No bones about it: Prevention is key with osteoporosis
May is Osteoporosis Awareness and Prevention Month, and the more knowledge you have about this condition, the better equipped you’ll be to guard against bone loss and deterioration—and the consequences that can come with weak, frail bones, such as fractures due to falls.
The first thing you should know is your risk of osteoporosis. Janice Gupta, DO, a rheumatologist with Swedish Medical Group, says one of the biggest risk factors is “becoming postmenopausal, with that drop in estrogen. Estrogen prevents bone loss, so when you don’t produce enough estrogen, it affects your bone health. So that’s the most common factor, especially with postmenopausal osteoporosis.”
Dr. Gupta adds that other risk factors for accelerated bone loss include diabetes, alcohol use, smoking and use of corticosteroids. “There are also less common things—hypoparathyroidism can affect, for example, patients with kidney disease and that can lower calcium levels in the body. There are also malabsorption syndromes, where patients may not be absorbing as much calcium, and multiple myeloma.”
How to help prevent bone loss and osteoporosis
There are many preventive steps you can take to lessen the risk of developing osteoporosis. Among them:
Don’t smoke or drink excessive amounts of alcohol. “These can lead to lower bone mass, which in turn can develop into osteoporosis,” Dr. Gupta says.
Incorporate weight-bearing or resistance-training activities into your fitness routine to strengthen bones. “Walking is good, as is running if you can do it and your joints are healthy enough,” Dr. Gupta says. “Exercises where you are putting some force on the ground are typically what we think of in terms of helping bone development. Weight training can be helpful as well in building strength.”
Get enough calcium, through diet and any doctor-approved supplements. “Typically, what’s recommended to improve bone density is 1,000 to 1,250 milligrams of calcium each day,” Dr. Gupta says. “You should also get about 800 units of vitamin D a day, as it helps your body absorb calcium.”
When it comes to diet, Dr. Gupta suggests considering every serving of calcium in your food—yogurt, cheese, a glass of milk—as measuring 250 milligrams. “I tell patients to keep track of how much calcium they’re getting each day over the course of a week, and then whatever they’re not getting to supplement it. So that may mean a 600-milligram tablet every other day or every day, depending on how much calcium they’re getting in their diet.”
It’s important to forego a calcium supplement if you don’t really need it. “Taking too much calcium can cause accelerated coronary artery disease with calcium buildup in the blood vessels and can lead to kidney stones. Calcium intake can vary each day, so look at a few days and average it out — it doesn’t need to be exact, but you want to make sure you’re not getting too much calcium either.”
Dr. Gupta generally recommends including dairy products in your diet because that’s where most of the calcium is. You can eat full-fat or low-fat dairy products, depending on your preference. And if you don’t eat dairy, look for calcium-fortified foods.
Ethnicity can play a role in osteoporosis, too. “African Americans start out with a higher bone mass, so they generally have less osteoporosis, while Asians tend to have lower bone mass to begin with, so they tend to have a higher rate of osteoporosis,” Dr. Gupta says. “Those things can make a difference, but age is the primary factor.”
Treatment for osteoporosis
There aren’t any significant symptoms of osteoporosis. To determine your bone mineral density, your physician can run a bone density scan. “ We typically order bone density scans for patients, especially those who are at higher risk and postmenopausal,” Dr. Gupta says. “The scan gives us a score, and anything less than -2.5 is considered osteoporotic. If the score is between -1 and -2.5, it’s considered osteopenia, which is a precursor to osteoporosis. The scores help us determine if patients can increase their physical activity and if they need to be on treatment.”
The National Osteoporosis Foundation recommends bone density testing for women age 65 or older, men age 70 or older, and men and women who break a bone after age 50 or who have other risk factors.
If treatment for osteoporosis is necessary, the first stage is most commonly a type of medication called bisphosphonates. They can be taken orally once a week or in an IV medication administered once a year. If those don’t work, there is a second line of medication called denosumab, which is a biologic treatment. It decreases the risk of vertebral and non-vertebral fractures and it’s given as an injection every six months.
The third osteoporosis medication is teriparatide, which is given as a daily injection for two years and increases bone formation. If you take bisphosphonates or teriparatide, you would take the medication for anywhere from three to five years before going on a “drug holiday,” in order to prevent possible atypical fractures. If you stop taking denosumab, however, it could result in accelerated bone loss, Dr. Gupta says, adding. “There’s actually a new treatment in clinical trials that is a biologic and is called romosozumab,” she says. “They’ve seen quite a bit of an increase in bone density with it. It affects the cells that inhibit bone formation.” Whatever the treatment is, your physician will generally keep up with the state of your bone health with scans every one to two years.
Knowing the preventive measures to take can make a big difference in your bone health and whether you will develop osteoporosis. “If you are postmenopausal, make sure to talk with your physician about getting a baseline bone density scan and having that monitored,” Dr. Gupta says. “And for older people, one of the biggest reasons we try to treat osteoporosis is because fractures can have a high risk of morbidity. So, they should keep their homes as safe as possible to prevent falls, and work on balance and muscle strength with yoga or tai chi.”
If you want to know more about getting a bone density scan, or have other questions about bone health, find a skilled Swedish physician. Learn more about Swedish rheumatology.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.