Osteoporosis

Osteoporosis is a concern for both men, but especially women as they age. Bone is living tissue, despite what it may seem. Over our entire lives, old bone breaks down and is replaced with new bone tissue. This cycling of bone tissue increases bone mass in the body through our 30s. At that point, the amount of new bone mass created often lags behind the amount of bone that breaks down and bone density begins to decrease in midlife and later.

Normal bone structure is not solid through and through. In fact, bone is made of a very strong honeycomb structure with gaps throughout.

Osteoporosis occurs when the body does not replace broken down bone fast enough, loses too much bone mass or does not generate enough new bone. Osteoporotic bones have larger gaps in their structure, making them weaker and prone to fracture.

Problems Associated with Osteoporosis

For mild cases of osteoporosis – those earlier in the progression of the disease – the symptoms may not be very noticeable. However, as bone becomes weaker, the chances of a fracture increase significantly. This often first occurs in the fingers, wrist and spine, but can affect any bone in the body. As bones begin to compress and/or a fracture, significant disability may occur resulting in postural changes, inability to perform certain activities and debilitating fractures from otherwise insignificant causes such as a hard cough or sneeze.

Symptoms of Osteoporosis

Fractures are a leading symptom of osteoporosis. With bone weakened significantly, fractures can occur from even mild activity. Those with advanced osteoporosis may have difficulty performing their normal day-to-day activities for fear of a fracture.

Osteoporosis may also change posture. Many people with osteoporosis find themselves needing to bend over to relieve pressure on the spine, which may be painful due to compression fractures in the vertebrae. Worsening discomfort in the back often accompanies these postural changes.

Patients with osteoporosis may also experience loss of height. This is due to collapsing vertebrae, which quite literally shorten the patient.

Risk Factors for Osteoporosis

Ultimately, the risk of developing osteoporosis Is closely linked to general health and lifestyle considerations. Patients who exercise, eat well, maintain a healthy weight and more have a lower risk of osteoporosis than those with generally unhealthy lifestyles.

• Age. As we age, the bone replacement cycle favors degradation rather than rebuilding of bone tissue. This is a natural occurrence that cannot be avoided.
• Being female. Women are far more likely to experience osteoporosis than men. This is especially true for postmenopausal women and women who have experienced early menopause.
• Family history may play a role in the development and progression of osteoporosis. If close family members have had osteoporosis, this increases risk. This risk is even higher if a parent fractured a hip as a result of osteoporosis.
• A small body frame.
• Patients that build more bone mass during their younger years are less likely to experience osteoporosis in their later years. To some degree this is not a modifiable factor. However, patients who are more active and healthier in their younger years may ward off osteoporosis later on.
• Race. Caucasian and Asian patients are at higher risk of osteoporosis and other races
• Hormones. There is a hormonal risk factor associated with the development of osteoporosis as well. Estrogen and testosterone are key to maintaining proper bone mass. As we age, these sex hormones tend to wane and so increases the risk of osteoporosis. Patients to undergo prostate cancer or breast cancer treatment that includes hormone lowering therapies, may be at increased risk. Thyroid, parathyroid and adrenal gland problems may also increase the risk of osteoporosis due to unbalanced hormonal levels in the body.
• Dietary considerations. Calcium is a key nutrient in the production of new and healthy bone. Patients who don’t get enough calcium in the diet are at higher risk of osteoporosis. Similarly, those who suffer from a deficiency of vitamin D may also have a higher risk of osteoporosis as vitamin D is critical to the absorption of calcium in the body. Patients with eating disorders or those who have had gastric surgery such as a gastric bypass or gastric sleeve may also be at a higher risk of developing osteoporosis due to reduced nutritional intake.
• Medical conditions and their treatments. Inflammatory bowel disease, gastric reflux, kidney disease and more can all interfere with bone growth. Similarly, treatments include corticosteroids, can cause bone loss to rapidly outpace bone regeneration.
• Lastly, drug use, tobacco use, excessive alcohol intake and a sedentary lifestyle can all contribute to the development and progression of osteoporosis.

How we Diagnose Osteoporosis

Osteoporosis is easily diagnosed using diagnostic imaging including bone density testing, CT scanning, when necessary, and x-rays. We can quickly understand the degree to which the bone has degenerated and develop a treatment plan to address this.

Treatment for Osteoporosis

When caught early, osteoporosis can be slowed or even reversed with proper lifestyle change, including reducing alcohol and tobacco use, improving vitamin D, calcium and protein intake, if deficiencies exist, all of which can help build new bone and re-mineralize existing bone.

If the progression of osteoporosis is significant, and the risk of bone fracture is high in the next decade, we often prescribe medication including antiresorptive agents like bisphosphonates, calcitonin and more and anabolic agents, hormonal therapies, to speed the regeneration of bone and to slow or reverse the progression of osteoporosis.

The Prognosis for Those Suffering from Osteoporosis

The prognosis largely depends on what damage has already been done. If the osteoporosis is caught in its earliest stages, lifestyle and medical interventions can often slow or reduce its effects. An understanding of the risks of osteoporosis as we age can help patients implement practical lifestyle changes that can keep the disease at bay. For patients who have not addressed early signs of osteoporosis and allowed the condition to continue unchecked, conservative treatment options become less effective and some skeletal damage may be permanent. Fractures are treated on a case-by-case basis, but when it comes to osteoporosis, prevention is a far better option than treating the resulting fracture. Complicated cases may require the input of multiple specialists to ensure the best outcomes.

If you believe you are at high risk of osteoporosis or to learn more about your specific risk, please schedule a consultation with Dr. Manning who will discuss your options, and offer practical advice to minimizing the risk of fractures later on in life. Remember that early intervention is key to having the best chance of preventing permanent damage and reversing bone loss that has occurred to this point.