Osteoporosis is a disease that often has no symptoms until a fracture occurs. Fractures, especially in the elderly, can be life altering and sometimes lead to loss of independence. Monitoring bone density helps reduce the risk of having a painful fracture and limiting mobility.
To understand the disease process, it is important to know that we reach our peak bone density approximately by age 20. Genetics significantly influences bone density, however a diet without enough calcium and vitamin D raises the risk of having a lower peak bone density. There is slow bone loss until around the age of menopause. The first several years after menopause is often the most rapid decline of bone density. Certain diseases (diabetes, lupus, celiac, etc), medications (steroids, blood thinners, etc), and lifestyle choices (smoking, increased alcohol intake) can accelerate bone loss. During the rapid decline of bone density in osteoporosis, there is also decline in bone quality. The combination of poor quality and less density can increase the risk for a fracture. Diagnosis of osteoporosis signifies an increased risk of fracture compared to women (and men) with normal bone density. Conversely, having a fracture from a low impact trauma, or a spinal compression fracture (noted possibly by back pain and loss of height), indicates the presence of osteoporosis, even with a normal screening result.
We typically screen for osteoporosis using Dual -energy X-ray Absorptiometry (DXA). This is a quick and painless process which takes very low dose X-rays, often of the spine and hip. This data is the basis for several computed scores (T-scores, Z-scores, and a FRAX score). These scores help compare current bone density with the ideal range and age-matched peers. These scores are the basis for calculating a fracture risk over the next 10 years. Our providers are well versed in interpretation and can help guide treatment options, if necessary. The initial age to begin screening depends on the presence of additional risk factors, but should begin by age 65 even in healthy women without risk factors.
An Ounce of Prevention…
Weight bearing exercise such as hiking, walking, and running can significantly decrease the risks of developing osteoporosis. However, maintaining a healthy body weight is also critical, as low body weight women are also at an increased risk. A diet that meets our calcium and vitamin D needs is also a critical component. The calcium intake requirement is 1200mg per day, and vitamin D varies slightly depending on age, but is between 600-800 IU per day. In addition to dairy, there are many other calcium rich foods including kale, beans and salmon. Vitamin D is also available in the diet especially in fish, egg yolks, and mushrooms, as well as in fortified foods such as dairy and orange juice. Lastly, if needed, there are many medications that slow the loss and potentially rebuild bone. Each woman’s scenario is unique and warrants a discussion with a provider to determine what interventions are recommended.
Preventing falls is essential for maximizing quality of life when living with osteoporosis. It is critical to identify and reduce tripping hazards in the home. This can include rugs, furniture, poorly lit hallways, poor vision, and sometimes our beloved pets.
To learn more, check out our medical information library or make a wellness appointment at an office convenient to you. In the meantime, eat well and get outside in the beautiful fall weather and take a walk or a hike to build your bones.