Osteoporosis (Brittle Bone Disease)

Many people who have osteoporosis do not know this until they break a bone usually the hip, spine or wrist. Thin fragile weak bones break easily hence the name brittle bone disease. We do not make any more bone after age 25-30. Our bodies build the amount of bone we are going to keep for the rest of our lives. Most importantly, building bone starts during pregnancy. If we do not make enough bone when we are children we do not have enough bone in our bone bank. When we do not have enough bone, especially when we get older, we increase our chances of getting the disease.

How Osteoporosis Affects Us

When calcium leaves the bone it does not hurt. There is no discomfort or signs that anything is happening. The process is silent. It is normal to lose about an inch or two in height when we age. Weak bones when compressed result in us losing height. Breaking bones in our spine is one way that we present with loss of height so your doctor should check your height at your annual wellness office visit. In addition to height loss our spine may become twisted when bones break. A twisted spine interferes with our breathing. Sometimes we feel no pain when we break our spine.

Osteoporosis and Fractures

More bones tend to break after the first fracture. Spine fractures are more common than hip fractures. Most of us do not die when we break our spine. A broken hip may be fatal, it is costly to treat, we may not be able to carry out our daily activities as is customary because of decreased mobility. The resulting chronic pain, loss of self-esteem and depression can affect our quality of life. The bones that tend to break are softer such as ribs, wrist, spine and the head of the thigh bone.

Bone Structure

When we look inside these bones, we see what looks like a honeycomb. There are small spaces with tiny pieces of bone connecting them. During the process of osteoporosis, bones become weak and thin as a result of breaks occurring on the inside. More bones tend to break after the first fracture. The resulting chronic pain, loss of self-esteem and depression can affect our quality of life.

Diagnosing Osteoporosis

DEXA scanning is the  recommended test to diagnose osteoporosis in the hip and spine. Dual Energy X-ray Absorptiometry is the way to achieve this. Other machines measure bone density in our forearm, finger or heel. Results using these devices are not as accurate. We are referred for DEXA scanning when screening reveals low bone mineral density (BMD). Measuring BMD is a way to assess the amount of  calcium and minerals like phosphorus, magnesium, fluoride inside our bones. We are better able to evaluate the possibility of breaking our bone. DEXA scanning does not require much radiation. A chest x-ray requires more. Bone density testing does not hurt and does not take a long time (usually about 15-20 minutes).

Preparation for  bone density testing

Testing requires no additional preparation. Supplements containing calcium and mineral may interfere with testing. Wear clothes that have no metals (zipper, belt buckle). Remove keys, coins from pockets.

Bone Density Testing Results

T-Scores compare bones measured with bones of younger healthy 30 year old males and females. We are better able to assess bone health for the population. The Z-score compares bones measured with bones of persons of the same age, gender, race, ethnicity. The T-scores and Z-scores are the standard for reporting results. Low Z-scores may be the result of a medical condition. It is helpful to continue investigations to ensure there is no underlying condition.    

T-score

-1.0 and above – Normal

-1.0 to -2.5 – Low bone density (osteopenia)

-2.5 and below – osteoporosis

Low bone density with fractures is severe osteoporosis. The results of your bone density test can be put into a program called FRAX which is available online. This online tool calculates the possibility of breaking our hip or spine over the next 10 years. First of all, a T-score is not the deciding factor for treatment of osteoporosis as was once thought. Second, research showed bone fractures in persons with osteopenia who had not developed osteoporosis. Third, FRAX offers a better way of assessing our fracture risk using information for risks for breaking bones in addition to bone mineral density and T-scores. FRAX results play a role in deciding when to treat.

What causes us to lose bone?

Osteoporosis is a disease affecting women and men usually when we get older. Women get osteoporosis more often than men do. Estrogen, our female hormone, protects our bones. Estrogen levels get very low after menopause. Low estrogen levels are not good for bone. Losing bone faster than we can make it increases risk of low bone density and osteoporosis. Men who have low androgen levels, not having enough calcium and vitamin D in our diet, smoking cigarettes and excessive drinking increase our risk of low bone mass. Prolonged use of corticosteroids used in the treatment of medical conditions, thyroid disorders, rheumatoid arthritis contributes to low bone mass as well. The body loses calcium when we eat salty foods. We lose bone by consuming phosphorus and caffeine in soft drinks.

Treatment of Osteoporosis

The objective of treatment is to stop the bone loss, increase bone density and prevent the first fracture. Walking is good for bones and has many health benefits. Strength training exercise reduces the risk of falling. Before starting an exercise program speak with your doctor first. Sardines, mackerel, tuna, salmon, beef liver, egg yolks, cheese are high in vitamin D. Skin exposure to sunlight helps us to make Vitamin D. Activated Vitamin D in the liver and kidneys absorbs calcium. Foods with chewable bones, cheese, milk, yogurt, dark green leafy vegetables are good sources of calcium.

Estrogen used in the treatment of hot flashes slows down bone loss. Estrogen, Alendronate and other bisphosphonates slow bone loss and increase bone density. The FDA approved these medications for  prevention and treatment of osteoporosis. Bisphosphonates are taken in the morning with a glass of water before eating, drinking or taking any other medication. Staying upright for about 30 minutes is recommended after taking this medication. Denosumab is given as an injection two times per year, Teriparatide (parathyroid hormone) builds bone. It is a daily injection. Calcium and vitamin D protect our bones. Staying active helps us maintain strong bones. Our risk of osteoporosis and fractures.