By Rebecca Boesl, DNP

Lake Region Healthcare

What is osteoporosis?

Osteoporosis is a condition that causes the bones to become weak or brittle. Decreased bone density occurs when the body doesn’t produce new bone as quickly as old bone is reabsorbed. I often describe this to my patients as “the bones become like Swiss cheese.” Loss of bone mineral (or decreased density) occurs over time and causes the bones to become weak, increasing the risk fractures. Unfortunately, many people do not even know they have osteoporosis or low bone density until they break a bone.  Fractures occur commonly in the hips, wrists, or spine. 

Who is at risk for osteoporosis? 

The short answer, everyone who lives to old age. Both men and women lose bone density with age, but men generally have higher bone mineral content and slower bone density loss over time. Estrogen plays an important role in slowing the natural breakdown of bone in our body (reabsorption). As women age and near menopause, estrogen levels start to fluctuate and then drop, increasing bone reabsorption and ultimately decreasing bone density. This is largely why women are more susceptible to osteoporosis than men. Women in early menopause or women that have had their ovaries removed need to make sure to talk to their healthcare provider about their risk of osteoporosis. 

White and Asian women over the age of 50 are higher risk.  Others at risk include men with low testosterone, anyone with low body weight, family history of osteoporosis, and those that have undergone bariatric surgery. Smoking tobacco and drinking alcohol increases risk, as well as other chronic illnesses including kidney failure, rheumatoid arthritis, inflammatory bowel disease, hyperthyroidism, liver disease, and eating disorders. There are medications that may decrease bone density as well including long term use of corticosteroids (prednisone and methylprednisolone ), anti-seizure and mood altering medications, proton pump inhibitors (prevacid and Nexium), Depo-provera, and certain medications that treat prostate cancer and breast cancer. Your healthcare provider or pharmacist can help you identify if you are on any medications that might increase your risk for osteoporosis. 

Is there anything I can do to prevent osteoporosis?

The good news is that there are things we can do as we age to help prevent bone loss. Stay away from smoking tobacco, and limit alcohol use (one drink per day for women or two drinks per day for men). Weight bearing exercises can help keep bones strong. Exercises include strength training, walking, jogging, stair climbing, and dancing several days per week. 

Make sure you are consuming enough protein, calcium, and vitamin D in your diet. Having grown up on a dairy farm, my personal favorite source of calcium comes from dairy products (give me all the cheese). Not everyone can tolerate dairy in their diet though, and there are plenty of other sources including fish, grains, dark leafy vegetables (broccoli, brussels sprouts, kale, spinach, peapods), and fortified juices. Because we live in Minnesota and we do not get as much sunlight depending on the season, it may be a good idea to talk to your healthcare provider about starting a vitamin D supplement. 

How is osteoporosis diagnosed?

As mentioned above, osteoporosis is sometimes discovered after a person suffers a fracture. Ideally though, appropriate screening measures are performed, and interventions are in place to help prevent bone loss and decrease risk of fracture. Bone mineral density can be measured by dual-energy x-ray absorptiometry (DXA), or what you might more commonly hear referred to as a “DEXA scan.”  A DEXA is a quick and painless procedure (similar to an x-ray) that looks at bone density most often in the hips and spine, but sometimes in the wrists as well. DEXA scans should be done in all women over the age of 65 and all men over the age of 70. Your healthcare provider may recommend screening sooner however if you have any of the above risk factors or fragility fracture (fracture from little or no trauma). Bone density testing is typically done every 2 years. 

How is osteoporosis treated?

If you are diagnosed with osteoporosis, you should continue some of the above measures including ensuring adequate calcium and vitamin D intake, as well as weight bearing exercises. You should also avoid smoking tobacco and limit alcohol intake. There are prescription medications your healthcare provider may also use to help strengthen the bones and decrease your risk of fracture. Bisphosphonates are most widely used (includes medications such as Fosamax, Boniva, and Reclast). Denosumab (prolia) is a once every 6 month injection that is also commonly prescribed for treatment of osteoporosis. 

It is also important to implement fall prevention strategies to decrease risk of falls and subsequent fractures. Make sure to wear supportive, low heeled shoes with nonslip soles. Your home should be checked for any cords, rugs, clutter, or slippery surfaces that might increase your risk of tripping and falling. Stand up slowly and keep your room brightly lit when getting up at night.