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  • Writer's picturereshma khan

Osteoporosis- ‘The silent disease’

Our bones provide structure for our body and protection for the organs. They also provide storage for minerals, such as calcium and phosphorus, that are essential for bone development and stability. We continue to build our bone until about 30 years of age and after that we begin to lose bone mass steadily. However, this is highly dependent upon genetics and other factors such as nutrition, exercise, and certain diseases and/or medications. The eighteenth-century English surgeon John Hunter discovered that as new bone is laid down in the body, old bone is destroyed, or reabsorbed. This process is now known as remodeling and was later shown to play a critical role in osteoporosis. Throughout life, bones are remodeled, meaning that they are continuously reabsorbed by osteoclasts and replaced with new bone made by osteoblasts. This process allows for maintenance of mechanical strength and repair. An imbalance in remodeling activity in which resorption exceeds formation may result in osteoporosis.

Approximately 10 million men and women in the U.S. have osteoporosis. Osteoporosis is a disease that makes your bones weak and increases the risk of fractures. Osteoporosis-related fractures can increase pain, disability, nursing home placement, total health care costs, and mortality. That is why it is very important to prevent and treat osteoporosis. The diagnosis of osteoporosis is primarily determined by measuring bone mineral density (BMD) using noninvasive dual-energy x-ray absorptiometry commonly know as ‘DEXA’.

Osteoporosis does not cause symptoms until you break a bone. The prevalence of osteoporosis is projected to rise in the United States from approximately 10 million people to more than 14 million people by 2020. Although osteoporosis is typically associated with women, it is also diagnosed in men. One in five Americans who have osteoporosis or low BMD is men. In 2015, direct medical costs totaled $637.5 million for fatal fall injuries and $31.3 billion for nonfatal fall injuries. During the same year, hospitalizations cost an average of $30,550 per fall admission, totaling $17.8 billion. By 2025, the cost of fractures in the United States is expected to exceed $25 billion each year to treat more than three million predicted fractures. Management of osteoporosis and its associated consequences is necessary to improve quality of life and reduce economic burden on our health care system. It also helps to decrease medical visits, hospitalizations, and nursing home admission.

Osteoporosis has two types, primary and secondary. Primary osteoporosis is often associated with age and sex hormone deficiency. Age-related osteoporosis results from the continuous deterioration of bone. The reduction of estrogen production in post-menopausal women causes a significant increase in bone loss. Secondary osteoporosis is caused by several medical conditions and/or medications. Glucocorticoids(steroids) are considered the most common medications linked to drug-induced osteoporosis. Many inflammatory diseases, such as rheumatoid arthritis, may require the patient to be on long-term glucocorticoid therapy and have been associated with secondary osteoporosis. If you are taking steroids for any medical condition, talk to your rheumatologist about how you can prevent and treat steroid induced osteoporosis. Your rheumatologist may also want to do blood work to look for various causes for secondary osteoporosis.

In general, most organizations recommend that all adults older than 50 years of age with a history of fracture or risk factors should receive osteoporosis screening. All women 65 years of age and older and men 70 years of age and older should be screened regardless of their risk factors. Ask your doctor if you should be tested.

These are some of the things you can do to keep your bones as healthy as you can.

  • Eat food with a lot of calcium like milk, soy milk, yogurt, orange juice, tofu with calcium, cheese (hard cheese= higher calcium), beans, dark leafy vegetables, almonds.

  • Eat food with a lot of vitamin D, such as milk that has vitamin D added and fish from the ocean.

  • Take calcium and vitamin D pills if you do not get enough from your daily diet

  • Be active and incorporate weight bearing exercises in your daily routine

  • Avoid smoking

  • Limit alcohol intake

  • Implement fall prevention techniques such as, make sure all your rugs have no-slip backing, tuck away all your electrical cords, light all walkways, have your eyes checked, check all your medicines for side effects like dizziness.

The Institute of Medicine (IOM) recommends that dietary calcium intake should be limited to 1,000 mg daily for men 50 to 70 years of age and to 1,200 mg daily for women 51 years of age and older and for men 71 years of age and older. Published literature on calcium and the risk of developing kidney stones is controversial, so it is important to differentiate the effects of dietary calcium and supplemental calcium from vitamins. High intake of calcium from supplements may increase the risk of kidney stones; however, high intake of dietary calcium may protect against kidney stones. Therefore, it is recommended that dietary calcium intake be increased first before initiating calcium supplements to meet calcium requirements.

I am also frequently asked if taking calcium supplement will increase their risk of having heart disease. The relationship between calcium intake and cardio vascular risk is also debated. Studies funded by the National Osteoporotic Foundation and the American Society of Preventive Cardiology concluded that dietary and supplemental calcium intake that does not exceed the upper limit recommended by the IOM doe not pose cardiovascular risk.

The goal of pharmacological therapy is to reduce the risk of fractures. Medications to treat osteoporosis are categorized as either antiresorptive (i.e., bisphosphonates, estrogen agonist/ antagonists [EAAs], estrogens, calcitonin, and denosumab) or anabolic (i.e., teriparatide, abaloparatide). Antiresorptive medications primarily decrease the rate of bone resorption while anabolic medications increase bone formation more than bone resorption. Talk to your rheumatologist to see what is the best option for you.

My patients always ask me if there are any side effects of these medications. I always tell them that like every other medication, osteoporotic medications also have side effects however your risk of having osteoporotic fracture is much higher than your chance of experiencing major side effects from these medications. Please talk to your rheumatologist about your treatment options.

Egyptian mummies from 4,000 years ago have been found with the telltale dowager’s hump with evidence of osteoporosis. Most of us today can expect to spend our old age standing as straight and tall as we ever were, thanks to recent dramatic improvements in the diagnosis, prevention, and treatment of osteoporosis.
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