Osteoporosis

Introduction:

Dr. Sanjay Godhwani completed medical training in Internal Medicine/Pediatrics and fellowship in Rheumatology from Stony Brook University Medical Center. Dr. Godhwani delivers compassionate care, education, and counseling for patients that suffer from osteoporosis. This is a silent disease which occurs when there is a change in the normal balance of hormones, especially in post-menopausal women, which leads to severely low bone mass. This can cause hip, vertebral and wrist fractures. Osteoporosis and osteopenia (low bone mass) can also occur in men. Some risk factors include a previous fracture, smoking, alcohol consumption, various medications (steroids/prednisone) and rheumatoid arthritis. Dr. Godhwani offers treatments to prevent osteoporosis related fractures and complications while delivering individual care plans for his patients.

Osteoporosis

Osteoporosis is a silent skeletal disorder which results from a loss of bone mass which affects men and women. The change in the structure of bones causes weakness and results in an increased risk of fracture. The most common fractures occur in the spine, wrist, and hip. Spine and hip fractures, in particular, may lead to chronic (long-term) pain and disability, and even death. Fortunately, you can take steps to reduce your risk of osteoporosis and avoid the often-disabling broken bones (fractures) that can result from this condition. If you already have osteoporosis, new medications are available to slow or even stop the bones from getting weaker. These medicines also can decrease the chance of having a fracture.

What causes osteoporosis?

Osteoporosis results from a loss of bone mass (measured as bone density) and from a change in bone structure. Many factors will raise your risk of developing osteoporosis and breaking a bone. You can change some of these risk factors, but not others. Recognizing your risk factors is important so you can take steps to prevent this condition or treat it before it becomes worse.

Major risk factors that you cannot change include:

  • Older age (starting in the mid-30s but more likely with advancing age)
  • Non-Hispanic white or Asian ethnic background
  • Small bone structure
  • Family history of osteoporosis or an osteoporosis-related fracture in a parent or sibling
  • Prior fracture due to a low-level injury, particularly after age 50

Risk factors that you may be able to change include:

  • Low levels of sex hormone, mainly estrogen in women (e.g., menopause)
  • The eating disorders anorexia nervosa and bulimia
  • Cigarette smoking
  • Alcohol abuse
  • Low calcium and vitamin D, from low intake in your diet or inadequate absorption in your gut
  • Sedentary (inactive) lifestyle or immobility
  • Certain medications, including the following:
  • glucocorticoid medications (also called corticosteroids), such as prednisone (brand names: Deltasone, Orasone, etc.) or prednisolone (Prelone)
  • excess thyroid hormone replacement in those taking medications for low thyroid or hypothyroidism
  • heparin, a commonly-used blood thinner
  • some treatments that deplete sex hormones, such as anastrozole (Arimidex) and letrozole (Femara) to treat breast cancer or leuprorelin (Lupron) to treat prostate cancer and other health problems
  • Diseases that can affect bones
  • endocrine (hormone) diseases (hyperthyroidism, hyperparathyroidism, Cushing’s disease, etc.)
  • inflammatory arthritis (rheumatoid arthritisankylosing spondylitis, etc.)

What is Osteoporosis?

Osteoporosis is more common in older women, mainly non-Hispanic white and Asian women. Yet it can occur at any age, in men as well as women, and in all ethnic groups. People over age 50 are at greatest risk of developing osteoporosis and having related fractures. Over age 50, one in two women and one in six men will suffer an osteoporosis-related fracture at some point in their lives. In the U.S., about 4.5 million women and 0.8 million men over the age of 50 have osteoporosis, according to 2005–06 data. These figures are lower than older estimates, suggesting that osteoporosis is decreasing in the population. This is consistent with recent trends seen in decreasing

However, another 22.7 million women and 11.8 million men over age 50 have low bone mass (known as osteopenia). People with low bone mass are also at higher risk of fractures, but it is not as high as for people with osteoporosis. If bone loss continues, people with osteopenia can become osteoporotic

How is osteoporosis diagnosed?

You can learn if you have osteoporosis by having a simple test that measures bone mineral density—sometimes called BMD. Dual energy X-ray absorptiometry (DEXA) is the best current test to measure BMD.

