Monday Medical: When bones don’t heal
For Steamboat Pilot & Today
STEAMBOAT SPRINGS — If you’ve always pictured your bones as being brittle and dry, it’s time to update that image. Your bones are actually living tissue that is constantly getting “remodeled.”
“Bones are building up and tearing down,” said Dr. Jessica Devin, an endocrinologist at UCHealth Endocrinology Clinic in Steamboat Springs. “It can be hard for people to understand that there’s a bone remodeling process going on.”
Sometimes, the remodeling process can go awry. Metabolic bone diseases are conditions that impact bone remodeling in various ways with one end result: fragile bones.
Types of metabolic bone disease
The most common metabolic bone disease is osteoporosis.
“Osteoporosis is silent: People don’t feel bad, and it doesn’t cause pain,” Devin said. “A lot of people say, ‘I feel great — why would I take this medication?’ But it has such a big impact on their lifestyle as they age.”
About 15% of women over age 50 have osteoporosis, and about half of women over age 80 have the disease.
Other metabolic bone diseases may result from an overactive parathyroid gland, vitamin D deficiency, thyroid disease and Paget’s disease.
“A lot of those have to do with hormones,” Devin said. “Post-menopausal osteoporosis is related to estrogen loss, while an overactive parathyroid causes more bone resorption, or bone breakdown.”
Orthopedic surgeons may be the first to notice a problem, for instance, if a patient’s bone architecture appears soft, or if a surgery to correct a fracture or fuse a portion of the spine doesn’t work. If an issue is suspected, an orthopedic surgeon will refer a patient to an endocrinologist.
“This is very, very common,” Devin said. “But often, when people come into the clinic, they’re confused about why they’re there.”
Diagnosing the issue
A bone density scan is the first step in diagnosing metabolic bone disease and is recommended for all women over age 65 and all men over age 70.
A bone density scan is also recommended for people between the ages of 50 and 65 who have additional risk factors. Those include having a disease or condition associated with bone loss, such as chronic kidney disease or inflammatory arthritis; using medications associated with bone density loss, such as steroid therapies, anti-epileptic therapies and medications used to treat breast cancer and prostate cancer; and having a “fragility fracture.” These fractures take place when one falls from a standing position, for instance, if someone trips over a curb.
In an effort to make sure metabolic bone disorders aren’t missed, a fragility fracture protocol is followed at the hospital when people are admitted with fragility fractures to ensure they receive a follow-up bone density scan.
Through the bone density scan and other laboratory tests, Devin can determine whether there’s an issue and how it might be corrected.
“We’re looking for the underlying reason why the bones are abnormally frail,” Devin said. “If we find something, we treat that. If we don’t identify another underlying cause, we can use medication to either inhibit bone resorption or stimulate bone building.”
Heal bone issues first
Before an elective orthopedic surgery, Devin recommends addressing metabolic bone disease. That helps ensure bones have the best chance possible of healing.
“Don’t go in for another surgery without having an evaluation. People can get anxious about waiting, and that part can be hard, but without an evaluation, it can set people up for failure,” Devin said. “It’s not uncommon in older individuals to have someone come in after a failed spine fusion and find hyperparathyroidism. But if we get that addressed and wait several months, then the surgery can work.”
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