Protecting Your Bone Health – Facts about Osteoporosis

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Osteoporosis is a serious, common health issue for men and women over age 50. One of two women and up to one in four men within this age group will break a bone due to osteoporosis. While osteoporosis is preventable and treatable if caught early, it can lead to extensive negative impact on quality of life -- even deadly consequences -- if untreated.

May is National Osteoporosis Awareness Month and your Capital Women’s Care team wants to share with you the importance of bone health to empower you to protect and maintain strong, healthy bones so you can live your best life.

Osteoporosis: Eye-Opening Facts & Numbers

  • Osteoporosis is treatable and preventable if caught during its early stages, but it can result in death if untreated. Each year in the U.S., approximately 300,000 hip fractures occur; about 75,000 of those experiencing hip fracture, or 25%, die within the following year.
  • Additionally, osteoporosis is responsible for about 2 million broken bones/year in the U.S. Yet nearly 80% of older Americans suffering bone breaks are not tested or treated for osteoporosis. Many suffer additional fractures, of which 50% could be avoided if treated.
  • Women are twice as likely to get osteoporosis as men. About 50% of women and 25% of men over age 50 break a bone during their remaining years. For women, this is equal to the risk of getting cancers of the breast, ovaries and uterus combined.
  • What’s more, osteoporosis can greatly impact quality of life. An additional 75,000 Americans with hip fracture move directly from the hospital into nursing home facilities, never returning to their home. The remaining 150,000 Americans never regain previous function and mobility.
  • Only 15% of those with hip fracture can walk unaided across a room six months afterwards.
  • And finally, osteoporosis is not a normal part of aging. The disease is preventable and treatable through diet, exercise, medical testing, specific medications to manage the condition and having a physician closely monitor additional prescribed medications for other health issues to avoid unnecessary risks to bone health.

What Is Osteoporosis?

Osteoporosis results in low bone mass and bone tissue deterioration, leading to bone fragility and increased fracture risks to hips, spinal vertebrae and wrists.

Our skeletal system has 206 bones. Bones are comprised of a strong collagen protein framework and calcium phosphate, a mineral which strengthens and hardens the outer framework. This makes bones strong, flexible and able to withstand stress. The body’s calcium store is 99% housed in bones and teeth, with the remaining 1% calcium within the blood.

The skeletal system provides structure to the body, provides framework for muscles and tendons to afford mobility, protects the organs and acts as a storehouse stockpiling essential minerals for the body’s systems. The minerals, mostly calcium, make it possible for:

  • the heart to beat
  • muscles to contract
  • nerves to conduct impulses
  • and other body processes.

To function properly, the body needs constant calcium levels within the bloodstream. If there is not enough calcium available for one system, it sends a request for more; if not enough calcium is in the bloodstream, it is extracted from bones. An occasional occurrence is not harmful; however, too many calcium withdrawals from bones can lead to osteoporosis and highly fragile bones that may break with little if any trauma.

Vitamin D is another important nutrient. The body uses vitamin D to absorb calcium from food. The body gets vitamin D when it is exposed to sunlight, fortified foods and/or supplements.

Throughout our lives, old bone is removed (bone resorption) and new bone is added to the skeletal system (bone formation.) From birth through teen years, bone formation outpaces bone resorption, resulting in larger, heavier and denser bones.

Peak bone mass – maximum bone density and strength -- is usually achieved in late 20s. Once peak bone mass occurs, bone resorption slowly begins to exceed bone formation. Osteoporosis is more likely to develop if optimal peak bone mass during bone-building years is not achieved.  

Osteoporosis develops when bone loss occurs too quickly or when bone formation occurs too slowly.

Greater Risk Factors

Some biological factors are strongly linked with weak bones and osteoporosis. You have greater risk of osteoporosis if you are:

  • Older age – especially over age 50. Mineral stores reserved in our bones that make them strong are lost during middle age. Some people lose stores more gradually than others. Those with bad health, weak bones and/or unhealthy nutrition are more susceptible to bone loss and fractures.
  • Female gender – especially in menopause. Women at menopause and beyond are also more susceptible to osteoporosis, as bone mineral loss speeds up due to dropping estrogen levels. Women experiencing early menopause or those having ovaries removed before menopause face higher risk for weakened bones and fractures.
  • Family history. Osteoporosis can be hereditary. There’s greater risk if one parent broke a bone as an adult.
  • Type 2 diabetes. Osteoporosis is more likely in adults with health issues involving hormone imbalances, which can contribute to weaker and more fragile bones.
  • Broken bones and/or height loss. Watch for noticeable height loss or bending forward, as spine vertebrae can fracture with no symptoms. There is greater chance of additional vertebral breakage after the initial occurrence. Risk for death goes up 15% in the six months following vertebral fracture.
  • Body type -- especially those with small and thin builds. Those with this body frame have less bone mass initially, low muscle mass, low circulating estrogen and less fat that may pad falls. Building muscle and bone mass through exercise and weight training is proven for improving bone strength of those having this body type.

If you respond yes to even just one of these factors, you have an increased risk of fragility fractures; if you answer yes to more than one factor, you should discuss getting screened for osteoporosis with your physician.

Minimize Osteoporosis Risk

Fortunately, there are several osteoporosis risks you can control:

Implement healthy eating habits to maximize bone health. Make sure your diet consists of calcium-rich foods, including cheese, yogurt, leafy greens and fortified cereals. Get some sunshine for vitamin D or ask your doctor about supplements. Other important nutrients important to bone health include magnesium, potassium, vitamin K among others to build and maintain a strong skeleton. These nutrients are found in fresh fruits and vegetables.

