Beyond the break: All about osteoporosis and how to prevent it

Osteoporosis, a common bone disease in older adults, occurs when bones become weak and brittle. Changes in bone density often develop silently without symptoms. Many individuals never suspect they have the disease until they sustain a fracture.

According to Dr. Amalia Landa-Galindez, associate professor and chair of internal medicine at FIU’s Herbert Wertheim College of Medicine, 1 in every 3 women and 1 in every 5 men over 50 may experience an osteoporosis-related fracture in their lifetime. In fact, a Bone Health Survey by the International Osteoporosis Foundation for World Osteoporosis Day (October 20) found that 43% of women reported a fracture from a minor fall after turning 50.

Women aged 50 and older tend to be at higher risk than men of developing osteoporosis, especially after menopause when estrogen levels are declining. However, men are diagnosed with this disease in large numbers later in life as they, too, become more susceptible to “fragility fractures,” which “result from low energy trauma, such as a fall from standing height or less.”

“After age 80, bone fragility becomes a huge issue for almost everyone,” Landa-Galindez asserts. “After 80, 77% of women and 46% of men may have osteoporosis.”

Yet it is not inevitable. By being proactive in adolescence and young adulthood, adopting healthy habits, and thinking long-term, osteoporosis can be prevented. And for folks who do develop this disease, new research offers fresh perspectives on effective treatments.

What is Osteoporosis?

Landa-Galindez explains how bones are continuously being remodeled, creating a balanced architectural system between bone-generating cells called osteoblasts and bone-dissolving cells called osteoclasts. This is a dynamic process in which osteoclasts first break down and clear damaged bone tissue, then osteoblasts build and replace new bone tissue in its place.

“About every ten years,” Landa-Galindez says, “your entire skeleton is remodeled.”

But what happens when this bone remodeling process doesn’t work the way that it should? When osteoclasts work too fast, breaking down bones before osteoblasts can rebuild them, the result is fragile, porous bones, also known as osteoporosis.

What are the symptoms of Osteoporosis?

Osteoporosis does not have any obvious symptoms, which is why it is often referred to as a silent disease. The most common “symptom” is a bone fracture that results from a minor fall.

In addition to fragility fractures and increased injuries, several warning signs can alert the unsuspecting to the stealthy onset of osteoporosis:

• Loss of height, specifically one inch or more – This occurs when each vertebra begins losing two or more millimeters, causing the spine to effectively shrink.
• Stooped posture – Some people will develop what’s known as a dowager’s hump at the base of the neck. Due to the weakness of the bones here, the upper spine begins to curve forward abnormally, creating a rounded hump or hunchback posture.
• Changes in gait – As a result of pain in one or more parts of the body, a person may alter how they walk, favoring one side of their body over the other.
• Bone pain – Pains throughout the body, especially in the lower back and hips.

How is Osteoporosis diagnosed?

DEXA or DXA scan (Dual-Energy X-ray Absorptiometry) is a fast, non-invasive imaging test that measures bone mineral density to determine the strength and overall health of bones. (Similar scans are used for body-composition analysis and to measure body-fat percentage, lean muscle mass, and fat distribution, making them very popular among folks interested in fitness, wellness, and longevity.) Healthcare providers use DEXA scans to diagnose osteoporosis and osteopenia, a condition characterized by bone density loss that can develop into osteoporosis if left untreated.

For DEXA scans, individuals lie prone on a table while a technician passes the scanning arm over the hips, spine, and other bones in the body. Using two types of low-level radiation, the scan produces bone density images, which are then read and translated into a “T score.”

To produce a T score, DEXA scans compare an individual’s bone mineral density to that of a healthy person in their 20s or 30s. Results are measured as negative numbers – the closer to zero a score is, the stronger the bones are.

If an individual receives a “healthy” diagnosis, the DEXA scan is repeated once every five years. However, if osteopenia is detected, these scans are typically ordered once every two years. And for anyone with osteoporosis, scans are ordered every one to two years.

By 65, all women should be screened for osteoporosis, and men over 70 who have risk factors should also be screened. However, medical practitioners may order a DEXA scan for anyone over 50 who has broken a bone suggestive of a fragility fracture.

Likewise, additional screening tools like the FRAX (Fracture Risk Assessment) calculator uses algorithms to estimate a person’s 10-year probability of experiencing a fracture caused by osteoporosis. FRAX is designed for women and men aged 40 and above, enabling earlier interventions and prevention.

What causes Osteoporosis?

