Osteoporosis, thin weak bones, is common in post-menopausal women and older men. While not fatal, it is a major risk for fractures and can severely impact your quality of life.
Estrogen in women and testosterone in men are needed to maintain healthy bones and the biggest risk factor for developing osteoporosis is aging. The precipitous drop in estrogen levels in women who go through “the change” accelerates bone loss, and some 80% of those with osteoporosis are female.
Other factors increasing your risk are smoking, alcohol consumption, poor intake of calcium and vitamin D, lack of weight-bearing exercise, taking cortisone-type drugs and being thin. (One of the few health benefits of obesity is that you are less likely to get osteoporosis.)
How do you know if you have it? Osteoporosis is a “silent disease,” with no symptoms until it is advanced, and may first be discovered when you suffer a fracture.
The best way to find it before a fracture is to have a modified X-ray called a DEXA scan, which measures the density of your bones at the hip, spine and/or wrist. This gives you two numbers, a T-score, which compares your bones to those of a young healthy adult, and a Z-score, which compares you to an average person of your age.
If your T-score is: (note that these numbers are a consensus, not “truth.”)
• –1 or higher, your bone is healthy.
• –1 to –2.5, you have osteopenia, a less severe form of low bone mineral density than osteoporosis.
• –2.5 or lower, you might have osteoporosis.
The risk of broken bones increases by 1.5 to 2 times with each 1-point drop in the T-score.
A DEXA should be done when a woman is 65, a man 75, unless they have many risk factors for osteoporosis. While there is no hard rule, it should be repeated in about 2 years. If the results are stable, you can probably wait 5 years before a third.
If you want a precise estimate of your risk of fractures, google “FRAX Score.” The first link that shows up (https://frax.shef.ac.uk/FRAX/tool.aspx?country=9) will take you to the validated tool developed at the University of Sheffield in England. In addition to your T score, it asks for information such as age, height and weight and will then tell you your risk of a major fracture in the coming decade.
How can you prevent osteoporosis? Don’t smoke; don’t drink much alcohol; do resistance exercise (weights); get adequate calcium in your diet (dairy, leafy greens, almonds) and get adequate Vitamin D. Note that dietary calcium is better than pills. We get D from sun exposure and fortified milk.
Since few adults are big milk drinkers, and most of us do not spend all day outdoors soaking up sun, a vitamin D supplement is a good idea, and the amount in a multivitamin is probably adequate for most.
If you are at high fracture risk, many different medicines are available that have been shown to reduce the likelihood of fractures – but are not a guarantee. The best-studied are the “bisphosphonates,” taken as a weekly or monthly pill, but there are many other classes of drugs highly marketed. All these remedies have the potential for serious side-effects, so the decision to start requires a careful dialog with your doctor.
There is also good evidence that taking a bisphosphonate for a couple of years and then stopping is a better idea than taking it forever.
Remember: prevention is better than treatment, so start early. The bones you preserve will be the ones to keep you upright and moving.
Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.
What Does The Doctor Say?
By Dr. Edward Hoffer
