Hello, I’m Dr. Alan Jacobs, Board Certified Rheumatologist with the Arthritis Center of Nebraska. One of my personal interests is in the prevention and treatment of Osteoporosis, a debilitating bone disease that affects as many as 10 million Americans. Thank you for joining me as we discuss “Osteoporosis-Building Your Bone Health.”
Osteoporosis literally means “porous” or spongelike bones that break easily as one ages. It is not the same as osteoarthritis which is a joint disease that leads to joint pain. Osteoporosis does not cause pain until a bone breaks.
There are two reasons why osteoporotic bones break. The first is that there is not enough calcium in the bone to make it strong, so the bones are too thin.
The second reason is mechanical weakness in the structural arrangement of the calcium. This is much like when an old bridge collapses. This is called “brittle” bone. This worsens with advancing age. That is why most osteoporotic fractures occur after 65 years old.
The effects of osteoporosis include serious fractures, especially of the hip and spine. Many people die of the complications of a hip fracture or end up totally disabled in nursing homes, needing wheelchairs or walkers to get around.
Multiple spine fractures collapse the spine and cause severe deformity. These changes cause permanent spine and rib pains.
The problem with osteoporosis is that it is a silent disease. Calcium from the skeleton can be lost slowly over 20 years leading to a gradual loss of height and a spine deformity called “dowagers” hump.
The amount of calcium in the skeleton depends a lot on genetic factors in the family and how fast calcium is lost from the skeleton, especially at the time of menopause for a woman. Men have more calcium in their bones then women.
To find out if early osteoporosis is present, please consider getting a bone mineral density test, which is also called a BMD. The most useful BMD test involves measuring the “density” or the amount of calcium in the lower spine and hip.
The BMD test takes only 10 minutes and is painless with minimal x-ray exposure.
Your bone calcium level is compared to young health individuals and also to people your age. When a comparison is made to your healthy bones, the result is called the T-score. The T-scores that are below minus 2.5 are in the osteoporosis zone.
Your bone density can be followed and a computer can graph the results over a long period of time.
The bone mineral density test is not the only important osteoporosis test. By evaluating a few key risk factors, a calculation can determine the likelihood of getting a fracture in the next 10 years. This can really help decide when to start osteoporosis treatment.
Another very important test is to look for fractures in the spine with x-rays. Many people are surprised to find out about a fracture that they did not know had occurred. These fractures increase the risk of getting more fractures.
Many bone density machines can detect spine fractures and add computer analysis. Repeat fracture tests can be very useful to help judge if osteoporosis treatments are working.
There are key risk factors that may predict who may get an osteoporotic fracture.
These include increasing age, female gender, white race, family history – especially for a hip fracture in a parent, diseases like rheumatoid arthritis, Crohn’s disease, medications like prednisone and seizure medications, smoking, excessive alcohol use, and frequent falling.
Because there are diseases that can cause osteoporosis, it is important to have testing that will look for them. Not every low bone mineral density test will be from the common form of osteoporosis.
It is important to check the “bone vitamin” or vitamin D. Experts want the vitamin D above a certain level for the best bone health.
Certain lab tests need to be done before starting osteoporosis treatments. This includes the blood calcium level and kidney function test.
You can do a lot to help yourself to limit osteoporosis.
Stop smoking, limit the use of alcohol, exercise regularly, and use the amount of calcium and vitamin D supplements as suggested by your health care provider.
For those with a high risk of getting an osteoporotic fracture, prescription treatments should be used.
There are many options like Fosamax, Actonel, Boniva, Evista, Reclast, Miacalcin, and Forteo. Ask your health care provider which one is best for you.
These medications over time will reduce the number of fractures by 50%. Successful osteoporosis treatment is considered to be a major medical breakthrough and one of the most significant medical discoveries in the last 15 years.
If you unfortunately have a spine fracture that causes severe pain, there is hope.
Doctors may be able to relieve the pain in 24 hours by injecting cement into the fractured spine.
This procedure is called an injection vertebroplasty and it is now widely available.
If you have osteoporosis and are on treatment, keep an eye on your calendar to consider repeating the bone mineral density test. In general, the optimal interval is every 2 years.
Bone mineral density changes very slowly and it takes a long time to measure a significant change.
Repeating key laboratory studies over time is also a good idea.
Thank you for your interest in learning more about the prevention and treatment of Osteoporosis. We hope we can be of service to you at the Arthritis Center of Nebraska. We invite you to call 402-420-1212 for more information, or to schedule an appointment.