As people age, osteoporosis may occur due to a gradual loss of bone mass. Postmenopausal women have a higher tendency to lose bone mass faster than others.

The following risk factors increase the probability of developing osteoporosis:

• Age – People over 50 are at elevated risk.
• Sex – Women, especially postmenopausal women whose bodies produce less of the bone-forming hormone estrogen, are at elevated risk.
• Genetics – A family history of osteoporosis increases a person’s chances.
• Body frame size – Those who are thinner or have naturally small frames have less padding and/or less bone-density to protect their bones from injury. “The thinnest individuals have less risk of heart disease, but higher risk of osteoporosis,” Landa-Galindez says.
• Dramatic weight-loss – Anyone who loses a lot of weight in a short period of time, particularly as a result of weight-loss surgery or weight-loss medications such as GLP-1 agonists, may be at increased risk for bone-loss and muscle-mass-loss.
• Inactivity – Anyone who is regularly sedentary, on bedrest and/or not exercising is rapidly losing bone strength.
• Lifestyle choices – Regular alcohol consumption and/or smoking or using tobacco products compromises bone strength.
• Vitamin D deficiency – Not consuming or exposing oneself to enough of this essential vitamin causes issues with bone loss.
• Certain health conditions – These include thyroid disease, rheumatoid arthritis (which affects bones), certain autoimmune diseases, diabetes, celiac disease and cancer, among others.
• Taking certain medications – Specific medications, like proton pump inhibitors (Prilosec, Nexium) for heartburn, steroids, thyroid-replacement therapy and hormone therapy for cancer, can accelerate bone loss as a side-effect.

How can Osteoporosis be prevented?

As early as adolescence (12-18 years-of-age), people can adopt healthy habits and integrate them into their lifestyle for the long-term. A nutritious diet that includes plenty of calcium and vitamin D (found in milk and yogurt, for example) and regular exercise form a solid foundation.

While adolescents are at the least risk for developing osteoporosis due to their high levels of activity and hormone production, specifically estrogen and testosterone which peak at puberty, people tend to change their behavior as they age, while hormone levels naturally start to decline. Adolescents become young adults who may begin drinking alcohol, smoking, exercising less, and electing less healthy food options.

For anyone interested in preventing or reversing osteoporosis, here are some tips:

• Increase vitamin D and calcium intake – After age 40, take 2,000 units daily of vitamin D and 1,000-1,500 units daily of calcium. Milk and yogurt are excellent sources, Landa-Galindez notes.
• Begin strength training – Under the guidance of a trained professional, use weights or resistance bands to build-up strength. Swimming is also an excellent exercise that builds muscle and bone strength.
• Enhance balance – By developing balance, individuals are less likely to fall and sustain fractures. Riding a bicycle and doing ballet, yoga, Pilates, karate or tai chi are all low-impact options.

How is osteoporosis treated?

Unfortunately, many people with osteoporosis or osteopenia resist medication treatment, Landa-Galindez reports. “There is often pushback or misinformation on social media based on outdated information or false advertisement.”

For example, bisphosphonates developed a bad reputation in the 90s when articles reported jaw necrosis and spontaneous fractures as common side effects. Large-scale trials followed and clarified that necrosis of the jaw affected less than 2% of individuals and only those receiving invasive dental work at the time of treatment, Landa-Galindez explains. “We recommend discontinuing this medication three months before invasive or extensive dental procedures to avoid this potential, though rare, complication.” Additional studies have shown long-term safety and tremendous benefits, she adds.

The most common treatments for osteoporosis are:

• Bisphosphonates – Medications that block or inhibit osteoclasts, the cells that break down bones. They have the greatest safety profile for long-term use. The most common side-effects are heartburn and dyspepsia. Landa-Galindez recommends pre-medicating with Pepcid the evening before dosing, then once a week, while starting the bisphosphonate at half-strength, if gastrointestinal issues are a concern.
• Infusions – Individuals who demonstrate problems with bisphosphonates are eligible for other treatments, including targeted monoclonal antibody injections that inhibit osteoclasts. These can be expensive and some are time limited, yet they offer an excellent alternative.

Healthcare providers may also prescribe estrogen or testosterone hormone-replacement therapy for certain women and men.

For those who have osteoporosis, the loss of independence that can accompany the fear of falling (and actually suffering a fracture) is hard felt. However, a few lifestyle changes can increase quality of life. And for many folks, osteoporosis is not inevitable.

The good news: We are not all doomed.

Check out Landa-Galindez’s latest article on osteoporosis here.