Understanding risk factors, diagnosing and treating osteoporosis

Here’s why you should practice good bone health at every age

When you think of osteoporosis, do you tend to associate the disease with elderly women?

Osteoporosis is extremely common in women over 65; however, weakening and brittle bones is something people of all ages should take seriously.

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone or both. A healthy bone looks like a honeycomb. When osteoporosis happens, the holes and spaces in the “honeycomb” are much larger than in a healthy bone.

“When we are younger, we are able to remake bone loss,” says Dr. Chandler Brandenburg, family medicine physician with St. Joseph’s/Candler Primary Care in Pembroke. “As we get older, the remaking process goes down; therefore, your bone density decreases and the mass of your bones get lesser and lesser, putting you at more risk for fractures.”

Osteoporosis is very common and is something Dr. Brandenburg has diagnosed and treated frequently. According to the National Bone Health & Osteoporosis Foundation, more than 10 million Americans have osteoporosis and another 44 million have low bone density (also known as osteopenia, which is like pre-osteoporosis), placing them at an increased risk of fracture.

Risk factors for getting osteoporosis

The biggest risk factor for osteoporosis in both women and men is aging. We can’t do anything about that. Unfortunately, another big risk factor – and the reason more women are diagnosed with the condition – is being post-menopausal, which we also can’t control.

However, there are some risk factors that anyone at any age can control and should practice healthy habits now to try to reduce the effects of an already diagnosis or try to prevent it all together. These include:

• Don’t smoke
• Don’t drink alcohol, especially excessively
• Don’t live a sedentary lifestyle
• Do include resistance exercises when you workout
• Do include plenty of vitamins and minerals in your diet, and not just calcium, but others such as vitamin D, vitamin K, potassium and magnesium
• Do talk to your doctor about any medications you are on

One other risk factor that we can’t control is our genetics. But, you can make sure you are aware of your family history and be extra proactive if you have family members with osteoporosis or a history of bone fractures.

Screening and diagnosing

Most people do not have any symptoms of osteoporosis or osteopenia and aren’t even aware they have brittle bones, until a fracture occurs, Dr. Brandenburg says. To try to prevent fractures, it’s recommended most women start bone mineral density screening at 65, also known as a DEXA scan. It’s not a scan you need every year, but a very important one that looks at your bone mineral density in the spine and hips.

The test measures the bone density of the cortical bone (spine) and cancellous bone (hip).  It is a painless, non-invasive and safe scan. The test results in a T-score and Z-score. The T-score compares your bone mineral density (BMD) to the peak of a 30-year-old healthy adult of your sex. The Z-score compares your BMD to someone of your age, weight, height and ethnic or racial origin.

“Based on your score, you’ll be diagnosed with either osteopenia, osteoporosis or nothing,” Dr. Brandenburg says.

Your primary care physician will order the screening. St. Joseph’s/Candler offers DEXA scans at many of its outpatient imaging centers.

“That’s something you should definitely start talking to your doctor about by age 65,” Dr. Brandenburg encourages. “It’s not something you have to do every year, but it’s an important tool in finding the condition early.”

Treating osteopenia and osteoporosis

If you do get a diagnosis of osteopenia, Dr. Brandenburg recommends taking a vitamin D and calcium supplement, which you can get over-the-counter. She also highly recommends incorporating resistance exercise, such as lifting light weights or joining an exercise class that focuses on strength and muscle as opposed to cardio.

“The baseline for exercise is 150 minutes a week. That’s however you want to get in moderate exercise, but at least two days of that should be weight-barring exercises,” Dr. Brandenburg recommends. “It doesn’t have to be CrossFit or lifting 20-pound weights at the gym. It’s some type of movement that puts gravity on your bones, allowing them to maintain that density.”

If you are diagnosed with osteopenia – or normal bone density – you do not need a DEXA scan every year, maybe every two or three years. Your physicians will make the best recommendation for you.

If you get a diagnosis of osteoporosis, it also starts with lifestyle changes, Dr. Brandenburg says, such as resistance training, stop smoking and stopping or decreasing alcohol consumption.

Most osteoporosis patients will be prescribed a medication that can be taken orally daily or weekly or via injection. Those medications are shown to help build up bone. You most likely won’t be on osteoporosis medication for the rest of your life, as they do come with side effects, Dr. Brandenburg says. Most women with an osteoporosis diagnosis will be reassessed around five years later to determine continued course of treatment.

“It’s not a hopeless diagnosis, but it’s important to stay on top of it,” Dr. Brandenburg says. “Unfortunately, if you do get a hip fracture, for example, and have other co-morbidities such as high blood pressure or diabetes, your odds of recovering from that fracture get worse and worse.”

Preventing falls

Dr. Brandenburg also likes to point out the importance of preventing falls that could lead to broken bones if you are diagnosed with either osteopenia or osteoporosis. It’s important to make sure your home is fall safe and that you review all your medications with your doctor, especially ones that would make you feel more sedated or reduce your blood pressure too low.

“That’s especially important in our older population because both of those things increase your risk for falls and put you at more risk for more fractures,” Dr. Brandenburg says. “Most people wouldn’t break a bone if they fell over a dog toy or tripped over a rug, but if you have osteoporosis, there’s more risk for that.”

In need of a primary care physician in the Pembroke area? Dr. Brandenburg is accepting new patients. Request an appointment today.