OSTEOPOROSIS
Being diagnosed with osteoporosis — or its precursor, osteopenia — can be both stressful and anxiety-inducing, leaving patients questioning what to do next. Within this blog we will discuss diagnosis, possible causes, and both medical and lifestyle interventions to resolve some of the mystery around “the silent disease.”
What is Osteoporosis?
Osteoporosis is a term used to describe a decrease in bone mineral density and bone mass. Osteopenia, its precursor, is a disease that describes the same process to a lesser degree. Both are very commonly diagnosed and affect over 50 million people in the United States alone.
What Are Symptoms of Osteoporosis?
Osteoporosis is commonly described as “the silent disease” as many patients go years without knowing about their diagnosis. Osteoporosis in and of itself has no symptoms, but it can increase your risk of other diagnoses including hip fracture, wrist fracture, and compression fractures of the spine. Loss in height, pain, and a hunched posture may all be symptoms of these sequelae. For this reason, osteoporosis is often a disease diagnosed after a patient sustains a fracture. However, early screening and treatment can help prevent fractures and lead to a healthier future.
How is Osteoporosis Diagnosed?
The gold standard for diagnosing Osteoporosis is a Dual-Energy X-ray Absorption scan, also known as a DEXA scan. It is a painless, quick imaging device that uses X-rays to determine and average the density of your bone in key areas of the body including the hips, spine, and sometimes the forearm (in cases where patients have prosthetic hips.) Using the scan, a radiologist will generate what is known as a t-score. The t-score determines how significantly your bone density compares to the average healthy individual and is measured in standard deviations. Below is a chart for interpreting your t-score:
t-score Diagnosis
Greater than -1 Normal
-1 to -2.5 Osteopenia
Less than -2.5 Osteoporosis
In some cases, a radiologist will also use what is called a z-score to determine your diagnosis. These scores are interpreted the same way but are used to compare your bone density compared to those with the same age and sex. For premenopausal women and men younger than 50, the z-score is a more accurate indicator of disease.
Based on all this information, we can use what is called a Fracture Risk Assessment Tool also known as a FRAX, to determine your risk for major osteoporotic fracture of the hip, spine, wrist, or shoulder. The FRAX score is an incredibly helpful tool that takes into account factors including sex, age, height, weight, family history, and lifestyle to determine your risk. In addition to giving you peace of mind, the FRAX score is also beneficial for medical professionals to decide if patients require treatment.
In addition to a DEXA scan, your medical provider will also order some lab work to assess possible secondary causes of osteoporosis including other underlying diseases or nutrient deficiency.
Why Do I Have Osteoporosis?
Osteoporosis occurs when your body loses its ability to effectively find balance between building new bone and absorbing old bone leading to bones lacking structure and integrity. There are many components that can ultimately lead to this scenario. As with many other diseases, genetics plays a substantial role in osteoporosis predisposition. In some cases, having a parent with osteoporosis can raise your risk of developing the same condition by as much as 50%. Sex can also play a substantial role in developing osteoporosis with 80% of those being affected are female. This occurs due to oestrogen (also known as estrogen), an essential hormone affecting bone density which depletes in postmenopausal women. Lifestyle choices, such as smoking tobacco products, consumption of alcohol, and diet as well as a sedentary lifestyle can also contribute to a weakening of the bones structure. Osteoporosis may also be induced by medications such as blood thinners, steroids, cancer drugs, and thyroid hormones showing a strong correlation with decreasing bone density. Additionally, other medical diagnoses such as diabetes, lupus, hyperthyroidism, celiac disease, rheumatoid arthritis, and multiple sclerosis have all shown to increase risk for osteoporosis.
Now that we have discussed the basics of symptoms, causes, and diagnosis, let's get down to addressing the important question: What next?
Lifestyle Changes
Cutting back or completely quitting smoking may be one of the best things you can do to improve your overall health. Treatment of Osteoporosis is no different. Smoking can cause oxidative stress and inflammation that in turn, can alter osteoclast (bone-resorbing cells) and osteoblast (bone forming cells) activity causing increase in bone loss.
Alcohol consumption also has a negative effect on bone health causing impairment on the endocrine system further leading to a lack in bone density. Limiting alcohol consumption has been shown to positively affect overall bone health.
Diet is another vital component of managing bone health specifically pertaining to foods rich in calcium, vitamin D, and vitamin K. Calcium, being the core building block for bones, may be found in foods such as dairy products, kale, broccoli, and calcium-fortified foods like cereals and tofu. Vitamin D aids in proper absorption of calcium and can be supplemented in your diet by consuming fish (specifically salmon, tuna, and swordfish), egg yolk and vitamin D fortified juices. Magnesium and potassium along with Vitamins C, K, and A also play a role in maintaining bone health and may be supplemented by consuming four servings of fruits and vegetables daily.
In addition to diet, over the counter supplements may be found at your local drug store to help improve deficits in these essential nutrients. If you have concerns regarding appropriate dosing for calcium or vitamins, please discuss this with a healthcare professional.
Conversely, excess salt can increase excretion of calcium and should be limited due to its negative effect on bone health. Processed foods have also shown to have a negative effect on bone density due to the presence of phosphorus which can decrease calcium absorption in the intestines.
Exercise is another early intervention that may be utilized to promote healthy bones. Increasing activity reduces the rate of bone loss and helps conserve healthy bone tissue. Specifically, weight bearing exercises, which force the body to work against gravity, are important to implement as they result in strengthening the bones. Examples include yoga, hiking, stair climbing and tai chi. Balance training may be implemented to reduce risk of falling that may ultimately lead to fragility fractures.
Prescribed Medications
Over the last 50 years, healthcare professionals have been prescribing medications to appropriately treat Osteoporosis. Finding the appropriate medication can be determined by assessing lifestyle and severity of disease. Rest assured, Ortho RI has a group of specialized providers referred to as the bone health clinic, that is willing to find the most appropriate treatment for you. If you have any questions about any of the information included in this blog or would like to set up an appointment with our bone health clinic regarding prescribed medications, please discuss a referral with your current medical provider or call our main phone number (401) 777-7000.
Please note that the information included in this blog is for informational purposes and should not be utilized alone for comprehensive treatment of osteoporosis.
