WHAT DO I NEED TO KNOW ABOUT OSTEOPOROSIS?

Osteoporosis is a major health problem with more than 10 million Americans affected by poor bone health.  It is estimated that another 44 million have osteopenia which can become osteoporosis. Osteoporosis and osteopenia cause softening of the bones and can lead to fractures of the spine and long bones. It occurs in women 2 x more common than men. 

Men are at the greatest risk at 75 years of age.

Osteoblast promote ossification or increased bone density

Osteoclast promote bone resorption or decreased bone density

When we are young our osteoblast makes more bone than our osteoclast can breakdown and strong bones are created. In the mid 30s osteoclast function better than osteoblasts and you start to lose bone overtime. 

When bone health is adequate we will continue to make strong bones as we age.

Who is at the most common risk of accelerated bone loss after postmenopausal period?

 White and Asian women followed by African American and Hispanic women.

What ethnicity has the most osteoporosis?

• White
• Asian 41 % less than white
• African American 54% less than white
• Hispanic 91% less than white

More women suffer from hip fractures than men, but the mortality in men is greater by nearly 50%.

Cost of Osteoporotic fractures is estimated $19 Billion in healthcare expenditures annually.  This is expected to rise to 25.3 billion by 2025.

What are the types of fractures and how many a year?

• Hip Fractures 300,000
• Spine Fractures 547,000
• Wrist fractures 397,000
• Other fractures 675,000

What are your risk factors that can lead to osteoporosis?

• Advanced age
• Family history
• Race (White)
• Estrogen deficiency (Menopause/hysterectomy)
• Tobacco use
• Steroid use (glucocorticoid) asthma, rheumatoid arthritis, psoriasis, chronic conditions.
• Hypogonadism
• Low calcium intake, Vitamin D and K2
• Physical inactivity
• Low body weight (154 lbs)
• Medications
• Female
• Low Cognitive function
• High alcohol ( two or more drinks/day)
• High caffeine- phosphoric Acid breakdown of bone tissue
• High carbonated beverages
• Premature ovarian failure
• Frame size

What is the gold standard of diagnosing osteoporosis?

DEXA (dual-energy x-ray absorptiometry) of the hip or spine with T-score measurements.

What does a T-score mean?

WHO Criteria for Diagnosis or Osteoporosis by T-Score

• T-score Diagnosis
• Equal to or above -1 Normal range
• Between -1 and -2.5 Osteopenia
• Equal to or below -2.5 Osteoporosis
• Equal to or below -2.5 + fracture Severe osteoporosis

When should I be treated if I am a woman over 50 years and postmenopausal?  When the T-score is less than -2.5

What are the most common medications associated with secondary osteoporosis?

Glucocorticoids, even small doses for long periods of time

• Anticonvulsants
• Thyroxine
• Lithium
• Tamoxifen (premenopausal use)
• Immunosuppressant drugs.

What are secondary causes of Osteoporosis?

• Liver disease
• Rheumatoid arthritis
• Celiac sprue
• Malabsorption syndromes
• Inflammatory bowel disease
• Lymphoma
• Multiple myeloma
• Thalassemia
• Acromegaly
• Amyloidosis
• Leukemia
• Thyrotoxicosis
• Nutritional deficiencies
• Sex steroid deficiencies
• Hyperparathyroidism
• Medical conditions that cause decrease calcium absorption: Stomach surgery, crohns’s disease, celiac disease, anorexia nervosa and Cushing’s diseases

How do I prevent osteoporosis?

• Balanced diet that is rich in calcium and Vitamin D with K2
• Healthy body weight
• Weight bearing exercises for 30-60 min, five days a week
• Stop smoking, moderate alcohol.
• Avoid secondhand smoke as well
• Fall prevention- ask your doctor, if you are Medicare there are home health companies that will come to your house for evaluation.

Factors that increase your fall risk?

• Problems with balance
• Mobility
• Vision
• Lower extremity weakness
• Blood pressure
• Back pain
• Side effect of medications
• Obstacles in the home such as rugs, poor lighting, animals

How to prevent falls:

• Wear low heeled shoes
• Check house for electrical cords
• Remove area rugs or other slippery surfaced
• Add lighting
• Install grab bars
• Lower extremity strengthening

Signs indicating Osteoporosis?

• Loss of height
• Back pain
• Fracture that occurred with minimal trauma
• Low body weight
• Vitamin D deficiency
• Low calcium intake

Author

Dovie McVean, MS, PA-C Certified Physician Assistant, Orthopedic Surgery & Nutritionist