Diagnosis, Treatment and Prevention of Osteoporosis
Osteoporosis affects about 8 million women and 2 million men in the United States. Americans are now suffering from hip and spine fractures which is increasing morbidity and mortality in the hospital, skilled nursing facilities, and home.
Osteoporosis is defined as low bone mass and structural deterioration of the bone tissue. This leads to increased risk of bone fractures. See the diagram below.
How do you know if you or your loved one is at risk for osteoporosis?
An easy way is to look at the posture.
You need to take a look at other risk factors as well.
- Increasing age
- Low body weight, less than 127 lbs
- Personal history of fracture
- Family history of osteoporotic fracture
- Not using hormone therapy
- White or Asian race
- Excessive alcohol (greater than 2 drinks per day)
- Heavy caffeine use
- Tobacco use
- History of falls
- Low levels of physical activity
- Low calcium or vitamin D intake
- Use of certain medications or certain medical conditions (should be discussed with your primary care doctor)
Screening for osteoporosis should begin at 65 years for a healthy females, and 70 years for healthy males. Screening can begin at a younger age depending on the comorbidities and medications the patient is taking.
The exam that is recommended is a
central DEXA scan
. There are other imaging modalities that you can receive such as a peripheral DEXA scan and CT scan. CT scan is limited by radiation exposure and cost. The peripheral DEXA scan, which is seen most commonly at health fairs, is not useful to monitor treatment over time.
You need to see your primary care physician for an order for this DEXA scan. Then your local radiologist will perform the DEXA scan and give you a final read.
There are several treatment options for osteoporosis. The bisphosphonates, calcitonin, raloxifen, teriparatide, hormone therapy are to name a few. You should discuss these treatment options with your primary care doctor.
Now, you must be asking, “How can I prevent osteoporosis?” There are several lifestyle changes you can make so that you can prevent osteoporosis.
- Exercise- It is recommended that you perform about 30 minutes of exercise 5 times per week. These exercises should include weight bearing (about 5-10 pounds of lifting) and non weight bearing (such as swimming or biking).
- Diet- Food rich in vitamin D and calcium should be eaten everyday. Dairy products, orange juice, leafy greens, and fish will help with maintaining healthy bones. Also, refrain from high caffeine intake and more than 2 alcoholic beverages per day.
- Calcium supplements- Your calcium intake should be about 1,200 mg per day. Your doctor can write you a prescription for calcium supplements. Also, take your calcium supplements with meals because it can cause gastrointestinal upset and constipation
- Vitamin D supplements- You should be receiving 800 to 1000 IU (international units) of vitamin D per day. Again, please speak with your primary care physician for instructions on how to take vitamin D
- Fall prevention- You should inspect your house to see if there are any loose rugs or tight stairways that can increase falls. This is especially important in those patients who are older who are on multiple medications. These patients have a higher risk of falling, thus leading to a potential fracture.