The test is quick and painless. It is similar to an X-ray but uses much less radiation. Even so, pregnant women should not have this test, to avoid any risk of harming the fetus. DXA test results are scored compared with the BMD of young, healthy people.

What's your T-Score?

Treatment:

If you have osteoporosis, your health care provider will advise the following:

Calcium. Make sure you are getting enough calcium in your diet or you might need to consider taking supplements. The National Osteoporosis Foundation recommends 1,000 milligrams (shortened as mg) per day for most adults and 1,200 mg per day for women over age 50 or men over age 70.

Vitamin D. Get adequate amounts of vitamin D, which is important to help your body absorb calcium from foods you eat. The recommended daily dose is 400–800 International Units (called IU) for adults younger than age 50, and 800–1,000 IU for those age 50 and older. (These are the current guidelines from the National Osteoporosis Foundation.) You may need a different dose depending on your blood level of vitamin D.

Physical activity. Get exercise most days, especially weight-bearing exercise, such as walking.

Some people also will need medication. A number of medications are available for the prevention and/or treatment (“management”) of osteoporosis.

Bisphosphonates a class of antiresorptive drugs approved by the FDA for the management of osteoporosis. They are taken orally or intravenously and have been shown to slow down bone loss and decrease risk for fracture. They are various side effects of orally taken medication and they often have to be taken on an empty stomach with plenty of water. They may cause irritation to the esophagus and you have to remain upright for at least an hour after taking the medications. There have been rare side effects that are linked to bisphosphonates such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures.

Other medications include Teriparatide (Forteo), Denosumab (Prolia), Calcitonin, Estrogen or hormone replacement therapy, Selective estrogen receptor modulators and others are available for management of osteoporosis.

Prevention:

Lifestyle changes may be the best way of preventing osteoporosis. Here are some tips:

  • Make sure you get enough calcium in your diet or through supplements (roughly 1,000–1,200 mg/day, but will depend on your age).
  • Get enough vitamin D (400–1,000 IU/day, depending on your age and your blood level of vitamin D measured by your doctor).
  • Stop smoking.
  • Avoid excess alcohol intake: no more than two or three drinks a day.
  • Be physically active and do weight-bearing exercises, like walking, most days each week.  Aim for at least 2½ hours a week (30 minutes a day five times a week or 50 minutes a day three times a week), or as much as you can. Exercises that can improve balance, such as Tai Chi or yoga, may help prevent falls.
  • Change lifestyle choices that raise your risk of osteoporosis.
  • Implement strategies to help decrease your risk of falling.

You also should get treatment of any underlying medical problem that can cause osteoporosis.  If you are on a medication that can cause osteoporosis, ask your doctor if you can lower the dose or take another type of medicine.  Never change the dose or stop taking any medicine without speaking to your doctor first.

If you have low bone density and a high risk of breaking a bone, your doctor may suggest medicine to prevent your bones from getting weaker. Health care providers now have a tool for estimating the risk of a patient’s having an osteoporotic fracture in the next 10 years call the fracture risk assessment tool (FRAX). It was developed by the World Health Organization, and the score can help guide treatment decisions.

As doctors who are experts in diagnosing and treating diseases of the joints, muscles, and bones, rheumatologists can help find the cause of osteoporosis. They can provide and monitor the best treatments for this condition.

The most serious health consequence of osteoporosis is a fracture. Spine and hip fractures especially may lead to chronic pain, long-term disability, and even death.

The main goal of treating osteoporosis is to prevent fractures. If you have osteoporosis, it is important to help prevent not just further bone loss but also a fracture.

Here are some ways to decrease your chance of falls:

  • Use a walking aid. If you are unsteady, use a cane or walker.
  • Remove hazards in the home. Remove throw rugs. Also, remove or secure loose wires or cables that may make you trip. Add night lights in the hallways leading to the bathroom. Install grab bars in the bathroom and non-skid mats near sinks and the tub.
  • Get help carrying or lifting heavy items. If you are not careful, you could fall, or even suffer a spine fracture without falling.
  • Wear sturdy shoes with soles that grip. This is above all true in winter or when it rains.

For more information:

National Osteoporosis Foundation – www.nof.org

International Osteoporosis Foundation – www.iofbonehealth.org