What is osteoporosis? Osteoporosis is a medical condition where there is decreased bone mass which increases the risk of fracture. Concerns with patients with osteoporosis. Osteoporosis is expected to increase as the baby boomers age. A recent study published in Osteoporosis International discusses some concerns with osteoporosis screening, diagnosis, and treatment. Work up and follow up are needed for those who sustain a fracture as they may have osteoporosis but were not diagnosed with it. There should be increased screening for those people who are at risk because they take medications that increase the risk of osteoporosis. There needs to be  additional public awareness for osteoporosis and need for medications when prescribed Co-author Professor Eugene McCloskey stated: “This review identifies, among other challenges, the current gaps in the delivery of best clinical practice, low levels of public awareness, and insufficient access and funding for diagnosis and treatment. Sadly, these gaps are a clear reflection of the low priority currently given to bone health and fracture prevention in healthcare policy.” Professor Cyrus Cooper, Chair of the International Osteoporosis Foundation (IOF) Committee of Scientific Advisors, stated: “We cannot afford to ignore the current and growing burden that osteoporosis and fragility fractures impose upon societies around the world. As we now have the knowledge and tools needed to manage bone health optimally, I urge healthcare professionals, stakeholder organizations, and healthcare authorities to make a concerted effort to implement these tools. Prioritization of fragility fracture prevention must become a reality worldwide.” Referencec Harvey, N.C.W., McCloskey, E.V., Mitchell, P.J. et al. Osteoporos Int (2017). doi:10.1007/s00198-016-3894-y

Information about osteoporosis?

  • Osteoporosis can cause loss of height as the back bones may collapse (vertebral compression fractures).
  • 80% of those who are affected are women.
  • As women age, their estrogen levels drop which increases the risk of bone loss .his increases the risk of osteoporosis.

How does bone remodel itself?

  • Bone is able to remodel itself, this is how a fracture heals.
  • New bone will replace old bone.
  • Bone will breakdown called resorption through the action of special cells called osteoclasts
  • Osteoblasts will form new bone.
  • When the bone cycle goes array, problems such as osteoporosis can occur.

Those at risk for osteoporosis Some people will be at higher risk for development of osteoporosis. This group includes,

  • Those with a family history of osteoporosis.
  • Caucasian women-20% of those who are older than 50 are estimated to have osteoporosis.
  • Chronic immobilization, such as wheelchair bound will increase the risk of osteoporosis.
  • Medications -Those who are on certain medications such as antacids, anti-seizure medication, chemotherapy drugs, and steroids may increase the risk of osteoporosis.
  • Diseases such as chronic obstructive pulmonary disease (COPD), pancreatitis, liver disease, kidney disease, diabetes, rheumatoid arthritis, inflammatory bowel disease, hyperthyroid and parathyroid abnormalities can be associated with osteoporosis.

Recommended screening for osteoporosis.

    • Alcohol intake greater than 3 drinks a day.
    • Females who are  65 years of age or older.
    • Menopause younger than 50.
    • Males who are older than 70.
    • Those who are on certain chemotherapy agents and medications.
    • Thin bones on x-ray
    • Fracture in a patient who is 50 or younger.

Prevention of osteoporosis

  • Regular exercise -A combination of weight resistance and low impact aerobics can help maintain bone mass.
  • Meeting you dietary needs-Calcium-Try to eat a diet that provides 1000 mg of calcium daily. Low-fat dairy products are a good source of calcium.
  • Vitamin D is also needed for bone strength and calcium absorption. Depending on your age usually, around 600 units are recommended daily. (reference-National Institutes of Health). This dose should be discussed with your doctor as some feel this level is too low.
  • Estrogen therapy can help decrease the risk of bone loss but increases the risk of breast cancer and blood clots that can cause strokes.
  • Decrease alcohol intake and smoking.

Diagnosis of osteoporosis The World health Organization has defined osteoporosis based upon x-ray measurements. Dual-energy x-ray absorptiometry — Also known as DXA is the most widely used method for measuring bone mass density. It does expose patients to low-dose ionizing radiation. What is a T and Z score? The results of the bone test will be shown with a Z-score and a T score. The T score is what is used to diagnose osteoporosis in post menopausal women and men. A T-score will compare bone density to what is normal in a healthy 30-year-old adult. Z score will compare you to what is considered normal in your age group. Normal ranges are considered higher than negative 2 (-2.0)

  • Other tests can be used such as blood serum markers, ultrasound and CT scan but there are no specific guidelines on what is normal and they have not been studied enough.
  • Most men are not routinely screened for osteoporosis unless they have a history of low impact fractures or loss of height.

Arguments against screening for osteoporosis

  • The only published randomized trial did not find a significant fracture benefit from screening, this was not a double blinded study.
  • Another argument is that preventive steps such as calcium and vitamin D intake, exercise, and smoking cessation should be recommended regardless of bone density.
  • The need for follow-up screening after the initial test is negative is unclear.
  • More studies are needed in this area.

Treatment of osteoporosis

  • Treatments come in a form of pills, injections and nasal sprays.
  • Most medications will work by slowing down bone resorption.
  • Teriparatide is the only FDA approved medication that works by increasing the rate of bone formation. There is some concern that this medication potentially increases the risk of bone tumors and there are specific guidelines when using this medication.
  • As with all medications, there is a risk of side effects such as bone pain and inflammation of the eye. People with kidney disease need to be closely monitored. Your doctor can go more in depth if these medications are being considered.
  • Osteoporosis medications are not approved or advised for most premenopausal women.
  • Bone density tests can be used to help guide decisions about treatment.
  • The results of cost-effectiveness for medication use to help prevent osteoporosis is unclear. More studies are needed in this area.

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