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6 Questions About Osteoporosis
Key tips for strong bone health
INstride asked Dr. Matthew Reeves, sports medicine physician at IU Health, Southern Indiana Physicians, to explain the causes of osteoporosis and how one might avoid its most serious effects. Here are our questions and his answers.
What causes osteoporosis?
REEVES: Put simply, it is an imbalance between bone resorption and bone formation. Let me explain: Our bones are constantly changing over, a process known as “bone turnover.” This process is controlled by hormones and involves special cells to build new bone, osteoblasts, and special cells to dissolve old bone, osteoclasts. When the osteoclasts become more active than the osteoblasts, our bones weaken. The root cause of this imbalance is multifactorial and relates to the many risk factors noted below:
Advanced age (>65 years)
Caucasian or Asian ethnicity
Family history of osteoporosis
History of fractures (broken bones) not caused by trauma
Low body weight
Calcium or vitamin D deficiency
Inadequate physical activity
Tobacco abuse (cigarette smoking)
Excessive alcohol intake (>2 drinks per day)
Hormone imbalances (estrogen for post-menopausal females and testosterone for hypogonadal men)
Medications (chronic corticosteroids, excessive thyroid hormone replacement, medroxyprogesterone acetate, heparin, and proton pump inhibitors, such as Prilosec, Nexium, Prevacid, etc.)
Are some people more susceptible than others?
REEVES: Yes, as noted above there is a genetic (or familial) predisposition and it’s more common in females, Caucasians, Asians, and the elderly.
Do certain behaviors contribute to your risk of getting osteoporosis?
REEVES: Absolutely. The modifiable risk factors identified above include those behaviors that increase our risk of getting osteoporosis. Specifically, smoking, excessive alcohol intake, a sedentary lifestyle and a poor diet leading to calcium and vitamin D deficiency, as well as an abnormally low body weight are all behaviors that increase your risk of getting osteoporosis.
How can I find out if my bones are weak or if I’m a candidate for the disease?
REEVES: First and foremost, visit with your primary care physician. He or she can perform an appropriate screening exam. This should include taking a good history to evaluate for the above-mentioned risk factors and identify associated clinical conditions such as menopause or thyroid disease. Additionally, they should conduct an appropriate physical exam and order necessary screening tests. Screening tests may include labs and imaging studies. Dual-energy x-ray absorptiometry (DEXA scanning) of the lumbar spine or hip is the “gold standard” for the diagnosis of osteoporosis. It measures bone mineral density. Initial screening labs geared to discover common causes of secondary osteoporosis include 25-hydroxyvitamin D, a complete blood cell count, calcium, protein, creatinine and alkaline phosphatase levels. Other labs may include blood levels of parathyroid hormone, thyroid stimulating hormone, and testosterone, amongst other specialty testing.
Are there things I can do to strengthen my bones or to prevent bone weakening in the first place?
REEVES: Yes, four essential steps to prevention include:
Get regular exercise.
Ensure proper calcium and vitamin D intake.
Limit alcohol intake.
One should exercise to increase bone mineral density. Weight-bearing with brisk walking and strength training are best. Additionally, calcium and vitamin D supplementation may be beneficial. The World Health Organization recommends at least 1,300mg per day, but not more than 3,000mg of daily calcium intake for women past menopause and men over the age of 65. This can be in the diet alone or through a combination of diet and supplements. Other measures to take in prevention of bone weakening include correcting treatable medical conditions such as hyperthyroidism, hormone replacement therapy for menopause and hypogonadism that increase your risk, and obtain appropriate screening by your primary care physician.
How is osteoporosis treated?
REEVES: There are many different treatments for osteoporosis. These may include lifestyle modifications mentioned previously, medications used to strengthen bones, and treatment aimed at correcting underlying medical conditions that have a high risk of secondary osteoporosis, such as thyroid disease, menopause, hypogonadism, chronic kidney disease and rheumatoid arthritis. All of these should be discussed with your physician prior to engaging in any specific treatment.
As stated, osteoporosis is further prevented and treated with exercise, diet, stopping unhealthy habits and preventing falls. Ongoing monitoring of your disease state and treatment options with your physician is wise.