Diagnosis, treatment and how to avoid osteoporosis – The Gazette


Posted: January 30, 2020 at 7:49 am

By Carrie Campbell, for The Gazette

Even though 50 percent of women and 25 percent of men over age 50 will break a bone because of osteoporosis, most people are unaware they have the condition until a bone is broken.

Osteoporosis is a state where your bones are weak. Theres no pain, said Dr. Gina Perri, a family practice physician at Physicians Clinic of Iowa in Cedar Rapids. Sometimes a patient will have an X-ray for some other reason, and a radiologist will see previous spinal compression fractures, and they didnt feel it.

Your body is constantly remodeling its bones.

Before age 30, the making of new bone outpaces the breaking down of old bone, so youre building up your bone mass.

After age 30, you lose slightly more bone mass than you gain. How likely you are to develop osteoporosis a condition that causes bones to become weak and brittle depends on how much bone mass you have banked by age 30 and how rapidly you lose it after that.

Certain factors can increase your risk of developing osteoporosis: having a family history of osteoporosis; being older and/or female; using tobacco; being thin or having a small body frame; not getting much physical activity; and eating disorders like anorexia and bulimia or long-term use of certain medicines such as steroids.

People who are at higher risk of developing osteoporosis and those who are over age 50 can talk with their primary care physician or gynecologist about getting tested for osteoporosis.

People who have certain conditions like rheumatoid arthritis or Crohns disease and are already under the care of an endocrinologist should consult with their doctor to see when they should be tested.

Testing consists of a bone mass density scan, a low-dose X-ray of areas such as your spine, hip, wrist, shin or heel to detect signs of bone thinning and mineral loss.

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Results are based on the bone mass density of a healthy 30-year-old compared to your own value. The ideal T-score is 0. People are considered to have osteopenia, or low bone mass, if they have a score of minus 1 to minus 2.5. A T-score of minus 2.5 or lower is diagnosed as osteoporosis.

Ronda Gibney, 76, of Palo, first discovered she had osteoporosis when her family doctor recommended she get a bone mass density scan after she turned 50.

She started treatment right away alternating a yearly infusion with taking the oral medicine Fosamax once a week. In addition, she takes daily calcium and vitamin D3 supplements.

She hasnt had any broken bones, even with her very low T-scores.

My numbers are usually miraculously bad, Gibney said. It shocks my family doctors.

After diagnosing a patient, PCIs Perri said she looks for secondary sources of their osteoporosis.

The vast majority of women who are postmenopausal, its from a lack of calcium and aging, Perri said. Over the last eight to 10 years, I frequently find people of all ages with low vitamin D levels.

Perri attributes this to increased usage of sunscreen and covering up due to concerns of skin cancer. Thats a good health habit, but sunlight provides vitamin D.

Several lifestyle changes can help prevent or delay osteoporosis.

These include regular weightbearing exercises like walking and dancing, getting the recommended daily dose of vitamin D and calcium, and avoiding tobacco products and overconsumption of alcohol.

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Im a huge promoter of exercise, Perri said. It helps every disease in the book, including osteoporosis.

Studies have shown that calcium works best if you get it through dietary sources such as milk, yogurt, tofu and leafy vegetables. The recommended daily amount for adults is 1,000 milligrams a day, with that amount increasing after age 50 to 1,200 mg a day.

Vitamin D, which helps your body absorb calcium, can be taken as a supplement or gained through your diet. Foods such as salmon, mushrooms and fortified cereals, as well as sunlight, are natural sources of vitamin D. It is recommended that adults get 800 to 1,000 international units (IUs) a day.

When people should start taking medicine for osteoporosis is based on their bone mass density T-score and whether they have any risk factors that might put them on an accelerated track for bone loss. Anyone with a T-score of minus 2 or less is a definite candidate for treatment.

The most common medicines prescribed are bisphosphonates, such as Fosamax or the generic Alendronate and Risedronate, which work for 90 percent of patients. These are usually taken once a week or once a month.

For people with esophageal disorders like acid reflux, chronic kidney disease or who didnt respond to these drugs, other medicines may be given intravenously or through an injection.

Once a patient is on a treatment plan, doctors will monitor their bone density, usually ordering a new bone mass density scan every two years.

What we want is to reduce number of fractures and their resulting impact on quality of life, Perri said.

Medicines are doing something on the biochemical level to stabilize your bones.

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Perri advises her osteoporosis patients to avoid high-impact activities and use common sense in slippery weather conditions.

I walk with a cane now, Gibney said. Im very worried about falling because I lose my balance easily.

I tell people, for Gods sakes, dont be the one on the ladder, Perri said.

Aging: Bones become thinner and weaker as you age

Tobacco use

More than 1 alcoholic drink a day for women, more than 2 for men

Gender: 80 percent of people with osteoporosis are women; men have more bone tissue because they have higher levels of testosterone

Size: Thin people or those with a small body might have less bone mass

Inactivity

Eating disorders

Long-term use of steroids such as prednisone

Family history of osteoporosis

People with rheumatoid arthritis

Women under age 35 who go through menopause

Exercise daily: Weight-bearing exercises, such as walking, jogging, dancing and climbing stairs

Avoid substance abuse: Dont smoke; for women, limit of 1 alcoholic drink a day; for men, limit of 2 alcoholic drinks a day

Get your vitamins: Women age 19 to 50 and men age 19 to 70 should get 1,000 mg of calcium a day, with that amount increasing to 1,200 mg a day for

women after 50 and men after 70. All adults need 800 IUs of vitamin D a day, which helps bodies absorb calcium

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Eat healthy: Foods rich in calcium include dairy products, almonds, broccoli, kale, fish with bones such as sardines, soy products like tofu. Foods that contain vitamin D include oily fish such as salmon, trout, whitefish and tuna, mushrooms, eggs and fortified foods like milk and cereals

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Diagnosis, treatment and how to avoid osteoporosis - The Gazette

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