Bone Health: What You Need to Know About Preventing and Treating Osteoporosis

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Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Falling and breaking a bone can be scary, especially for older people. Every 11 seconds, a US adult over the age of 65 is treated in the emergency room for a fall, and statistics show that 1 in 5 older adults die within one year of sustaining a hip fracture.

It’s not all bad news though. We’ve actually made progress in decreasing the total hip and spine fractures each year. And it turns out, many falls are, in fact, preventable.

Osteoporosis, or brittle bones, is a major risk factor for falls amongst older people. Here’s how you can prevent and treat osteoporosis, so your bones stay strong.

What is osteoporosis?

Bone health directly impacts everyday life, but it’s often taken for granted until a bone breaks. With osteoporosis, bones have low mineral density, which means they are porous and fragile. This increases the risk for fractures, especially in the hip, spine, and forearm, and can lead to limitations in walking, loss of independence, chronic pain, and even mental health issues with age.

How do I find out if I have osteoporosis?

Screening for osteoporosis is super easy. To measure your bone mineral density and find out if you have osteoporosis, you doctor will order a DEXA (dual-energy x-ray absorptiometry) and bone density scan.

Osteoporosis Screening for Men

A 60-year-old man has a 25% chance of having an osteoporotic fracture during his lifetime. Screening is recommended in men who’ve experienced any of the following:

Osteoporosis Screening for Women

Women 65 and older should have a DEXA scan to look at their bone density. You will have one younger than 65 if you have risk factors. Common risk factors for osteoporosis in women include:

It’s not all downhill from 20!

Osteoporosis is largely preventable, especially if you start young and take advantage of your bone-building years. Women acquire about 90% of their maximum bone strength and density by 18 years of age. For men, it’s 20 years of age. Then, overall bone building stops at around age 30 for both genders.

As you get older, you keep adding minerals to your bones, but more and more, processes that break down your bones take over. Women experience a rapid shift to bone loss soon after menopause, but by age 65 to 70, men and women lose bone at about the same rate. Whether or not you’re in your bone-building years, you can take steps to keep your bones strong and slow bone loss.

So, how do I build bone?

High-Impact Exercise

Research shows that bones like impact to grow. In a study from 2014, researchers observed how jumping affected bone density in women aged 25 to 50. Some women in the study performed 10 jumps with 30-second rests in between each jump, twice daily. Others did the same thing with 20 jumps. And the remaining women performed no jumps. After 8 weeks, compared to the women who didn’t jump at all, those who performed 10 jumps had slight improvements in hip bone density, while those who performed 20 jumps showed significant gains.

Vitamin D and Calcium Supplements

Another way to build bone? The sunshine vitamin, vitamin D, and its sidekick, calcium. Vitamin D helps us absorb calcium from food, and adults up to age 70 need at least 600 IU daily (800 IU if you’re above 70 years of age). If you’re not getting enough, vitamin D supplements can be useful. With calcium, try to get at least half of your daily calcium needs from dietary sources, like milk and cheese, before turning to supplements. Depending on age and gender, adults need anywhere from 1000 to 1200 mg of calcium daily.

Is osteoporosis treatable?

Yes!

Bisphosphonates

Currently, the mainstay of treatment is a class of drugs called bisphosphonates. Commonly prescribed options are ibandronate (Boniva), taken once a month, and alendronate (Fosamax), taken once a week.

Bisphosphonates receive a bad rap, but the reasons are often unfounded. For example, there’s a myth going around that bisphosphonates cause esophageal cancer, which they don’t. Some people also seem to think that they cause “dead jaw bone”, but this is exceedingly rare. 100,000 people would need to take bisphosphonates for an entire year to maybe see one case of it.

Prolia

Prolia, an injection you receive once every 6 months, is an alternative to bisphosphonates. It can be expensive, but Prolia actually builds bone better than bisphosphonates do and may prevent more fractures. It can used in people who experience upset stomach with bisphosphonates, and overall, studies show that people prefer getting a Prolia injection twice a year over taking a pill once a month or more.

What about hormone replacement therapy for women?

Hormone replacement therapy (HRT) gives women more estrogen, and bones love estrogen. Doctors used to recommend that all menopausal women consider HRT — that is, until a major research study known as the Women’s Health Initiative Study was published in July 2002. It determined that even though estrogen replacement helps increase bone density, it shouldn’t be used for that purpose given the alternative medications above.

Dr O.

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