Tag Archives: Osteoporosis

What’s it going to take—a break?

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Keep osteoporosis at bay with exercise, calcium, vitamin D and other healthy habits. (Courtesy Spectrum Health Beat)

By Eve Clayton, Spectrum Health Beat


If someone asked you to name the silent disease that affects half of all adults age 50 and older, what would you say?


Would you say osteoporosis?


That’s the answer we’re looking for. But not many people—doctors or patients—give the bone-weakening disease the attention it deserves, according to Jodi Hamblin, MD, a bone health specialist.


“Osteoporosis is a lethal disease that is frequently ignored,” Dr. Hamblin said, explaining that the disease signals a problem with both the quantity and the quality of bone.


In the United States alone, half of adults age 50 and older either already have osteoporosis or are well on their way to developing it.

Silent and overlooked

The trouble is, osteoporosis doesn’t have symptoms, so most people don’t know they have it until they break a bone.


And even then, many patients don’t realize that osteoporosis was the cause of their fracture—when in fact, a low-trauma fracture almost always indicates osteoporosis in older adults.


“After 50, if you fall from a standing position and you break a bone, excluding your hands and feet, then you have osteoporosis,” Dr. Hamblin said. This type of break is called a fragility fracture.


Osteoporosis can also be diagnosed when a bone density test reports low bone density.

Research suggests doctors and patients tend to overlook the threat of osteoporosis.


According to a 2016 study by Northwell Health in New York, more than two-thirds of patients who suffered a hip fracture said their doctors didn’t tell them they have osteoporosis, and more than half said they weren’t given medication to treat osteoporosis after their fracture was treated.


This lack of information and follow-up is a huge problem, the study’s senior author said, because of the seriousness of hip fractures.


“You can die after a hip fracture, and you’re at great risk of prolonged complications,” said author Gisele Wolf-Klein, MD, in a statement. “You can also be left as an invalid—a fear of many older adults.”


Six months after suffering a hip fracture, only 15 percent of patients can walk across a room without help, according to the National Osteoporosis Foundation.

Getting on top of the problem

Bringing more attention to the prevention and treatment of osteoporosis is the goal, said Dr. Hamblin.


By following up after a break and treating the cause of the bone loss or poor bone quality, doctors can help prevent future fractures.


Patients are more likely to sustain a secondary fracture if they are not treated for their osteoporosis, Dr. Hamblin said.


High-risk patients include:

  • Heart and lung transplant patients, who are at risk because the anti-rejection medications they take are bone weakening
  • Breast cancer patients, who are on estrogen-preventing medications that can cause bone loss
  • Gastric bypass surgery patients, who typically have bad absorption of nutrients so don’t get sufficient calcium and vitamin D—two essential nutrients for bone health
  • Cystic fibrosis patients
  • End-stage COPD patients

The care plan includes balance testing, nutritional counseling, bone density testing, blood and urine testing to identify risk factors, and medication review and management.

“Sometimes medications taken for other conditions can get in the way of calcium absorption or directly weaken the bone or even contribute to dizziness,” which can increase a patient’s risk of falling, Dr. Hamblin said.


Physical therapy can help people learn how to build bone through exercise and how to prevent falls, which are responsible for 90 percent of hip fractures.


“Fall prevention is half the battle,” Dr. Hamblin said. “If you have weak bones and you don’t fall, you may never break.”

Osteoporosis risk factors

In addition to the medical issues listed above, several other factors can put you at risk for bone loss and poor bone strength. Risk factors include:

  • Advanced age—this applies to both women and men, though the incidence of osteoporosis is higher in aging women because of a drop in hormone levels
  • Diabetes
  • Steroid use (5 or more milligrams a day for three months or longer)—this lowers bone quality in men and women equally
  • Overactive thyroid or parathyroid activity
  • Cigarette smoking
  • Regularly drinking more than two alcoholic beverages a day
  • Lack of appropriate exercise
  • Low calcium intake
  • Vitamin D, vitamin B12 or folic acid deficiency

“There’s an extensive list of causes for bone loss and for poor bone quality,” said Dr. Hamblin. “If we can get those conditions in order, sometimes that’s all we have to do.”


When medications are called for, doctors have a variety of options based on the patient’s situation. For example, some patients need medications that help build new bone, while others need medications to prevent bone loss.


The aim is to decrease the risk of fracture by keeping bone loss in check and by limiting the risk factors for poor bone quality.

A preventable disease

Of course, prevention is the best course of action, and osteoporosis is very preventable, Dr. Hamblin said.


“If we could get kids and young adults to improve their dietary calcium intake and have a good exercise program, that would be huge,” she said. “And if we could eliminate smoking and excessive use of alcohol, that would make all the difference for most people.”


Reprinted with permission from Spectrum Health Beat.


The hidden fallout of stroke

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Pay attention to bone health, particularly if you have limited mobility. (Courtesy Spectrum Health Beat)

By Robert Preidt, HealthDay


Stroke survivors often face limited mobility, which quadruples their odds of osteoporosis, broken bones and falls. But most are never screened for these problems, new research reveals.


