ADC doctor Q&A: Bone health and osteoporosis

Around 10 million Americans have osteoporosis.

closeup of spine

Over 30 million people in America have low bone mass, which puts them at high risk for developing osteoporosis. Osteoporosis, which literally means “porous bones,” affects both men and women as they age. While it’s a largely preventable disease, there is no cure.

“A healthy lifestyle can keep your bones strong and prevent osteoporosis from developing,” says Michele McDermott, M.D., an endocrinologist and director of the Menopause and Osteoporosis Center at The Austin Diagnostic Clinic (ADC). “It’s a good idea to start thinking about prevention early, because building strong bones when you are younger is essential to having strong bones as you age.”

Question: What is osteoporosis?
Osteoporosis is a disease that causes your bones to become weak and brittle. When you have osteoporosis, sometimes even small movements like sneezing or bending over can cause bone fractures. According to the National Osteoporosis Foundation (NOF), osteoporosis is a major health threat to 55 percent of people age 50 and over. While it is often thought of as a disease that only affects women, about 20 percent of people who have osteoporosis are men.

Question: What are the symptoms of osteoporosis?
Because you can’t feel your bones weakening, many people with osteoporosis may not know they have it until they fracture a bone. Sometimes a stooped posture or back pain can be indicators of spinal fractures due to osteoporosis. There are few obvious symptoms of osteoporosis, so it’s important to see a doctor to determine if you are at risk for developing the disease.

Question: What are the risk factors for osteoporosis?
Women are four times more likely to develop osteoporosis than men, mostly because of hormonal changes during and after menopause.

“A few years before menopause, women begin to experience a drop in estrogen production,” says Dr. McDermott. “Loss of estrogen contributes to bone loss. Women can lose as much as 20 percent of their bone mass in the five to seven years after menopause.”

Age is also a risk factor for osteoporosis, as bones weaken as you age.

Other risk factors include

  • Smoking;
  • Living a sedentary lifestyle;
  • Drinking too much alcohol;
  • Taking certain medications. Medications such as the blood-thinner heparin, certain antidepressants, corticosteroids, and thyroid medications can contribute to low bone density.

All ethnicities are at risk for osteoporosis, but Caucasians and people of Asian descent are at the highest risk for the disease. If you have a family history of osteoporosis, you also have a higher risk for developing it. Another major risk factor in the development of osteoporosis is not getting enough calcium throughout your life, which contributes to low bone density.

Question: How is osteoporosis treated?
There are several prescription medications that are used to treat osteoporosis. These include bisphosphonates, which can reduce the risk of fracture, slow bone loss, and increase bone density. Drugs called selective estrogen receptor modulators (SERMs) can act like estrogen to help prevent bone loss. Calcitonin, a hormone that your body naturally produces, may also be taken to help slow bone loss for some patients. Hormone or estrogen replacement therapy may also help prevent osteoporosis in postmenopausal women, but this type of therapy is not recommended for everyone. Talk with your doctor about the risks and benefits of these treatments.

Medical research has made great advances in the area of osteoporosis treatments.  Two new medications have been recently approved.  Prolia has been approved for postmenopausal women at high risk for fracture,  is given by subcutaneous injection just twice per year.  A new oral medication, Atelvia, can be taken with food and is not associated with gastrointestinal side effects.  These treatments offer new options that may be safer and better tolerated for some patients with osteoporosis.

Question: How can you help prevent osteoporosis?
You can help prevent osteoporosis by living a healthy lifestyle: not smoking, eating well, staying fit and getting plenty of exercise. Exercise keeps your bones healthy, especially weight-bearing exercises like jogging, dancing, and hiking. It’s especially important for children to get plenty of exercise, as building strong bones during childhood helps to prevent osteoporosis later in life.

“The more bone mass you build up during your younger years, the less likely you are to develop osteoporosis,” says Dr. McDermott. “Start exercising early in life and continue as you age to keep your bones strong. Mix weight-bearing exercise with strength training to gain the most benefit.”

Getting enough calcium and vitamin D in your diet is also important for bone health. Don’t smoke, and limit alcohol consumption, as both can affect calcium absorption and increase bone loss.

Question: How is osteoporosis diagnosed?
“We now have advanced, non-invasive methods of osteoporosis screening available,” says Dr. McDermott. “Previously, evaluating bone density by X-ray did not reveal a problem until patients had lost 25 to 30 percent of their bone density. Now, we have bone densitometry to help us identify your risk for developing osteoporosis much earlier than we could with X-rays.”

Bone densitometry only takes minutes to measure your bone mass and is highly accurate.

“Any woman over age 40 that fractures a bone should have a bone density test,” advises Dr. McDermott. “Every woman should also have this type of screening when they reach menopause to determine if preventive treatment is necessary.”

Osteoporosis doesn’t have to be a part of getting older, even if you are at high risk for developing the disease. By staying healthy and focusing on prevention, you can help to keep yourself—and your bones—strong throughout your life.