Ask the doctor: 7 questions about osteoporosis
As with many things about our health, most of us don’t think about our bones until something goes wrong. But we should pay attention to our bone health throughout our lives.
Most bone mass is formed between the ages of 25 and 30. After that, new bone is produced at about the same rate as older bone is broken down. This means your whole skeleton is renewed over a period of 7 to 10 years. Around 40, bone starts to break down more quickly than it’s replaced. So our bones slowly begin to lose their density.
And that’s when osteoporosis can start. It’s a disease that causes bones to become weak and brittle, which raises the risk of breaks or fractures. Women are especially prone to osteoporosis, so it’s important to take steps to help build strong bones and prevent bone loss.
To find out more about osteoporosis and how to protect our bones, we talked with Suken A. Shah, MD. He’s the vice chair and an orthopedic surgeon at Nemours Children’s Hospital in Delaware and a professor of orthopedic surgery at Thomas Jefferson University.
What happens when you get osteoporosis?
Our bones consist of 2 parts. There’s a thick, hard outer layer called cortical or compact bone. Inside that is a softer, spongy mesh of bone that’s like honeycomb. That’s called the trabecular bone. Osteoporosis literally means spongy (porous) bone. The disease makes the holes in the honeycomb grow larger. This lowers overall bone density. And low bone density is what makes the bone more likely to break.
Why are women at greater risk of osteoporosis than men?
Part of it has to do with the fact that women in general start with less bone density than men. Men’s bones are just larger. And the density begins to drop faster with the onset of menopause because there’s less estrogen in the system.
Among other things, estrogen influences the cells that make new bone. When there’s less estrogen, those cells don’t produce enough new bone, and they don’t properly maintain bone structure. Women can lose 2% of their bone density per year during menopause. After the age of 50, 1 in 3 women will sustain an osteoporotic fracture.
What can I do to prevent osteoporosis?
Building strong bones during childhood and the teen years is important. But there are things you can do as an adult that will help, too. Get enough calcium and vitamin D each day. Focus on weight-bearing exercise (more on that below). Don’t smoke and limit how much alcohol you drink. Both of these increase your risk for brittle bones — as can drinking carbonated beverages such as sodas that have a lot of phosphorous and sugar. Low body weight (under 127 pounds) can also increase your risk.
Unfortunately, there are some risk factors that you can’t change. Those include family history or certain medications you may need to take. Some endocrine disorders such as hyperparathyroidism, hyperthyroidism, diabetes and certain cancers can also increase risk.
How can I make sure I’m getting enough calcium and vitamin D?
There are many foods that contain both calcium and vitamin D. For example, cheese, ice cream and yogurt have both. So do orange juice, fortified cereals and whole grains.
Foods that are high in vitamin D include eggs, dairy, salmon, sardines, avocados, almonds, leafy greens (kale and spinach), Brussels sprouts, broccoli and mushrooms. But sometimes food alone isn’t enough. A vitamin D supplement may be needed, especially among those who don’t eat dairy.
Your physician can do a simple blood test to see if you’re getting enough vitamin D and calcium. If you need a supplement, work with your doctor to figure out the correct amount. There can be side effects to taking too much calcium, including kidney stones.
(If your doctor suggests supplements, you can get them — along with plenty of other health essentials — at the Optum Store.)
What forms of exercise are best for bone health?
Exercise plays a huge role in fending off brittle bones. The focus should be on weight-bearing exercises or activities such as walking, running, dancing and Zumba. Weight-bearing activities put stress and force on the bone, making your bones work harder. That force triggers bone-forming cells into action and leads to denser, stronger bones.
It’s important to keep in mind that lean muscle mass and bone density go together. Lifting weights or doing resistance training can help keep or increase lean muscle mass. And it can help prevent sarcopenia, which is the muscle version of osteoporosis.
Be sure to choose forms of exercise that limit your chances of falling. If you have brittle bones, your risk of severe injury from a simple fall is increased. There are lots of floor and chair workouts available that are safe but still work well.
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When do you need a bone strength test?
A bone density test (DEXA) measures the mineral content of the bones. It’s an imaging test that uses very low levels of X-ray. It’s a way to track bone loss as you age. There’s also a 3D X-ray called a QCT scan. This is for people at high risk. It’s used mostly to see the hips and lumbar spine. Doctors suggest testing at the following ages:
- For women with no risk factors, routine screening should begin at age 65.
- For women with risk factors, routine screening should start at age 50.
- For higher-risk men, those age 70 or older should consider testing.
Through these tests, doctors can determine if you have osteoporosis and at what level. After diagnosis, your doctor will look at treatment plans and likely recommend routine bone scans.
How is osteoporosis treated?
Your primary care physician is always the first place to start. They may then send you to a specialist. Depending on your diagnosis, this could be an endocrinologist or an orthopedic surgeon. Or it could be a rheumatologist or geriatrician.
Once you’re diagnosed with osteoporosis, your doctor may prescribe medication. You’ll work together to figure out the right choice for you. There are many types of osteoporosis medications. Some of them include:
These are usually the first choice for osteoporosis treatment. They slow down and prevent further bone loss. Bisphosphonates affect the bone “remodeling” cycle. The cycle is bone resorption (when bone tissue dissolves) and bone formation. By slowing or stopping bone resorption, these medications help new bone formation to catch up:
- Alendronate (Fosamax®), a daily or weekly pill
- Risedronate (Actonel®), a weekly or monthly pill
- Ibandronate (Boniva®), a monthly pill or quarterly IV infusion into the vein
- Zoledronic acid (Reclast®), an annual IV infusion into the vein
RANK ligand (RANKL) inhibitor
This medication blocks a certain receptor to decrease bone breakdown. It can be good for people who can’t take bisphosphonates, such as someone with reduced kidney function.
- Denosumab (Prolia®, XGEVA®), 1 shot under the skin every 6 months
These types of medications can build new bone. They stimulate bone-forming cells called osteoblasts. They are typically for people who have very low bone density or have had fractures. They are also for those whose osteoporosis is caused by steroid medication.
- Teriparatide (Forteo®), a daily shot
- Abaloparatide (Tymlos®), a daily shot
- Romosozumab (Evenity®), a monthly shot at the doctor’s office
There are always steps you can take to keep your bones as healthy as possible. Keep up with weight-bearing exercise. Get plenty of vitamin D and calcium in your diet. And make sure you get your bone density test when it’s time. And if you’re prescribed medication for osteoporosis, be sure to print out your free prescription discount card. Just show it to your pharmacist at checkout.
Healthy bones at every age: The American Academy of Orthopaedic Surgeons
Osteoporosis and women: National Library of Medicine (2021). “Gender Differences in Osteoporosis: A Single-Center Observational Study”
A Guide to Calcium-Rich Foods: Bone Health and Osteoporosis Foundation