Bones are made up of living tissue that’s constantly changing. During our lifetime, the body relies on the minerals calcium and phosphate to keep our bones strong and healthy. As we age, however, our bodies tend to reabsorb these minerals instead of keeping them in our bones. When more old bone is reabsorbed and not enough new bone is generated, bone loss occurs. Osteoporosis affects about 54 million people in the United States alone.

Although there’s no single cause of osteoporosis, there are risk factors including age, gender, race, family history and body weight and frame. Medications and medical conditions impact bone density as well. Women experience rapid bone loss during the first 10 years after entering menopause.

Symptoms of osteoporosis may include lower back pain, loss of height (1” or more), and postural changes. Osteoporosis is often a silent disease, until there is a fracture. Fragility fractures are defined as a fractures of the wrist, spine, hip or pelvis from a standing height.

Osteoporosis often reveals itself through symptoms like back pain, changes in posture, and fragility fractures. The best way to prevent bone fractures is catching osteoporosis before it can hurt you. (Image licensed from Unsplash)

Fifty percent of patients with a fragility fracture will sustain another fracture within a year. Most worrisome are hip and vertebral (spinal) fractures as these cause the most disability and loss of independence. Current data also indicates a 1-year mortality rate post hip fracture of 21%, so follow up care is essential.

Patients with certain medical problems are at greater risk for osteoporosis and fractures. These include rheumatoid arthritis, diabetes, eating disorders, excessive alcohol intake, smoking, chronic steroid use, and many medications for seizures and chemotherapy. Medications that affect alertness and balance such as sleeping medications and narcotics also increase the risk of fracture.

To better manage care for these patients, Lebanon Internal Medicine (LIMA) and Central Pennsylvania Osteoporosis Center will be working collaboratively with WellSpan Good Samaritan Hospital in developing a Fracture Liaison Program.

Treatment

All treatments include weight bearing exercise, as well as getting adequate calcium and vitamin D. However, these alone are not enough for those at highest risk. Coordinating care with a fracture liaison provider will make sure you complete any rehabilitation plan, keep follow-up medical appointments, and begin and stay on prescription medication to prevent broken bones. Also, you will receive education and counseling on fall prevention and safety measures, and on diet and lifestyle changes that may need to be made, such as reducing the amount of alcohol you drink or stopping smoking.

Bone density testing

In addition to those with a fragility fracture, the guideline for bone density testing (DEXA) is for postmenopausal women over age 65 and men over age 70. For consistency in interpretation, getting the test on the same machine is recommended. LIMA has been managing osteoporosis and performing DEXA scans for over 25 years, with our staff and providers maintaining ISCD (International Society for Clinical Densinometry) certification.

Bone density testing is a painless procedure. There is minimal radiation exposure, roughly equivalent to two days out in the sun and is less than a chest x-ray, or an airplane trip from New York to Los Angeles. The results can guide medical management as there are many treatment options now available.

Patients can obtain an order for the DEXA from their primary care provider, orthopedist, endocrinologist, or rheumatologist.

Prevention

In addition to following the guidance and medications prescribed by your physician, general safety tips can reduce your risk of a fragility fracture.

Always wear your seatbelt.
Wear the right protective equipment for all activities and sports.
Make sure your home and workspace are free from clutter that could trip you or others.
Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
Follow a diet and exercise plan that’s healthy for you.
Use a cane or walker if you have difficulty walking or have an increased risk for falls.

Living with osteoporosis

Osteoporosis itself isn’t fatal and won’t change your life expectancy. But it can make you more likely to experience a bone fracture (and can increase your risk of more severe breaks or complications from a fracture). As described, following a diet and exercise plan that’s healthy for you will help you maintain your bone health. See a healthcare provider for regular checkups. They’ll also help catch any issues or symptoms that affect your bones as soon as possible.

The best way to prevent bone fractures is catching osteoporosis before it can hurt you. Talk with your provider if you have any concerns about your bone health. Prevention and risk reduction is always the best opportunity to ensure your health.