What’s it going to take—a break?
If someone asked you to name the silent disease that affects half of all adults age 50 and older, what would you say?
Would you say osteoporosis?
That’s the answer we’re looking for. But not many people—doctors or patients—give the bone-weakening disease the attention it deserves, according to Jodi Hamblin, MD, a bone health specialist with the Spectrum Health Medical Group Bone Care & Osteoporosis Center.
“Osteoporosis is a lethal disease that is frequently ignored,” Dr. Hamblin said, explaining that the disease signals a problem with both the quantity and the quality of bone.
In the United States alone, half of adults age 50 and older either already have osteoporosis or are well on their way to developing it.
Silent and overlooked
The trouble is, osteoporosis doesn’t have symptoms, so most people don’t know they have it until they break a bone.
And even then, many patients don’t realize that osteoporosis was the cause of their fracture—when in fact, a low-trauma fracture almost always indicates osteoporosis in older adults.
“After 50, if you fall from a standing position and you break a bone, excluding your hands and feet, then you have osteoporosis,” Dr. Hamblin said. This type of break is called a fragility fracture.
Osteoporosis can also be diagnosed when a bone density test reports low bone density.
Research suggests doctors and patients tend to overlook the threat of osteoporosis.
According to a 2016 study by Northwell Health in New York, more than two-thirds of patients who suffered a hip fracture said their doctors didn’t tell them they have osteoporosis, and more than half said they weren’t given medication to treat osteoporosis after their fracture was treated.
This lack of information and follow-up is a huge problem, the study’s senior author said, because of the seriousness of hip fractures.
“You can die after a hip fracture, and you’re at great risk of prolonged complications,” said author Gisele Wolf-Klein, MD, in a statement. “You can also be left as an invalid—a fear of many older adults.”
Six months after suffering a hip fracture, only 15 percent of patients can walk across a room without help, according to the National Osteoporosis Foundation.
Getting on top of the problem
Bringing more attention to the prevention and treatment of osteoporosis is the goal that Dr. Hamblin and her colleague, Jeffry Knibbe, MD, are pursuing at the Bone Care & Osteoporosis Center.
The center treats osteoporosis patients who have had fragility fractures in the hip or other bones and compression fractures in the vertebrae. By following up after a break and treating the cause of the bone loss or poor bone quality, doctors can help prevent future fractures.
Patients are more likely to sustain a secondary fracture if they are not treated for their osteoporosis, Dr. Hamblin said.
The bone care center also sees high-risk patients who want to prevent osteoporosis and its effects. These patients include:
- Heart and lung transplant patients, who are at risk because the anti-rejection medications they take are bone weakening
- Breast cancer patients, who are on estrogen-preventing medications that can cause bone loss
- Gastric bypass surgery patients, who typically have bad absorption of nutrients so don’t get sufficient calcium and vitamin D—two essential nutrients for bone health
- Cystic fibrosis patients
- End-stage COPD patients
The care plan includes balance testing, nutritional counseling, bone density testing, blood and urine testing to identify risk factors, and medication review and management.
“Sometimes medications taken for other conditions can get in the way of calcium absorption or directly weaken the bone or even contribute to dizziness,” which can increase a patient’s risk of falling, Dr. Hamblin said.
Physical therapy can help people learn how to build bone through exercise and how to prevent falls, which are responsible for 90 percent of hip fractures.
“Fall prevention is half the battle,” Dr. Hamblin said. “If you have weak bones and you don’t fall, you may never break.”
Osteoporosis risk factors
In addition to the medical issues listed above, several other factors can put you at risk for bone loss and poor bone strength. Risk factors include:
- Advanced age—this applies to both women and men, though the incidence of osteoporosis is higher in aging women because of a drop in hormone levels
- Steroid use (5 or more milligrams a day for three months or longer)—this lowers bone quality in men and women equally
- Overactive thyroid or parathyroid activity
- Cigarette smoking
- Regularly drinking more than two alcoholic beverages a day
- Lack of appropriate exercise
- Low calcium intake
- Vitamin D, vitamin B12 or folic acid deficiency
“There’s an extensive list of causes for bone loss and for poor bone quality,” said Dr. Hamblin. “If we can get those conditions in order, sometimes that’s all we have to do.”
When medications are called for, doctors have a variety of options based on the patient’s situation. For example, some patients need medications that help build new bone, while others need medications to prevent bone loss.
The aim is to decrease the risk of fracture by keeping bone loss in check and by limiting the risk factors for poor bone quality.
A preventable disease
Of course, prevention is the best course of action, and osteoporosis is very preventable, Dr. Hamblin said.
“If we could get kids and young adults to improve their dietary calcium intake and have a good exercise program, that would be huge,” she said. “And if we could eliminate smoking and excessive use of alcohol, that would make all the difference for most people.”