September 12, 2020
When you think everything is going OK in your world, then out of the blue, after an annual exam your doctor reports… “You have osteoporosis.” Hearing the news may leave you a little shell shocked! This “silent enemy”/disease can be lurking inside one’s body without signs or symptoms for decades.
Osteoporosis is a condition in which the bone becomes porous, brittle and fragile from loss of bone structure and minimal content. As a result, the bones become very weak and are prone to break. Even a simple sneeze can cause a fracture (break).
Some 44 million people in the United States are at risk for this potentially debilitating disease, which is responsible for 2 million fractures a year. These fractures are usually the first signs of the disease. It can affect any bone, but the most common locations are hip, spine and wrist.
Our skeletal bones are living tissue which is constantly being renewed through resorption and formation that occurs throughout life. Resorption is the process where old bone is broken down and formation is the stage in which new bone is produced to replace the old. During childhood and early adulthood more bone is produced then removed, reaching maximum mass and strength by mid 30’s. After that, bone is lost at a faster rate than it is formed. Most cases of osteoporosis occur as an acceleration of this normal aging process.
Osteoporosis occurs most often in older people and in women after menopause. It affects half of men and women over the age of 75. Women are 5 times more likely than men to develop the disease, because they stop producing the bone protecting hormone called estrogen. In the first 5-7 years following menopause, women can lose about 20% of their bone mass. By age 65 to 70, men and women lose bone mass at the same rate.
Several diagnostic tools are available to measure bone mineral density (BMD). One of the preferred and most accurate ways to measure BMD is a DEXA Scan. While no bone density test is 100% accurate, the BMD test is an important predictor of whether a person is at risk for fractures in the future.
Once a BMD test is done, that person is given a T-score. The greater the negative number the more severe the osteoporosis. According to the World Health Organization and National Osteoporosis Foundation, a T-score of -2.5 or lower indicates that you have osteoporosis. A score between -1.0 and -2.5 is osteopenia (low bone mass), that can be a precursor to osteoporosis.
Ideally, women should have bone density measured at menopause, and periodically afterward, depending on their risk factors and condition of their bones. Men should be tested around age 65.
The good news is, under the supervision and guidance of your medical doctor or specialist there are a number of treatments for osteoporosis, most of them medications. There are alternative treatments to focus on maintaining or building strong bones. A healthy diet with calcium-rich foods, fresh fruits, vegetables and nutritional supplements (such as calcium, magnesium, and vitamin D). Performing weight bearing exercises and activities is an important component for both prevention and treatment to good bone health.
Fear of hurting oneself is very common but do not let this “silent enemy” take you down! If you have been diagnosed with osteoporosis/osteopenia you would benefit from a physical therapist who specializes in this condition. He or she will first perform an initial evaluation looking at past medical history and assess overall strength/flexibility. An individual plan of care will then be developed which includes education and guidelines for safe and appropriate exercises. Emphasis will be on weight bearing activities, strength, posture and balance to maintain or improve bone strength and decrease the risk of falls.
Remember osteoporosis/osteopenia is 100% preventable if we can reduce our risk factors, eat a calcium fortified diet and exercise at an early age to build that bone mass as much as possible.
Bone, Joint and Back Health Lecture March 13 2020. Ginger Shirmer, PhD., R.D.
National Osteoporosis Foundation’s, PR Newswire Arlington, VA., March 10 2020
Osteoporoses Int. 2016 July 11; 27(8): 2643
Osteoporosis Int. 2015 May 19; 26(7): 2045
Osteoporosis Int. 2015; 26(7): 2045-2047
T-Score graph from: https://ihealthmama.com/when-does-osteopenia-develop-who-gets-it/
Osteoporosis bone comparison from: https://www.caribbeanmedstudent.com/2016/01/osteoporosis/