Breaking the silence around osteoporosis
Something that makes osteoporosis so dangerous is its silence. The disease gradually weakens bones over time often without symptoms, sometimes until a simple fall, awkward step, or lifting something heavy leads to a fracture.
What is osteoporosis?
An estimated 10 million Americans have osteoporosis, and 80 percent of them are women. As we age, especially after menopause, bone minerals can become less dense, to the point that even a low-impact injury can cause a break called a fragility fracture.
"Our goal is to prevent that," says Dr. Tricia Markusen, an obstetrician/gynecologist and medical staff member at Montage Health's Community Hospital of the Monterey Peninsula. "Osteoporosis is a silent disease. We don’t know if somebody has low bone density unless they start sustaining fragility fractures as they get older."
Bone-density testing for osteoporosis
Fortunately, osteoporosis doesn't have to stay silent. A bone-density test uses low-dose X-rays to measure bone loss, analyze bone density, and give a result called a T-score. The test can:
- Identify bone-density decreases before you break a bone
- Determine your risk for broken bones
- Confirm whether you have osteoporosis
- Be a baseline for monitoring loss in bone density
"Knowledge is power," Markusen says, "and we want people to be proactive about their health. Learning about your bone density helps you be proactive."
Many people may put off this test, Markusen says, because they incorrectly assume it's done in an enclosed scanner. In reality, the patient lays on a table and scanners pass above and below them.
"Unlike a CT scan or most MRI scans, it’s non-enclosed," Markusen says. "You lie flat on the machine, so it’s non-invasive, not uncomfortable or intimidating, and the entire procedure only takes 15 to 20 minutes."
Osteoporosis screening
The Bone Health & Osteoporosis Foundation recommends bone-density testing for:
- Women ages 65 or older and men ages 70 or older
- People who break a bone after age 50
- Postmenopausal women with risk factors
- Men ages 50–69 with risk factors
What causes osteoporosis?
Bone density usually remains stable until menopause, when declining estrogen levels can accelerate bone loss by 2 to 4 percent each year. Men can also develop osteoporosis, but they rarely experience a dramatic decrease in bone density as they age unless they take certain medications, such as prednisone or other steroids.
"If a man is being treated for prostate cancer," Markusen says, "and he's taking medications that lower his testosterone, he may be at increased risk of developing osteoporosis."
Risk factors include family history of osteoporosis, being small and thin, and broken bones or height loss. Other causes can include:
- Low testosterone and hormone imbalances
- Having a diet low in calcium and vitamin D
- Lack of exercise, especially weight-bearing activities
- Smoking and excessive alcohol use
- Certain medical conditions and medications
Adolescents with eating disorders like bulimia or anorexia risk not developing peak bone mass during their lifetimes and might be more prone to developing osteoporosis later in life.
Treatments for osteoporosis
The good news? Osteoporosis can often be prevented, slowed, or treated.
"If a woman is experiencing significant hot flashes or other menopause-related symptoms," Markusen says, "she might want to consider hormone therapy to prevent or delay further bone loss."
Supplements like calcium or vitamin D can also be helpful, but Markusen cautions against overusing calcium because of increased risk for developing kidney stones or calcification of coronary arteries.
"If someone has fragile bones," Markusen says, "we can try medications like bisphosphonates or Prolia, which can maintain or improve bone density by slowing the rate at which bone breaks down. We can also try Evenity, which can help build new bone to improve bone density and reduce fracture risk."
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