Osteoporosis
Osteoporosis Overview
Osteoporosis is a progressive disease in which the bones become weak due to decreased bone mineral density. Over time, the loss of mass weakens bones and makes them more likely to fracture—especially in the hip, spine and wrist.
Eighty percent of Americans with osteoporosis are women. Reasons for this include:
- Women have less bone mass to begin with than men
- Women tend to live longer than men
- Women take in less calcium than men
- The rate of bone loss in women speeds up after menopause when estrogen levels fall
- Since the ovaries make estrogen, faster bone loss in women may also occur if both ovaries are removed by surgery
Men are at risk of getting osteoporosis later in life.
You may not know you have osteoporosis until you begin to display symptoms, which often don’t show until after a significant amount of bone loss has occurred. Symptoms of osteoporosis include:
- Frequent broken bones or fractures
- Low back pain
- A hunched back
- Shrinking as osteoporosis causes your vertebrae to collapse
Your Wellstar physician can work with you on a plan to minimize your risk of developing osteoporosis.
Risk Factors
Osteoporosis most commonly affects post-menopausal women, but other groups carry high incidences, including the elderly and people of Asian and Caucasian descent. Factors that can increase the risk of developing osteoporosis include:
- Family history of osteoporosis or broken bones
- Thin body and small bones
- Certain race/ethnicities
- History of broken bones
- Low sex hormones (estrogen)
- Early menopause, before age 45
- Missing periods (amenorrhea)
- Low levels of testosterone and estrogen in men
- Low calcium and vitamin D intake
- Excessive intake of protein, sodium and caffeine
- Inactivity
- Smoking
- Alcohol abuse
- Long-term use of steroid medications, some anticonvulsants and other medications
- Diseases, conditions and eating disorders such as anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases, hyperthyroidism and others
Let your Wellstar physician know if you have any of these risk factors.
Osteoporosis Prevention
It is possible to maintain bone health and prevent osteoporosis. The best defense against osteoporosis later in life is to begin building strong bones as a child. Women develop about 98% of their bone mass by the age of 20, making early intervention vital. Continue with the following healthy behaviors throughout your life to decrease your risk of osteoporosis:
- Eat a diet rich in calcium and vitamin D. The Institute of Medicine recommends you get the following amounts of calcium:
- Up to 1 year old—210 to 270 milligrams (mg)
- Ages 1 to 3 years—500 mg
- Ages 4 to 8 years—800 mg
- Ages 9 to 18 years—1,300 mg
- Ages 19 to 50 years—1,000 mg
- Age 51 and up—1,200 mg
- Participate in regular weight-bearing and resistance-training exercises
- Avoid smoking and excessive alcohol intake
- Consult healthcare professionals about bone health, hormone therapy and medications to prevent or treat osteoporosis
- Get a bone density test when age appropriate
Osteoporosis Diagnosis
If you or your Wellstar physician suspect you have osteoporosis, a bone scan, called bone densitometry, can confirm it. Bone densitometry is a low dose x-ray test that evaluates specific bones to determine if there is mineral loss or bone thinning.
Another available test is the dual energy X-ray absorptiometry (DEXA) test. This test measures the density of the bones in your hips, spine and wrist, which are places likely to be affected by osteoporosis.
DEXA tests can:
- Show if you have low bone density before a fracture occurs.
- Show if your bones are losing density or staying the same when the test is repeated at intervals of one year or more.
- Predict the chances that you will have a fracture in the future.
- Help you and your physician decide if treatment is needed.
Your physician may also order an ultrasound or a CT scan to help check the density of your bones.
Osteoporosis Treatment
Although there is no cure for osteoporosis, it can be treated. Treatment starts with changes to your diet, specifically increases in calcium and vitamin D intake. Your Wellstar physician will help you get more calcium and vitamin D into your diet through food, drink and supplements.
In addition, you will need to increase weight-bearing exercise, which helps increase bone density, through walking, jogging, climbing steps or similar exercises.
Your Wellstar physician will help you plan a diet and exercise program that is right for you.
Medications
Medications are available to help treat osteoporosis by slowing bone loss and helping maintain bone mass.
- Bisphosphonates can slow bone breakdown, preserve bone mass and even increase bone density in your spine and hip, reducing the risk of fractures. Bisphosphonates are used to prevent osteoporosis in people who require long-term steroid treatment for diseases such as asthma or arthritis. Side effects can be severe, and include nausea, abdominal pain, difficulty swallowing, an inflamed esophagus, esophageal ulcers, osteonecrosis (bone death) of the jaw, irregular heartbeats and visual disturbances.
- Raloxifene (Evista®) belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene is recommended only for postmenopausal women, not for men or younger women, to slow bone thinning and increase bone mineral density in the spine and neck. In addition, it seems to lower the risk of breast cancer. A common side effect is hot flashes, and you shouldn't use this drug if you have a history of blood clots.
