What you need to know about your risk factors
If you are over 50, post-menopausal or taking certain medications, you face a higher risk of developing osteoporosis, a medical condition in which bones become brittle and susceptible to fracture.
“If you have osteoporosis, your bones are weak and at risk for to fractures even by doing something as simple as coughing or stepping off a curb,” said Suzelle Luc, MD, Rheumatologist at the Southcoast Physicians Group Rheumatology practice.
Both men and women are at risk for osteoporosis, but the risk is higher in women. Approximately 1 in 2 women and 1 in 5 men will have a bone-related issue due to osteoporosis, Dr. Luc said.
Osteoporosis can be caused by decreased hormone levels (estrogen in women, testosterone in men), whether from aging or from certain medications used to treat cancer and other illnesses. Other factors that may put a person at higher risk for osteoporosis include chronic illnesses such as kidney disease, rheumatoid arthritis, lupus, hyperthyroidism, diabetes, or use of steroid medications (such as prednisone).
Dr. Luc stressed the importance of a bone density scan (often called a BMD test DEXA scan). “With the scan, we are looking at the lumbar spine and the hips to see if there’s evidence of low bone mass, which tells us that these are the patients who are at risk for osteoporosis, or may have already progressed into osteoporosis,” Dr. Luc said.
Bone scans are generally ordered by a patient’s primary care doctor, but Dr. Luc encourages people to become educated about their risk factors. “Family history is important,” she said. “If your mother fractured her hip, for example, that may be a clue that you are at risk for osteoporosis.” Other signs may be if a person has lost height over the years or has developed a curved spine.
Dr. Luc also recommends patients have their Vitamin D and calcium levels checked, and take supplements as necessary. “The bones need the mineralization,” she said. While not a cure-all for preventing osteoporosis, “Having enough calcium and Vitamin D is important, in terms of providing building blocks for the bones.” (See sidebar for other recommended lifestyle changes.)
“I always tell my patients osteoporosis is a silent disease until you fracture, so it’s important that we get ahead of it and put you on the appropriate treatment when necessary,” Dr. Luc said.
Osteoporosis is commonly treated with medication. Bisphosphonates are the most commonly prescribed medications, and include a number of options, such as those that can be taken orally on a regular schedule at home, such as Fosamax; or taken once a year by infusion at the hospital (Reclast).
Another treatment is denosumab (Prolia), which is a twice-a-year injection patients receive at the doctor’s office.
Dr. Luc said the kind of medication prescribed varies depending upon a patient’s tolerance for certain side effects. For example, bisphosphonates can cause heartburn. Also, Dr. Luc said one treatment for osteoporosis, Raloxifene (Evista) has been associated with a decreased risk of breast cancer, so she would consider that option for patients who have had breast cancer.
While osteoporosis can result in fractures, it can also hurt a patient’s state of mind. “The 70-year-old patients who walk into my clinic, they are active people,” Dr. Luc said. “They have their own homes, they are vacationing. What was once considered ‘elderly’ is now only an age – it’s not who these patients are. Some of them are more active than my 20-year-old patients.
“When they have a bone fracture, they go from maintaining their independence to having surgery. They may not be able to go home right away, they may need rehab. It can have a huge psychological impact.”
Proper education and screening is key. Dr. Luc is happy to see any patient who has or is at risk for osteoporosis, to guide treatment.