Everything You Need to Know About Osteoporosis

Did you know up to 45% of patients with osteoporosis related fractures die within the first year due to complications?

Osteoporosis affects 5% of men and 25% of women over the age of 65…which means it’s a major health issue. If those statistics don’t grab your attention, then this one certainly will:

50% of all women will suffer from an osteoporosis related fracture in their lifetime…that’s equal to the risk of breast, ovarian and uterine cancer combined!

The good news is that osteoporosis is a preventable disease if proactive steps are taken to prevent it. Here’s what you need to know to protect your bones from this ‘silent killer’.

What is Osteoporosis?

The World Health Organization defines osteoporosis as:

“A progressive systemic skeletal disease characterized by low bone mass and

microarchitectural deterioration of bone tissue, with a consequent increase in

bone fragility and susceptibility to fracture.”

In other words…osteoporosis causes widespread weakening of the bones which causes them to break more easily.

Osteoporosis vs. Osteoarthritis

Many people mistake osteoporosis with osteoarthritis, but they are quite different. Osteoporosis results from the loss of healthy bone. Contrary to what many believe, osteoporosis does not cause pain unless there is an associated bone fracture.

Osteoarthritis, on the other hand, is commonly painful and results from deterioration of the protective cartilage that cushions the ends of bones. Patients can also experience swelling and reduced range of motion of the affected joints.

Osteoporosis Risk Factors

There are several risk factors associated with the development of osteoporosis. Some risk factors can’t be changed, for instance age, ethnicity, or genetic predisposition. But, most of the other risk factors can be avoided or corrected. These factors include:

1. · Sedentary lifestyle

2. · Drinking too much alcohol

3. · Smoking

4. · Unhealthy diet without enough nutrients

5. · Not getting enough sleep

6. · Being underweight

7. · Being overweight

8. · Being in menopause without using hormone replacement therapy

9. · Taking certain prescription drugs, especially steroids and stomach acid reducing medications

If you’re wondering if you're at risk for developing osteoporosis, use this risk calculator to get a general idea of where you stand.

Diagnosing Osteoporosis

The standard diagnostic tool used to screen for osteoporosis known as a DEXA (dual energy X-ray absorptiometry) scan. A DEXA scan is basically a sophisticated type of x-ray which offers a simple, non-invasive way to quickly assess bone mineral density and body composition.

A DEXA scan measures bone density in the hip and the spine as representative examples of overall bone health. Two scores are usually reported, a T-score and a Z-score.

• The T-score compares a patient’s bone density to that of an average, healthy 30-year old person, the age at which peak bone mass is achieved.

• The Z-score compares a patient’s bone density to that of a person who is the same age as the patient.

Here’s an example of a typical DEXA scan report:

Here’s how to interpret the T-score:

• Normal: T-Score < -1.0

• Osteopenia (early bone loss): T-Score -1.0 to -2.5

• Osteoporosis: T-Score > -2.5

What does the Z-score mean? If the Z-score is close to zero, it means the decrease in bone density is probably age related. If the Z-score is more than -2.0, it means there are other (‘secondary’) factors contributing to bone loss.

The Downsides to DEXA Scanning

There are some down sides to DEXA testing, especially follow up DEXA scans after treatment is prescribed. Here are some of them:

1. A DEXA scan does not provide information about bone loss in real time. In fact, it can take up to two years for a DEXA scan to show any changes in bone density once risk factor modification and/or treatment measures are initiated.

2. Measurements must be done on the same machine for results to be accurately compared.

3. There are several unrelated factors that can make DEXA scan results unreliable. One example is in the case of osteoarthritis which can cause DEXA readings to be higher than they actually are.

4. DEXA scan results do not always correlate with the risk of fracture.

The other point of confusion is different medical organizations recommend different testing intervals for DEXA scan surveillance. For instance, The North American Menopause Society recommends DEXA scanning every two years while The National Institutes of Health Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy have no specific recommendations at all.

One prominent medical organization, the American Academy of Family Physicians, recommends no follow up DEXA scans unless patients meet certain criteria:

“The optimal interval for repeating DEXA scans is uncertain, but because changes in

bone density over short intervals are often smaller than the measurement error of most

DEXA scanners, frequent testing (e.g., < 2 years) is unnecessary in most patients.