- Calcitonin is a hormone produced by your thyroid gland that reduces bone loss, may prevent spine fractures and may provide pain relief from compression fractures. When delivered as a nasal spray, it may cause nasal irritation, but it's also available as an injection. Calcitonin isn't as potent as bisphosphonates, so it's normally reserved for people who can't take other drugs.
- Teriparatide (Forteo™) is a parathyroid hormone used to treat postmenopausal women and men who are at high risk of fractures. Teriparatide stimulates new bone growth, while other medications prevent further bone loss. Teriparatide is given once a day by injection. Long-term effects are still being studied, so therapy is recommended for two years or less.
Discuss the risks and benefits of all of these medications with your Wellstar physician before deciding which one is right for you.
Ongoing Care for Osteoporosis
If you begin to take medication for osteoporosis, you will still need to continue a diet rich in calcium and vitamin D, combined with regular exercise. Your Wellstar physician may also recommend other long-term therapies including:
- Hormone (estrogen) therapy can help maintain bone density, especially when started soon after menopause. However, hormone therapy can also increase your risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Because of these concerns, hormone therapy is no longer a first-choice treatment.
- Physical therapy programs may help you increase bone strength and improve posture, balance and muscle strength, making falls less likely.
Protect your back with these measures:
- Good posture—keeping your head high, chin tucked, shoulders back, upper back flat and lower spine arched.
- Place a rolled towel in the small of your back when driving or sitting for an extended period.
- Don't lean over while reading or doing handwork.
- When lifting, bend at your knees and lift with your legs, keeping your upper back straight.
Prevent falls with these measures:
- Wear low-heeled shoes with non-slip soles.
- Check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall.
- Keep rooms brightly lit.
- Install grab bars just inside and outside your shower door.
- Make sure you can get in and out of your bed easily.
- Don’t ignore chronic pain, which can limit your mobility and cause even more pain. Discuss pain management strategies with your Wellstar physician.
Osteoporosis Care
(706) 721-2741
Osteoporosis Care
Osteoporosis, a disease that makes your bones porous and fragile, is twice as common in women than in men. Often called a "silent disease ", many don't realize they have it until they suffer a broken bone, typically in the hip, wrist or spine, due to bone loss.
You can build better bone health throughout your lifetime with things like proper calcium and vitamin D intake, adding weight bearing exercise to your fitness routine, and avoiding behaviors such as smoking or alcohol use.
Our Approach
As you age, it is important to get your bone health checked, especially if you have suffered a fracture that could be related to bone loss. Our osteoporosis team is here to help. We are the region's only Osteoporosis Clinic. Our care starts with a screening questionnaire to evaluate you for risk factors of osteoporosis. From there you get the benefits of our,
- Multispecialty team, including endocrinologists, orthopaedic surgeons and physical therapists, all located in one place and ready to assess and treat your bone health.
- Advanced technology: Dual X-ray absorptiometry (DXA) is a bone density test that takes only 10 to 20 minutes. It is a simple and painless scan that measures bone mineral density in your hip, spine or forearm.
- Bone health counseling and risk assessment: It's never too late - or too early - to do something about osteoporosis. At Augusta University Health, we counsel women of all ages, from adolescents to seniors on how to prevent osteoporosis.
- Clinical trials: As part of the region's only academic medical center, we are actively researching new and improved therapies. Patients may be able to benefit from ongoing clinical trials that offer new treatments to repair or rebuild bone.
Diagnostic Tests and Procedures
It is very important that patients make an appointment with an osteoporosis specialist before a fracture happens. Prevention starts with checking a patient for risk factors and performing tests including:
- Bone density screening, to measure how strong, or how weak, your bones are.
- Blood or urine testing, to screen patients for secondary causes of osteoporosis.
Treatments
Treatments for osteoporosis can range from simple lifestyle modifications to surgery. Our treatments include:
Non-invasive treatments
- Lifestyle modifications and counseling: Our clinic always emphasizes conservative treatments first, including calcium and vitamin D supplements and weight-bearing exercise to counter or prevent osteoporosis, we also offer nutritional counseling.
- Medications and hormone therapy: For patients at higher risk for fractures, we offer antiresorptive medications that can help stop bone loss. Other medications, such as Teriparatide, is an FDA-approved drug that can rebuild bone. Our clinic also has expertise in managing the side effects of these medications.
Surgical treatments
- Advanced fixation and other surgical techniques: Bone healing can be challenging in osteoporosis patients whose bones are already fragile. We specialize in using the latest equipment and techniques for patients with wrist, hip or other fractures or compression fractures resulting in height loss.