodburn, women over the age of 50 are 4 times more likely to have osteoporosis and 2 times more likely to have osteopenia, a precursor to osteoporosis, than men. Additionally, she says 1 in 2 women and up to 1 in 4 men over 50 will break a bone due to osteoporosis.
Without obvious symptoms, it is important to discuss osteoporosis with your provider. Risk factors for osteoporosis may include:
- Genetics or a family history of osteoporosis
- Certain diseases, such as diabetes, rheumatoid arthritis, autoimmune conditions, hypothyroidism, hyperparathyroidism, malabsorption or malnutrition—such as celiac disease or eating disorders—and certain cancers or cancer treatments
- Medications, such as glucocorticoid or steroid use, and certain medications for depression, chronic pain, seizures, heartburn, arthritis and others
- Disuse or lack of movement
- Age—as you age, the greater your chance of developing osteoporosis
- Race—people who are white or of Asian descent have a greater risk
- Gender—women are more at risk than men
- Frame size—the smaller your size, the greater your risk
- Eating disorders, such as anorexia or bulimia
- Diet, including those low in calcium and vitamin D
- Sex hormone deficiency (estrogen in women and testosterone in men)
- Alcohol may decrease calcium and Vitamin D levels and increases risk of hormone deficiencies
- Smoking, which increases risk of bone loss as you age and may delay fracture healing
Woodburn says there are two main ways osteoporosis may be diagnosed. The first is a DXA scan, which measures the density of your bone and the second is from a fracture after a fall. Not surprisingly, the preferred way to diagnose osteoporosis or osteopenia is through a DXA scan.
Unfortunately, falls and fractures are typically the next way osteoporosis is diagnosed. Woodburn explains, if you fall from a standing height and fracture your hip, wrist or spine, your doctors can to help diagnose osteoporosis.
“These types of fractures tell us your bone may not be as healthy as it should be, and the most common reason your bones would break in these situations is if your bone is osteoporotic,” Woodburn said. “These types of falls typically should not cause a fracture in an otherwise healthy bone.”
Woodburn says examples of these types of falls might include a hip fracture after losing balance and falling in your house or garden, or a slip out of bed onto your back resulting in spinal or wrist fracture.
Osteoporosis treatment options
Because osteoporosis leads to an increased risk of fracture, the quality of life, mobility and independence of a patient with osteoporosis can be impacted. This can lead to depression, and additional complications, such as pneumonia, which can be fatal. Therefore, it is important to talk with your provider about treatment after any fractures and take steps to reduce your future risk of fracture.
Woodburn explains that a patient can do well with osteoporosis by seeking osteoporosis safe physical activity and taking steps to reduce fall risk. Woodburn says physical activity should include weight-bearing exercise and balance training, such as Tai Chi, to help with fall prevention.
“If we can prevent falls, modify dietary and lifestyle habits, use osteoporosis medications effectively and appropriately screen for and treat any underlying causes of osteoporosis, this can go a long way toward maintaining and improving bone health and overall prognosis,” Woodburn said.
As far as treatment options, Woodburn says there are two different types of medication your doctor can prescribe. Your doctor may prescribe antiresorptives, “bone maintainers,” such as Fosamax, Actonel, Boniva, Reclast or Prolia. Your doctor also may prescribe anabolics, “bone builders,” such as Forteo, Tymlos or Evenity.
Woodburn also says there are things you can do earlier in life to avoid later osteoporosis. Normal bone growth occurs into your 20s, according to Woodburn, and by the time you are in your 30s, bone breakdown can outpace formation. That’s why Woodburn says it’s important to think about bone health throughout your life.
Woodburn’s top two tips are to eat healthy and stay physically fit. She recommends optimizing intake of calcium and vitamin D—the building blocks of bone—and engaging in weight-bearing exercise. Following a healthy lifestyle, such as not smoking and drinking alcohol in moderation, can also help you prevent or delay the onset of osteoporosis.
What should I do now?
As you age, it’s also important to remember to be your own advocate. Woodburn says, if you are a man nearing 70 or a woman getting close to 65, talk to your doctor about osteoporosis and getting a baseline DXA scan. By getting a head start on understanding the status of your bone health with a DXA scan and identifying any causes for your osteoporosis and correcting these, you may prevent progression of bone loss and future fractures.
“In many cases we can slow or halt your bone loss and often improve it,” Woodburn said. “Osteoporosis is something that can be managed once identified.”
Finally, Woodburn recommends taking advantage of local resources, too. Local area agencies on aging often can help you get assistive devices or contractors to help you modify your home to reduce fall risk. Your local fire department also may offer free home safety evaluations.
Before starting any supplements or exercise program make sure to talk with your provider. For help finding a doctor visit: doctors.bannerhealth.com.