Even in high-risk patients receiving drug therapy for osteoporosis, DEXA changes

do not always correlate with probability of fracture. Therefore, DEXA should

only be repeated if the result will influence clinical management or if rapid changes

in bone density are expected. Recent evidence also suggests that healthy women 67 years

and older with normal bone mass may not need additional DEXA testing for up to 10 years

provided osteoporosis risk factors do not significantly change.”

It's best to discuss your case with your physician to determine the optimal testing interval for you. You can also learn more about ongoing bone loss by doing urinary testing for the breakdown products of bone. Ask your doctor about testing C-telopeptide and N-telopeptide levels as a more accurate way of determining active bone loss.

Treating Osteoporosis

Here are some of the main drug classes used to treat osteoporosis:

Hormone Replacement Therapy

Prior to 2001, hormone replacement therapy was the most commonly prescribed treatment for osteoporosis. However, the results of the 2001 Women’s Health Initiative Study suggested hormone replacement therapy caused too many adverse side effects to be safe. The study was ultimately found to be flawed and its conclusions inaccurate. However, fear over hormone replacement therapy remains. Nonetheless, hormone replacement therapy is a safe and viable option if properly dosed and monitored by an experienced health care professional.

Bisphosphonates

Bisphosphonate drugs are now the first line treatment for osteoporosis, and can be given by mouth (Fosamax, Boniva, and Actonel) or intravenously (Reclast and Aredia). They have been shown to prevent both spine and hip fractures. The pills take about three months to be fully effective, and the improvement in bone density remains as long as the drug is taken. IV therapy takes effect much more quickly than the oral preparations. IV Bisphosphonates are usually prescribed if patients cannot tolerate the oral medications or if the oral medications are ineffective based on follow up DEXA scans.

Bisphosphonate drugs have been associated with numerous side effects including gastrointestinal upset, headache, dizziness, visual changes, swollen joints, muscle pain, and mouth ulcers. The IV preparations can also cause kidney failure. The most concerning side effects are destruction of the jaw bone (osteonecrosis) and abnormal fractures of the leg bone. These risks increase the longer the drugs are taken.

There are two key points to know about bisphosphonate drugs:

1. They can stop bones from breaking down, but they do not cause new bone to form.

2. Use of these drugs has not been shown to lower the death rate from complications of osteoporosis related fractures.

Selective Estrogen Receptor Modulators

SERMs, such as Evista, are also prescribed for osteoporosis. They have estrogen like effects on the bone but not on the uterus and breast. They are more commonly prescribed for postmenopausal women who can’t use hormone replacement therapy, such as those with an increased risk of breast or uterine cancer.

SERMs are less effective than bisphosphonates in that they prevent spine fractures but not hip fractures. In addition, because of their anti-estrogen effects in other tissues, they can cause hot flashes, night sweats, and weight gain. They can also cause other side effects, including flu-like symptoms, insomnia, headaches, and rash.

Other medications less commonly used to treat osteoporosis are Calcitonin, Parathyroid Hormone, and Antibodies (i.e. Prolia).

Osteoporosis Prevention

The best way to prevent osteoporosis is to educate yourself about the modifiable risk factors so you can make changes before you lose bone. Here are things you can do right now to protect your bones:

1. Get regular exercise. The International Osteoporosis Foundation has specific recommendations for exercises based on age and menopausal status. You can review them HERE.

2. Stop smoking

3. Limit alcohol consumption to no more than one drink per day.

4. Take supplements that maintain bone health. Calcium is important, but so are several other nutrients essential for strong, healthy bones. They include Vitamin D, Vitamin K, manganese, magnesium, molybdenum, and strontium. The ideal bone health supplement should contain more than just calcium. Talk with your doctor about the right bone health supplement for you based on your age, menopausal status, and fracture risk. If you need some suggestions, you can also look HERE.

5. If you are postmenopausal, consider working with a highly skilled and experienced functional medicine doctor who can properly dose and monitor bioidentical hormone replacement therapy. Hormone therapy prevents bone breakdown, builds bone, and decreases death rate from complications of osteoporosis related fractures.