Recommendations for daily calcium and vitamin D amounts including both food and supplements: for women age 50 and younger: 1,000 mg calcium and 400-800 IU vitamin D daily. Women 50-plus: 1,200 mg calcium and 800-1,000 IU vitamin D daily. Get as much calcium from food sources as is possible.

Supplements are recommended for those with restricted diets, unhealthy eating habits or digestive issues interfering with nutrient absorption.

Get moving for strong bones. Bone relies on the push of gravity and pull of muscle to maintain strength. Lack of exercise causes alarming losses of bone mineral and muscle mass, especially for those over 50. Both weight-bearing and strength-training exercises help avoid these losses. Talk with your physician about a personalized exercise program.

Monitor alcohol intake. Heavy drinking makes bones weaker and more susceptible to breakage. Heavy drinking is 2-plus alcoholic beverages/day for women and three/day for men. One drink roughly equals 8-10 g. of alcohol: 10 oz. beer, 1.5 oz. liquor, or 3-4 oz. wine.

Practice safe, healthy weight loss. Fast weight loss is unhealthy, as it strips bones of calcium and important minerals, particularly if scrimping on nutrients or food intake, causing bones to become weaker and more likely to break. Proper weight loss can improve and strengthen bones when incorporated with weight-bearing and resistance exercise, healthy diet and plenty of calcium and vitamin D. Consult your doctor for safe weight loss recommendations.

Avoid smoking. Smoking causes skeletal damage and increases risk of bone breakage, which can lead to disability, threatening mobility or independence and adversely affecting quality of life.

Health Problems May Impact Bone Health

Many health problems can impair calcium metabolism, making bones prone to breaking. Damage can be caused by the condition, the treatment or in combination.

Disorders reducing mobility like multiple sclerosis, stroke, Parkinson’s disease, bed-ridden injury/surgery recovery, paralysis and fatigue disorders like anemia, sleep apnea and clinical depression can cause bones to weaken and threaten future breaks because they are not exercised.    

Glucocorticoid (steroid) medications used to calm many autoimmune disease symptoms, including those associated with inflammatory bowel disease, lupus, rheumatoid arthritis and sickle cell disease may also damage bone, causing subsequent fractures.

Disorders disrupting nutrient absorption in the digestive tract like celiac disease or weight loss surgery may compromise bone health.

Hormone imbalance disorders can weaken bones and cause fractures. Diabetes, eating disorders, breast cancer, irregular or lack of menses and abnormal levels of parathyroid or thyroid hormones can contribute to weaker bones and increased risks of fractures.

Talk with your doctor to discuss healthy choices that preserve your bones while successfully managing additional conditions.

Diagnosis Tests

There are several tests that determine bone density and bone quality.

A bone mineral density (BMD) tests on a dual-energy x-ray absorptiometry (DXA) machine is the best diagnosis tool to determine osteoporosis.

The results, known as T-scores, indicate osteoporosis based on density; however, if you have normal BMD T-scores and multiple risk factors, you may need treatment to avoid fractures.

Majority of fractures occur in those having BMD above the threshold. When this occurs, your doctor may recommend the following tests to ascertain bone quality:

  • FRAX (Fracture Risk Assessment Tool) is an algorithm used to determine fracture risk within 10-year timeframe. It uses BMD results, age and major risk factors to guide on how to best preserve bone health. FRAX is used for post-menopausal women and men 50-plus.
  • Vertebral Fracture Assessment (VFA) is done via DXA technology or conventional lateral x-rays of the spine for those experiencing hidden vertebral compression failure (VCF) in one of the 33 bones within the spinal column. Unfortunately, these are often silent because they don’t cause pain. The resulting shifting vertebrae usually lead to additional VCFs, with most people having a second VCF within a year of initial occurrence. Those with one VCF are 5 times more likely to have another and over two times as likely to break a hip. VFA aids in beginning treatment to avoid additional VCFs. VFA can be done when you have BMD measured.
  • Trabecular Bone Score (TBS) examines the interior bone honeycomb (trabeculae) of bones. If trabeculae are poorly formed, broken, or otherwise defective, fracture is much more likely to occur. The DXA imagery estimates bone strength by calculating trabecular number, thickness, connectivity and spacing. Adding TBS to DXA helps indicate poor bone quality among those with normal BMD to identify and treat before additional bone damage occurs.

Screening Recommendations

The National Osteoporosis Foundation recommends BMD measurement via DXA for:

  • Women age 65-plus
  • Younger postmenopausal women with clinical risk factors for bone loss
  • Women approaching menopause whom have suspected bone loss
  • Men age 70-plus
  • Men age 50-69 with clinical risk factors
  • Adults with a condition or taking medication associated with low bone mass or bone loss
  • Adults experiencing a fracture at 50-plus

Therapeutic Medications

Several medications are available for the prevention and/or treatment of osteoporosis, including: bisphosphonates; calcitonin; estrogen (hormone therapy); estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMs); parathyroid hormone (PTH) analog; parathyroid hormone-related protein (PTHrp) analog; RANK ligand (RANKL) inhibitor; and tissue-selective estrogen complex (TSEC).

Talk with your doctor about your full medical history and additional health issues and treatments you are receiving to help determine a plan to effectively maintain and preserve strong, healthy bones and provide necessary treatments if required.

Contact your Capital Women’s Care team if you have any questions relating to osteoporosis, its treatment options, or to discuss your risk factors. Our team can closely monitor your bone health and work with you so you can achieve the best life possible.

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