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Treating osteoporosis early is key to success

By Jeremy Cockerill | January 21, 2010

Dr. Susan L. Hall is a preventive medicine physician and a bone medical scientist at Loma Linda University and the Jerry L. Pettis Memorial VA Medical Center in Loma Linda. She answers questions on osteoporosis in this week’s Focus on 5.

QUESTION: What is osteoporosis?

ANSWER: Osteoporosis is a bone condition where the bones of the body are prone to breaking. It is important to realize that bone is not a rock, but rather, it is a dynamic tissue composed of a hard component (containing calcium and phosphate), an elastic component (cartilage), and living cells.

Throughout our lives, bone is continually being destroyed by one set of cells and new bone is laid down to replace it by another type of cell. Osteoporosis occurs when the rate of bone destruction outpaces bone formation. When this occurs, bones throughout the body become less dense and become prone to fracturing.

Osteopenia is the condition where bone is lower in density than normal bone, but it is not as severe as osteoporosis. Over time, if nothing is done to prevent bone loss, osteopenia often develops into osteoporosis.

Q: So what? Broken bones will heal, right?

A: Yes, most bone fractures will heal, but some fractures - especially major fractures, such as those of the hip and the spine - can lead to lifelong pain, disabilities and even death. One out of five people who fracture a hip will die from complications (due to the fracture, surgery or hospitalization), and a significant portion of those who survive are not able to return to the level of independence and functioning they had prior to the fracture.
Fractures of the vertebral bones of the spine can result in chronic back pain for life, severe curvature of the spine, and impingement of the organs in the abdomen.

Q: Who is at risk for getting osteoporosis?

A: Everyone, it just depends on when. As we get older, the rate of bone formation does not keep up with the rate of bone destruction, and so our bones become less dense. For most men, the increase in risk of fracture occurs around the age of 65, but for women, risk increases after menopause (or after surgical removal of ovaries).

This is because estrogen slows the rate of bone destruction, so when a woman stops producing estrogen, bone destruction speeds up. In addition, at any age, there are numerous factors that can increase risk. These factors include having a close relative with osteoporosis, having a slim body frame, taking certain medications, having certain medical conditions, smoking and excessive alcohol intake.

Your doctor can help to determine your personal risk, and if you are at risk, he/she will order an imaging test called a bone density scan. This scan is noninvasive, involves low level radiation, and compares your bone density to the average density of the bones of young, healthy people (individuals whose bones do not break easily). This comparison is called a T-score and the lower your T-score is, the more prone your bones are to breaking.

Q: How can I reduce my risk of developing osteoporosis and fracturing bones?

A: First, avoid smoking and limit your alcohol consumption to no more than two drinks per day. Next, provide your body with the materials (calcium, vitamin D3 and phosphate) that are required for healthy bones. People often obsess over the details of calcium intake. (Which calcium is absorbed faster? Which type is absorbed better? Should I take it all at once or spread it out throughout the day?) Relax, it doesn’t have to be an exact science. While there are some differences between the types of calcium and how they are taken, for most people, these differences are not as important as consistently getting the calcium into your body.

For the average person, the goal is to consume approximately 1,000 mg to 1,200 mg of calcium per day. This can come from diet, a supplement, or both. Calcium-rich foods include dairy products like yogurt, milk, cheese and ice cream, but because some of these products are also high in fat content, it may be difficult to get the full amount of calcium from diet alone without gaining weight.

Estimate how much calcium you get from your diet (a typical dairy serving contains about 100 mg to 300 mg, but you can read the nutrient label to be sure), then add a supplement to make up the difference. Remember, the goal is to be consistent. So choose a supplement that you are willing to take regularly.

Vitamin D is also very important for bone health, but it is difficult to get from foods. We get some vitamin D naturally from sun exposure, but this may not be enough. Recent studies suggest there are additional health benefits from taking extra vitamin D, such as better muscle strength and balance, improved immunity, and a decreased risk of developing certain cancers. Therefore, most experts now recommend taking a vitamin D 3 supplement with a goal of getting around 600 to 1,000 International Units (IU) per day.

Again, it does not have to be an exact science. The vitamin D-3 can come in combination with your calcium, with your multivitamin, or by itself. Remember, it is more important to be faithful in taking it. In regards to phosphate intake, this compound is found in almost every type of food we eat, so for most people, there is no need to seek out supplements or eat any specific category of foods. (More on vitamin D: see page 3)

Q: Is medicine necessary, or can I manage my bones by natural interventions?

A: The answer is “it depends on your individual situation.” Interventions such as adequate calcium and vitamin D-3 intake, regular exercise, reducing fall risk, limiting alcohol intake and no smoking are important. But depending on your age and other risk factors, these nonpharmacological interventions may not be enough to slow the progression of bone loss, and taking a medication may be necessary. There are several FDA-approved medications available to treat osteoporosis, and all are effective in preventing further bone loss.

There have been numerous reports regarding the risk of serious side effects with osteoporotic medications. While these risks should not be taken lightly, in general, these events are rare, and the risk of complications from osteoporotic fractures significantly outweighs the risks posed by taking the medications. It should also be noted that while most individuals on medications to treat osteoporosis will gain back some bone density, the gain is relatively slow, and the amount regained is modest. Therefore, it is important to prevent bone loss early in the process before the loss is significant.

If your care provider has recommended that you take an osteoporotic medication, it is in your best interest to initiate the treatment to reduce the risk of a major osteoporotic fracture.