Osteoporosis

Osteoporosis is a condition characterized by low bone mass and skeletal fragility. It is important to detect and treat as it increases the risk of bone fracture. Osteoporosis is a condition that largely affects postmenopausal women, although it can occur in some premenopausal women and in men. It is most common is postmenopausal women due to lower estrogen levels and increased age. Men tend to develop osteoporosis later in life. By age 80, 15% of women and 5% of men will have osteoporosis.

The decision to treat osteoporosis is based upon the results of a DEXA scan which compares an individual’s bone density to that of a young healthy adult population; it is expressed as a T score.

Osteopenia, or bone thinning, is defined by a T score of -1.0 to -2.4.

Osteoporosis is diagnosed by a T score of less than or equal to -2.5.

The World Health Organization introduced the FRAX index which is perhaps a more accurate means of diagnosing osteoporosis. It uses multiple factors such as age, weight, height, smoking status as well as the T score to calculate the ten year risk of a hip or other major osteoporotic fracture.

It is important to screen for this condition as there are no symptoms until an individual suffers a bone fracture. Unlike osteoarthritis, osteoporosis does not cause pain so the only way to know if it is present is by routine screening.

There are medications used to prevent bone fracture once osteoporosis has been diagnosed. However, as with many other medical conditions, prevention is crucial.

Some preventive recommendations:

-intake of 1200 mg of calcium daily. This can be achieved by diet, especially intake of dairy products, leafy green vegetables, beans and almonds, to name a few. You may take a calcium supplement if you feel it is needed. However, our bodies have uniquely evolved to extract the nutrients we need from food and drink.

-vitamin D- this is only helpful if calcium intake is adequate. In general 800 IU of vitamin D3 daily is sufficient. There is no need to take higher amounts unless your vitamin D level is low.

-exercise, such as walking (at least 3 times per week and ideally more). The more your bones are used to oppose gravity, the stronger they will be.

-smoking cessation if needed. Cigarette smoking accelerates bone loss.

-avoid excessive intake of alcoholic beverages to minimize risk of falls.

References:

1. Rosen, Harold, Overview of the Management of Osteoporosis in Postmenopausal Women, Up To Date, Updated June 13, 2022, accessed July 12,2022

2. Lewiecki, E. Michael, Prevention of Osteoporosis, Up To Date, updated Jan 25, 2021, accessed July 12, 2022

3. Effect of Exercise Training Programs on Bone Mass, Osteoporosis Institute, 199