Monday Medical: Guidelines for treating osteoporosis
For Steamboat Pilot & Today
STEAMBOAT SPRINGS — Osteoporosis, a condition in which bones become thinner and more porous, is a “silent” disease: you’re unlikely to experience symptoms until you have that first fracture.
That makes screening and treatment especially important. But recommendations can be confusing.
Dr. Jennifer Kempers, an internal medicine physician in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center, was one of several local doctors who recently worked together to review and align around screening and treatment options. Kempers outlines what you need to know about osteoporosis below.
Why does it happen?
Healthy bone isn’t solid — it actually looks like a honeycomb. But with osteoporosis, the spaces become much larger, either because bone tissue is not replaced quickly enough, or too much gets absorbed.
An estimated one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.
“In the U.S., the annual cost of treating osteoporosis is estimated at more than $16 billion,” Kempers said. “The main bones at risk are the femur and spine, which are bigger bones and result in bigger issues when they are fractured.”
How is it diagnosed?
Osteoporosis is diagnosed through a bone density screening, which helps doctors classify patients in one of three categories: normal, low bone mass (also known as osteopenia) or osteoporosis.
Don’t be surprised if you’re in the low bone mass category.
“The majority of postmenopausal women fall in that osteopenia category,” Kempers said.
Women should start screenings at age 65 while men should begin at age 70.
“You hear about osteoporosis most commonly with women, but men are also at risk and should be screened,” Kempers said.
Earlier screenings may be recommended for people who have other risk factors, such as entering menopause early, a personal or family history of fractures, low intake of calcium or vitamin D, excessive alcohol use and smoking.
Prevention and treatment basics
To help prevent osteoporosis, as well as to treat osteoporosis and osteopenia, adults should consume between 1,000 to 1,200 mg of calcium — a component for healthy bones — from food and supplements each day.
“We used to recommend taking a 1,200- to 1,600-milligram supplement but recent studies show that may increase calcification of the arteries,” Kempers said.
A vitamin D supplement of 800 to 1,000 IU daily helps ensure that the calcium is absorbed.
Be sure to incorporate weight-bearing exercise, such as walking, hiking and jogging, into your workout regimen and maintain core strength and balance.
“Keep muscles strong and work on your balance to prevent falls in the first place,” Kempers said.
When medication is needed
To treat and prevent osteoporosis, medication may be recommended. Bisphosphonates, such as Fosamax, are often a good place to start.
“They’ve been around the longest, and there’s great data on their performance,” Kempers said. “Fosamax shows a 50% fracture reduction at three years.”
However, there are side effects, including irritation to the esophagus and breakdown of the jaw bones. Your doctor will determine whether it’s best to continue or stop treatment after five to 10 years, as atypical bone remodeling may be seen at that time.
Another option is the RANK/RANKL inhibitor, which is given as an injection every six months. While it helps prevent fractures, it has similar side effects as bisphosphonates. And if injections are stopped, bones quickly revert to their previous condition.
Estrogen therapy increases bone density, but since it can also increase risk of cancer, blood clots and cardiovascular issues, it’s not a first-line treatment.
“Talk with your doctor about the options and the risks versus benefits of these medications,” Kempers said. “And remember that recommendations can change. It’s not a perfect science.”
Don’t forget that a healthy lifestyle makes a difference.
“The biggest message of hope I give my patients is to stay active, prevent falls in the first place and eat right,” Kempers said. “A pill is obviously not the end-all-be-all answer.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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