“Our study adds to previous research that found despite an increased risk, only a small number of people who have recently had a stroke are tested and treated for osteoporosis,” said lead author Dr. Moira Kapral. She is director of general internal medicine at the University of Toronto.


Impaired mobility can result in bone mineral density decline, which is associated with osteoporosis. The condition weakens bones and increases risk of fractures.


In this study, researchers looked at more than 16,500 Canadian stroke survivors, aged 65 and older, from Ontario.


Of these patients, only 5% had undergone bone mineral density testing, 15.5% had been prescribed medications for osteoporosis within the year after their stroke and only a small percentage were prescribed medications for osteoporosis for the first time.


Patients most likely to have bone mineral density testing tended to be younger, female and to have had low-trauma fractures in the year after their stroke.


Patients were more likely to be prescribed medications for osteoporosis after their stroke if they were female, already had the bone-thinning disease, had previously broken bones, had previous bone mineral density testing, or had fallen or broke bones after their stroke.


The study was published recently in the journal Stroke.


“This study offers more evidence that there is a missed opportunity to identify people with stroke at increased risk of fractures and to initiate treatment to prevent bone loss and fractures,” Kapral said in a journal news release.


Less than one-third of older U.S. women are screened for osteoporosis.


The maximum treatment rate for some high-risk patients is about 30%, the researchers pointed out.


Reprinted with permission from Spectrum Health Beat.


Maintain your bone health

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Don’t forget to give your skeleton what it needs to carry you safely through life. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


One in 3 women and 1 in 5 men older than 50 will experience an osteoporosis-related fracture.


Hip fractures often require surgery and may lead to loss of independence, and vertebral fractures lead to loss of height, pain, nerve compression, and sometimes deformity.

A bit about bones

Our bones are constantly remodeling, with steady building and breakdown, and we reach a peak bone mass in our late 20s.


After our peak, we lose a bit more each year than we build, and when the bones get to be too porous and weak, we are at risk for a fragility fracture, or a break that occurs with minimal trauma such as stepping wrong off a curb or a low-impact fall.


Osteoporosis is the condition when the bones are thin enough to increase risk of fracture to the point that treatment might be indicated, and our goal is to keep osteoporosis from happening.


Osteoporosis is a silent disease, and has no symptoms. The good news is osteoporosis can be prevented, and also predicted if you know the risks.


The basic concept is we want to support our bone-building cells by supplying adequate calcium in our diet. This includes four servings of dairy or leafy greens, adequate vitamin D to allow for calcium absorption (about 2000 IU per day for most adults), and enough weight-bearing activity to let the bones know they are needed. Research shows we need approximately 20 minutes of weight-bearing activity per day.

Midlife wellness

As a busy obstetrician and gynecologist, I should have been thinking about my patient’s bone health way more than I did, but it was not on my radar for those years of delivering babies.


As I started to care more for women approaching midlife and thinking about how I could support wellness, I started asking my patients about risk factors.


I soon met with an internal medicine physician who is passionate about bone health and supports our patients on how to avoid fracture and disability. He taught me about prevention, diagnosis and treatment options.


Also at that time, I had a patient who underwent a bone scan and, when I called her with the bad news that she had osteoporosis, she felt absolutely floored. How could she, a healthy 52-year-old, have osteoporosis?


We went through the risk factors, and she probably never took enough D like the rest of us, avoided dairy due to lactose intolerance, was active but perhaps not enough, and occasionally took oral steroids for asthma.


She decided to start hormone replacement therapy for her menopause symptoms, which is also indicated for prevention of osteoporosis as it supports the good bone she still had. She also became serious about vitamin D and calcium supplements, and exercised every day or at least did her 50 jumps.


A followup scan three years later showed stable bones. Further, her fitness regimen had improved her balance so she was less likely to fall. Thank goodness we found her osteoporosis before she had a fracture.

Supporting your skeleton

We support bone health by knowing what risk factors to avoid. If we have other health conditions that put our bones at risk, we should be aware of the issues and do what we can to make up for the risk.


Lifestyle risk factors for osteoporosis include more than two alcohol drinks per day, cigarette smoking, inactivity, low body weight, and inadequate calcium and vitamin D.


Genetic factors for osteoporosis include family history and conditions such as cystic fibrosis and other metabolic conditions. Hormone conditions— such as menopause, especially if premature, diabetes, Cushing disease and parathyroid dysfunction—are also factors.


Medical conditions such as anorexia and bulimia also put people at risk, as well as celiac disease, epilepsy, rheumatoid arthritis, gastric bypass surgery and lupus. Many cancers also put people at risk for accelerated bone loss such as multiple myeloma, treatments for breast cancer, and medication use to include oral steroids, antacids and anti-seizure medication.


The good news is, if we look, we can get information in time to act and help slow or prevent bone loss. The results from a scan, together with risk factors, help us make recommendations for potential treatment.


Reprinted with permission from Spectrum Health Beat.