Often, breaking a bone after a fall is a patient’s first sign of osteoporosis. If your bones are weak, it doesn’t take much to break them.
Breaks from low-energy injuries are called fragility fractures.
Your bones are living tissue, constantly changing and rebuilding from calcium and other nutrients from your diet. After age 30, your skeleton loses old bone faster than it’s replaced with new bone. The bones don’t shrink in size, but they become less dense and more fragile. For women, the rate of bone loss accelerates after menopause. “Osteopenia” in mid-life means you’re headed for trouble if you don’t get serious about maintaining your skeleton!
Until recently, osteoporosis was considered an inevitable part of aging and there was nothing we could do about it. Now, we can recognize and mitigate risk factors, measure the severity of bone loss and restore some bone density with treatment. The goal is to prevent fractures and the disability they cause. Even if you’ve had a fragility fracture, we want to prevent another.
Adults need:
- 1500 mg of Calcium + 800 IU of Vitamin D in your daily diet. If you don’t consume a quart of milk or 3 cups of yogurt AND spend 30 minutes in the sunshine every day, you need supplements! Measure your diet and do the math.
- 30-60 minutes of exercise every day.
- A balanced, nutritious diet.
- To not smoke!
- A DEXA scan for women at menopause (about age 50) and men at age 65. This bone-density test reveals your “T-score,” or how you compare to healthy, 30-year old bone.
The T-score: Is reported as a negative number. Good = 0
- 0 to -1 = Normal. Keep up the good work.
- -1 to -2.5 = Osteopenia. Change your habits to build bone strength and prevent fractures.
- -2.5 and lower = Osteoporosis. Change your habits AND consider taking bone-building medicines (like Fosamax®).
- Have DEXA scans every 2 years for at least 10 years to trend your bone health and fracture risk.
- If your T-score gets worse even if you’re on medicine like Fosamax, you need more tests to figure out why.
- If your T-score remains stable for 10 years after menopause without medicine like Fosamax, you can probably stop getting DEXA scans.
- If your T-score remains stable for 10 years after menopause WITH medicine like Fosamax, you can probably stop taking the medicine for 2 years, but keep getting DEXA scans. If your T-score starts to go down again, you might need to restart the medicine.
Treatment
- In my practice, I teach patients about bone health and fracture risk, and fix the fractures.
- Your primary-care physician or gynecologist will order routine DEXA scans and medicines like Fosamax, Actonel or Boniva.
- Even if you take medicines like Fosamax, you still need 1500 mg of Calcium + 800 IU of Vitamin D in your daily diet!
- Recommendations for treating osteoporosis are evolving as new research is done. Talk to the doctor who prescribes your Fosamax, etc.. about how long you should take it.
- I refer patients with severe osteoporosis or complex bone health issues to the Osteoporosis Clinic at the University of Rochester.
Osteoporosis–Get more general info from AAOS
National Osteoporosis Foundation
Cool bone health programs: Visit these sites for great info
