By Dr. Shani Saks
Osteoporosis is a common disorder in which the insides of the bones lose their density and the outside of the bones become thinner. This is a natural process of aging, since after age 35 years of age, bone is degraded faster than it is produced. People with osteoporosis are at increased risk of bone fractures, most commonly affecting the hip, spine, and wrist. Over 50 million women and men in the United States have osteoporosis, which can be silent, with no warning symptoms until a bone fracture occurs. Sometimes however, there are symptoms of osteoporosis, which include decrease in height of one inch or more, stooped posture, or low back pain (www.my.clevelandclinic.org). Another 44 million people have osteopenia, a condition of low bone density that predisposes them to developing osteoporosis.
Risk factors for developing osteoporosis include post-menopausal status, female gender, being of Caucasian or Asian descent, age above 50, family history of osteoporosis, sedentary lifestyle, and low calcium and vitamin D levels. Certain medications can increase the risk of developing osteoporosis, including steroids. Tobacco and alcohol use are also associated with development of osteoporosis. Some medical conditions are more commonly associated with osteoporosis, including rheumatoid arthritis and irritable bowel disease.
After age 50, one out of two women and one out of four men will have an osteoporosis-related fracture in their lifetime. These fractures result in significant pain, loss of mobility, loss of independence, and involve costly treatments to restore the patient to baseline functioning.
The ability to screen for osteoporosis and detect early cases of osteoporosis helps to minimize the severity of the disease and prevent incidence of fractures. When the patient is able to undergo preventative screening, lifestyle changes can be implemented proactively to minimize the degree of bone loss.
Regular X rays of the bones will only show advanced stages of osteoporosis. The test that is used to diagnose and screen for osteoporosis or osteopenia is called a bone mineral density test, such as a dualenergy X ray absorptiometry, also known as DEXA or DXA scan. This is a painless test involving a small amount of radiation that measures how dense the bone is in your hip, spine, or wrist. The DEXA scan report will tell you a T-score and a Z-score.
The T-score indicates your bone density compared to a young adult of your gender. T-scores of –1 or higher mean that your bone density is normal; T scores of –2.5 and lower indicate osteoporosis. A T-score between –1 and –2.5 indicate osteopenia, putting you at higher risk of eventually developing osteoporosis.
The Z-score is an age matched score for someone of your age and body habitus. A normal Z-score is 2.0 or higher.
Your primary care physician should review your DEXA scan results with you, and make recommendations for preserving your bone strength, with lifestyle and dietary changes, and possibly with medication as well.
Methods to prevent or minimize osteoporosis include dietary and lifestyle changes. Calcium is a vital mineral involved in bone production. The recommended daily calcium intake is 1,000 milligrams per day for women ages 19-50 years old and for men up to age 70. For women over age 50 and men over age 70 years old, the recommended daily intake is 1,200 milligrams per day. Pregnant or nursing women should have 1,000 milligrams per day, while pregnant or nursing teenagers require 1,300 milligrams of calcium per day. Sources of calcium include dairy products, broccoli, and calcium supplements.
Calcium absorption requires adequate vitamin D supplies. The recommended daily intake for vitamin D for the average adult is 800 international units (IU), and 600 IU if pregnant or nursing. Sources of vitamin D include exposure to sunlight, fortified milk, and dietary supplements.
There are screening tests for osteoporosis that help determine if DEXA testing should be done. These tests include peripheral quantitative computer tomography (pQCT).
The quantitative CT scan is a safe, painless test that uses low dose radiation to measure bone density, usually in the hip and spine. The amount of radiation you receive during this test is comparable to that of a mammogram. The qualitative CT scan provides 3D information about your bone density. In particular, this test is appropriate for patients that cannot have a DEXA scan, such as those with severe spinal stenosis, arthritis, or obesity. Patients with osteoporosis, those at risk for osteopenia, or patients who are receiving steroids are also candidates for qualitative CT scanning. People with small body size or who are tall are also good candidates for this test. Your primary care physician should discuss your CT scan results with you and make recommendations based on your risk of developing osteoporosis or severity of osteoporosis.
Medicare will cover a DEXA scan once in 24 months if you are a woman with osteoporosis, or are at risk for developing it, have signs of osteopenia, are taking steroids, have a medical condition called primary hyperparathyroidism, or need assessment of the effectiveness of your osteoporosis medications. Medicare insurance coverage for men is less inclusive but can be obtained by your primary care physician. Private insurance may also cover bone density tests for the conditions listed above, but it is best to check with your specific insurance carrier based on your medical history.
If you are diagnosed with osteoporosis, there are a number of medications that may be prescribed for you. These include the bisphosphonates, such as alendronate (Fosamax) and ibandronate (Boniva). These medications prevent the loss of bone density. Taking calcium and vitamin D supplements are also beneficial. Maintaining an active lifestyle with weight bearing exercise, including walking, running, and lifting light weights is also recommended.
Prevention of falls is also important if you have osteoporosis or osteopenia. Take care to have your home well lit, and minimize clutter, cords, or throw rugs that are tripping hazards. Wear rubber soled shoes to prevent slipping.
You should discuss your risk of osteoporosis and osteopenia with your primary care provider, and what medications or supplements would be best for your specific case. Leading a healthy and active lifestyle with proper nutrition and routine screening help you to be proactive and minimize future complications.