Know Your Bones

By Intern: Armond Schwartz

An unfortunate consequence of growing older is that your bones become weaker. Bone strength and density peaks in the your twenties.  As bones lose density they become more brittle and susceptible to fracture. Osteoporosis is a disease of low bone density. Low bone mineral density at levels above the cutoff for osteoporosis can still lead to bone fracture. Osteoporosis is more common in women, but can also occur in men.  In fact, Osteoporosis is the most common bone disease.

Bones are a living part of our bodies. They are continually being rebuilt and broken down. In this way, new bone replaces old or damaged bone. Old bone is recycled and important minerals such as calcium and potassium are used in the biological processes of the body. This continual recycling system remains in balance during youth meaning bone rebuilding equals bone recycling. Generally, around the age of 30-45 this system loses balance and favors recycling over rebuilding. This leads to the loss of bone density. This system falls into even greater imbalance for women after menopause. Although bone seems like a completely solid structure, it is made up of varying degrees of passages and canals. As bone density decreases, the porous open spaces in bones increases. Our body uses minerals build bones, calcium is a primary building block for bones and Vitamin D helps our bodies absorb calcium.  Collagen and potassium are also important for bone health.

National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.OR

Osteoporosistreatment.link. Healthy Bone Vs Osteoporotic Bone | Osteoporosis Treatment. 2015. Available at:

http://www.osteoporosistreatment.link/tag/healthy-bone-vs-osteoporotic-bone

Over 9.9 million Americans have Osteoporosis and over 43.1 million Americans have low bone density.  Because of the aging population these figures will most likely increase. Loss of bone density is so common that one out of every two Caucasian women will suffer an osteoporosis related bone fracture. This figure drops to one out of every five for males. The incidence of osteoporosis is lower amongst the African American population.  It is important to understand that both low bone density as well as osteoporosis can lead to fracture.  Other common risk factors for osteoporosis include advancing age, menopause, parental history of hip fracture, low body weight, cigarette smoking, excessive alcohol consumption, sedentary lifestyle, long term glucocorticoid use (steroids such as prednisone), chemotherapy, radiation, low calcium intake, and vitamin D insufficiency. There are many diseases that can increase the risk for osteoporosis, some more common diseases include Rheumatoid arthritis, Lupus, Celiac Disease, Inflammatory Bowel diseases, Diabetes, Hypo/Hyperthyroidism,  Hypo/Hyper Parathyroidism, Depression, and Eating Disorders.

Now that you understand the basics about osteoporosis and the associated risks, you might be wondering how osteoporosis is diagnosed? Osteoporosis and low bone density is diagnosed through a bone density scan. Often, a DXA- dual-energy X-ray absorptiometry scan is used, although, there are additional bone density scanning methods. These scans measure bone density at specific places in your body, such as the hip, pelvis and spine. The bone mineral density is comparted to that of an average young adult of the same gender. This comparison gives a score called a T score.  A T score between -1 and -2.5 means that the person is at risk for osteoporosis, this is sometime called Osteopenia.  A T score below -2.5 means the person has osteoporosis. It is always good to talk to your doctor about your bone health. Your healthcare provider can help you decide when is the right time to begin assessment for osteoporosis. Generally, all women should be tested if they are above 65 years of age, and men should be tested if they are above 70. If you possess risk factors you might be a candidate to begin bone density testing early. It does not hurt to initiate the conversation with your physician after the age of 50 so you can screen for any risk factors early.

The good news is that it there are various ways to help prevent and treat osteoporosis. It might be useful to think of these methods as a pie. The pieces of the pie include diet, exercise, and maybe medication.  The diet slice of the pie focuses on the building blocks of bone: calcium and Vitamin D.  In this way, it is necessary to make sure that your intake of calcium and vitamin D is adequate. Milk and other dairy products, such as yogurt and cheese, are good sources of calcium. 1000 to 1200mg of calcium per day is recommended. Vitamin D fortified milk is a great source of Vitamin D as well as calcium. 800-1000 IU (International Units) of Vitamin D is recommended as well for bone health.  If you are unable to get enough calcium and Vitamin D through your diet it might be necessary to take supplements.

Another slice of the bone health pie is exercise. Weight bearing exercise increases bone density by increasing muscle mass. Some weight bearing exercises include: lifting weights, using tension bands, and using weight machines.  Walking, jogging, and other exercises also help increase bone density. It is best to discuss with your healthcare provider what types of exercises are best for you.  Decreasing alcohol use and discontinuing tobacco products can also decrease the risk for osteoporosis and help to reestablish bone density.

The last slice is medication. Based on your T score your doctor might decide a prescription medication would help with bone health. There are various types of medications, but they all help restore the balance in the bone building and recycling process, in order to increase bone mineral density. Your healthcare provider can help you make an individualized plan to ensure optimum bone health. This plan can include diet, exercise, and lifestyle changes and might include prescription medications. These interventions can help reduce your risk for fracture.

For more information, visit the National Osteoporosis Foundation at http://nof.org/ .

 

 

Bibliography

Askabiologist.asu.edu. Bone Anatomy | ASU – Ask A Biologist. 2016. Available at: https://askabiologist.asu.edu/bone-anatomy.

Lindsay R, Cosman F. Osteoporosis. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19eNew York, NY: McGraw-Hill; 2015.http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&Sectionid=79753850

National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.

Osteoporosistreatment.link. Healthy Bone Vs Osteoporotic Bone | Osteoporosis Treatment. 2015. Available at: http://www.osteoporosistreatment.link/tag/healthy-bone-vs-osteoporotic-bone. Accessed January 1, 2016

Rosen, HN, Drezner, MK. Overview of Management of Osteoporosis in Women. UpToDate, Waltham, MA.