by Anna Melissa S. Lo, MD
Maintaining strong, healthy bones is an important yet often undertreated aspect of health. In our practice, we unfortunately see these cases quite often.
Most commonly, an elderly patient returns for follow-up of other medical concerns but now presents with a new and serious problem following a traumatic fall or injury.
What may initially seem like a simple fall can result in a debilitating fracture, often requiring surgical intervention and significantly impacting the patient’s independence and quality of life.
Osteoporosis is a silent, serious, and potentially life-threatening disease. Most people with osteoporosis experience no symptoms and may not realize they have it until a fracture occurs.
According to the International Osteoporosis Foundation, approximately 1 in 3 women, and 1 in 5 men, over the age of 50 will suffer an osteoporotic fracture. As a systemic skeletal disease, any bones can be affected, but the most affected sites, which are the spine and hips, unfortunately also cause the most morbidity and mortality.
Vertebral or spinal fractures are the most common fractures, with approximately 75% of the cases going undetected due to a lack of or subtle changes in symptoms, such as loss of height or assuming a more stooped or “hunchbacked” posture.
Some patients with chronic back pain may be due to underdiagnosed and untreated vertebral fractures. Patients with hip fractures often carry more serious consequences and cause the most morbidity. Similarly to spinal fractures, hip fractures are associated with chronic pain, disability, and immobility.
Around 40% of patients are unable to walk independently 1 year after a hip fracture; 10-20% require long term care; and even more shockingly, a 20-24% mortality within the first year for these patients.
Osteoporosis is a progressive disease that causes bones to lose their density and strength, making them more fragile and more likely to break.
As the disease progresses, even everyday activities or minor stresses, such as bending, lifting, or even sneezing, can sometimes lead to a fracture. I often describe osteoporosis like a house that has been slowly damaged by termites.
From the outside, the house may appear normal, but inside, the materials that give it strength have been gradually weakened and thinned out. As the structure becomes more fragile, it takes much less force to cause it to collapse.
In much the same way, bones affected by osteoporosis may look normal on the outside, but their internal structure has become weaker, leaving them much more vulnerable to fractures.
Most osteoporotic cases occur in postmenopausal women. This is due to the abrupt cessation of estrogen production during this time. Estrogen is an important hormone in the bone-building process, and without it, bone becomes weaker. However, osteoporosis does not only exclusively occur in postmenopausal women.
Some men and premenopausal women can develop osteoporosis if they have certain risk factors, such as strong family history of osteoporosis, smoking, heavy alcohol drinking (usually 3 or more per day), low intake of calcium and vitamin D, sedentary lifestyle, eating disorders, low body mass index, long-term use of steroids and certain medications, or having concomitant medical illness, such as diabetes, rheumatoid arthritis, inflammatory bowel disease, kidney or liver diseases to name a few.
When should one suspect Osteoporosis as it is a silent disease? If you are over the age of fifty and suffer from a broken bone and fracture, then you are at twice the risk of having another one in the future. If this has happened, your health care provider may order several tests to check for underlying bone disease.
Most commonly, a dual x-ray absorptiometry or DEXA scan can easily measure a person’s bone density. It is a quick, easy, and painless procedure that uses very minimal radiation to examine the spine, hip, and/or wrist.
For those who have not suffered any fractures, the U.S. Preventive Services Task Force (USPSTF) recommends to screen for all women over the age of 65 with a bone density scan. Those below the age of 65 with high risk factors should discuss with their health care providers if they qualify for an earlier screening test.
For Osteoporosis, prevention is always the best action plan. Once a fracture happens, the damage is already done. Depending on the extent of damage, patients may often require aggressive measures such as hip surgeries.
Prevention is key. Early on, we can adopt certain lifestyles that can build and protect our bones:
1. Stay physically active. Weight-bearing, resistance, muscle-strengthening and balance exercises like walking, squats, heel raises, tai chi, can help make the bones stronger.
2. Getting adequate calcium and vitamin D intake. Calcium of 1,000-1,200 mg/day and Vit D of 600-800 IU/day.
3. Avoid smoking and limit alcohol intake.
4. Practice fall prevention at home, ensuring adequate lighting, removing trip hazards, vision checks, and having balance training.
5. Working with your health care provider in addressing and treating underlying medical conditions that can potentially worsen bone health.
Patients with confirmed osteoporosis may also benefit from certain medications that can help treat osteoporosis and prevent risk of fractures from it. There are several anti-osteoporotic medications that can slow down bone loss and/or help with the bone building process. Talking to a healthcare provider helps in deciding which medication may be the right fit for a patient with osteoporosis.
Osteoporosis is both preventable and treatable. While we cannot stop the natural aging process, we can take important steps to protect our bones and reduce the risk of fractures by staying physically active, getting adequate calcium and vitamin D, avoiding smoking and excessive alcohol, preventing falls, and addressing medical conditions that may affect bone health.
Most importantly, don’t wait for a fracture to be your first warning sign. If you are over 50, have experienced a fracture, have risk factors for osteoporosis, or are approaching the recommended age for screening, talk with your healthcare provider about whether a bone density test or further evaluation is appropriate for you.
Osteoporosis may be a silent disease, but acting early can help preserve bone strength, prevent fractures, maintain independence, and protect your quality of life for years to come.
ANNA MELISSA LO, MD is board-certified through the American Board of Internal Medicine, both in Internal Medicine and Endocrinology, Diabetes, and Metabolism. She is currently practicing at the Primary Specialty Clinic of Hawaii across different islands, including Oahu, Lihue, and Hilo.
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