By Gina C. Del Giudice, M.D.
An estimated 10 million Americans have osteoporosis, and another 44 million have low bone density, increasing their risk for the disease, according to the National Osteoporosis Foundation.
This means that half of all adults age 50 and older are at risk of breaking a bone and should be concerned about bone health.
Osteoporosis doesn’t have to be a normal part of aging. You’re never too old or too young to improve the health of your bones.
A Silent Disease
Osteoporosis is a chronic disease that occurs when there is an imbalance in the body’s normal process of bone development. Calcium and phosphate are essential for normal bone formation. As the body ages, these minerals may be reabsorbed back into the body from the bones, which makes the bone tissue weaker.
Normally, bone is constantly breaking down and rebuilding, but when the breakdown of bone occurs faster than the rebuilding, bones can become weak and brittle, which leads to an increased risk of broken bones, also known as fragility fractures.
Osteoporosis is often called a “silent disease” because there are typically no symptoms or pain, especially in its early stages. Bone loss typically occurs gradually over time.
Symptoms occurring late in the disease include:
- Fractures with little or no trauma
- Loss of height (as much as 6 inches) over time
- Low back pain due to fractures of the vertebrae
- Neck pain due to fractures of the vertebrae
- Stooped posture or kyphosis, also called a “dowager’s hump”
In most cases, people are unaware they have osteoporosis until a fracture occurs. By then, the disease is often advanced.
Age, Gender Common Risk Factors
Age and gender are two of the most common risk factors for osteoporosis. One in two women and up to one in four men over age 50 will break a bone due to osteoporosis, according to the National Osteoporosis Foundation.
Other common risk factors include:
- Race (Asian and Caucasian)
- History of smoking
- Family history of osteoporosis
- Personal history of fractures at age 50 and older
- Excessive alcohol intake
- Low body mass index (BMI)
- Post-menopausal state (and possibly low testosterone in men)
- Rheumatoid arthritis, chronic kidney disease and eating disorders
- Taking corticosteroid medications (prednisone, methylprednisolone) every day for more than three months and some anti-seizure medications
If you are concerned about your risk for osteoporosis, talk to your doctor about screening and steps you can take to reduce your risk.
As the National Osteoporosis Foundation notes, osteoporosis is responsible for an estimated two million broken bones per year.
Breaks are most likely to occur in the hip, spine and wrist. In addition to being painful, these breaks can also limit mobility, and lead to isolation and depression.
Moreover, 20 percent of seniors who break a hip die within a year from complications. Most hip fractures occur because of falls.
Diagnosing, Treating and Preventing
If your doctor suspects you are at risk of or suffering from osteoporosis, you may be asked to undergo a bone density test, called a DEXA scan. The test uses x-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. The bones most commonly tested are in the spine, hip and sometimes the forearm. The test is safe and painless.
Treatment of osteoporosis typically involves medications to build new bone and prevent bone from breaking down. In fact, certain medications have proven effective in reducing bone fractures by more than 50 percent.
Medications come in a range of formulas from daily pills to yearly intravenous infusions. It is important to talk with your doctor to identify an approach this is right for you.
It is also important to undergo a fall risk assessment and take steps to reduce your risk for falls, including:
- Installing grab bars in bathrooms
- Using a non-skid mat in the shower or bathtub
- Installing brighter light bulbs
- Keeping a flashlight beside your bed
- Keeping floors free of clutter
People of all ages can help protect their bones and guard against osteoporosis by adopting a healthy lifestyle, including:
- Eating a well-balanced diet that includes calcium-rich foods such as such as low-fat milk, yogurt and cheese; vegetables, like kale and broccoli; many grains such as bread and pasta; and fish with soft bones, including salmon and sardines
- Engaging in regular exercise to improve muscle strength and balance
- Avoid smoking and limit alcohol consumption
- Getting enough Vitamin D, whether through sunlight, fortified foods, or supplements
If you have sustained a fragility fracture, Penn Medicine Princeton Health’s Osteoporosis Program can help.
In addition to increasing awareness and providing education on the early diagnosis and treatment of osteoporosis, the program aims to prevent future fractures through services including DEXA scan testing, physical and occupational therapy, nutrition counseling, pain management, fall risk assessment, and fall prevention and home safety education.
To learn more about the Penn Medicine Princeton Health Osteoporosis Program call 609.853.7965 or visit www.princetonhcs.org.
Gina C. Del Giudice, M.D., is board certified in internal medicine and rheumatology. She is a member of the medical staff at Penn Medicine Princeton Health.