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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.

What’s the Difference Between Osteoporosis and Osteoarthritis?

Many people mistake osteoporosis with osteoarthritis, but they are quite different. The bone loss associated with osteoporosis doesn’t cause pain. There are typically no symptoms whatsoever until a bone fracture occurs.

In contrast, osteoarthritis is a painful condition due to inflammation in the joints, not the bones themselves. In some cases, osteoarthritis is caused by the deterioration in cartilage within a joint. However, autoimmune diseases and infections can also cause osteoarthritis. This condition causes not only pain but also swelling and decreased range of motion in the affected joint.

Are You at Risk for Developing Osteoporosis?

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. The good news is that most of the risk factors for developing osteoporosis can be avoided or corrected. These factors include:

· Sedentary lifestyle

· Drinking too much alcohol

· Smoking

· Unhealthy diet without enough nutrients

· Not getting enough sleep

· Being underweight

· Being overweight

· Being in menopause without using hormone replacement therapy

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

If you’re wondering what your risk of developing osteoporosis is, you can use this risk calculator to get a general idea.

How is Osteoporosis Diagnosed?

The conventional way to diagnose osteoporosis is by measuring bone density with a DEXA (dual energy X-ray absorptiometry) scan. The simple, quick, and painless procedure is basically a sophisticated xray. The patient lays on a table while an x-ray scanner passes over their body.

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 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 Are the Treatment Options for 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.

Bisphosphonate Drugs

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 results are long lasting if the drug is continued. IV therapy takes effect much more quickly than the oral preparations. They are 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 are Calcitonin, Parathyroid Hormone, and Antibodies (i.e. Prolia).

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