Understanding Osteoporosis

Article written by Eeric Truumees, MD

Osteoporosis is a medical term that describes bones that have become softer and more brittle. This bone weakness makes it vulnerable to fractures and a curvature of the back. Luckily, there are many new means of treating both osteoporosis and its side effects.

Who Gets Osteoporosis?
Osteoporosis is extremely common, and as people live longer, it’s becoming more common. There are several types, but the most common form is called post-menopausal osteoporosis. With the female change of life, the decrease in hormones leads to changes in the way the body makes bone. Normally, the body is always turning over the bone it has (remodeling). After menopause, the body seems to take bone away faster than it makes new bone. The earlier a woman undergoes menopause, the more likely she is to get osteoporosis. Therefore, women that have their ovaries removed early in life are at very high risk. The next most common form of osteoporosis occurs in everyone, men and women alike, as they get older. The older they are, the more bone they lose. In this form of osteoporosis, the less bone you had to start with, the more likely you are to have a fracture. That is, men, who had more bone to begin with, even though they lose bone at a similar rate, are more likely to have enough left over and therefore are less likely to get fractures. People with a history of nutritional or stomach problems, low body weight, or very fair complexion all have an increased risk of osteoporosis. The last important type of osteoporosis is related to medications and other medical problems. People with thyroid or kidney problems, those on steroids (Predisone) or seizure medications (like Dilantin), and others have a high risk of getting osteoporosis and fractures.

How Do You Get Checked for Osteoporosis?
Most women and any patient with risk factors should talk to their family doctor about a screening test for osteoporosis. There are several, but the most common is called a DEXA scan. This painless test takes just a few minutes. You lay on a special table and a camera passes over you, counting the amount of bone in your skeleton. It generates numbers that compare the amount of bone you have with both other people your age (Z-score) and healthy, young adults (T-score). If you have a low score, treatment may be recommended.

What Treatments are Available?
Treatment usually begins with Vitamin D and Calcium. Weightbearing exercise helps maintain bone strength as well. People with severe osteoporosis should avoid certain activities, though. For example, picking up heavy objects from the floor may lead to sudden fracture. Your doctor will discuss an appropriate set of guidelines. Decreasing the risk of falls by removing throw rugs and cords may also be recommended. In those people with worse osteoporosis, various medications may be recommended. There are a number of types, but once a week pills like Fosamax and Actonel have been a major step forward in our ability to protect bone. Your doctor may recommend that you repeat the DEXA scan a year or two later to see how your bones are holding up. Doctors are getting more aggressive in treating osteoporosis because we are learning that fractures of the hip are life threatening.

How About Spine Fractures?
Many of us have seen older ladies with a severe curve to their upper back (hyperkyphosis). This is from untreated osteoporosis and may result from collapse (fractures) of the spine bones (vertebra). Depending on how soft the bone is, these fractures can occur after a fall or simply by turning over in bed. Luckily, most of these fractures heal on their own. Unfortunately, with more fractures, the osteoporotic person gets shorter and more stooped forward. This curvature makes digestion and breathing more difficult. Physical therapy may be recommended to strengthen the back to improve posture and protect the bone. Sometimes, braces are used after a fracture to encourage healing. For especially painful fractures, bone cement can be injected into the spine through a needle (vertebroplasty). In some cases, a balloon is placed into the bone first. When the balloon is inflated, some of the lost height may be restored (kyphoplasty). The cement then holds the fracture to decrease the pain and prevent further collapse. These procedures are done without an incision and with x-ray guidance. There are risks to these procedures. Cement can leak out and pinch the nerves, but this is uncommon.