Bones

Both osteopenia and osteoporosis refer to decreased bone strength and it is one of the most important issues facing both men and women as they age. It is the health of their skeletons. No one wants to break a bone from trauma; a car accident, a fracture while jogging, or because of a tumor that has spread to bone or in rare cases originates in the bone itself. However, there are conditions in which one’s bones get weak and sometimes break. Some of it has to do with age, but most of it has to do with gender and nutrition.

Just how important is this? About 8 million females and some 2 million males suffer from osteoporosis in America. Eighteen million suffer from osteopenia. Two million people suffer fractures per year, vertebral bones first (the bones of the spine), followed by the hips and then the wrists. This is not easy since 5-20% of people who are elderly die after a hip fracture.

Let’s understand gender and nutrition. First let’s take gender. Being male or female has a big difference in your propensity for weak bones. Estrogen, a female hormone, is the mainstay of bone health in both men and women. But men have large amounts of testosterone in their blood (around 1000 to one compared to females) and the testosterone keeps bones intact. Females reach menopause and estrogens decline and this results in bone resorption and the latter coupled with genetics; namely, whether mother or your aunts and female cousins have deteriorating bones adds to the risk of bone resorption. After menopause, hormone replacement treatment helps to ameliorate bone loss, but that has its own issues like a risk for cancer in a variety of organs from the breast to the ovaries. So, it’s a balancing act for most women. If your doctor feels that you are at risk of fracturing bones, the doctor will prescribe something to protect your bones.

Women who are post menopause should have a bone mineral density (DEXA) study every so any years depending on the risk of osteoporosis. Men who have had loss of androgens after something like prostate surgery and are on hormone therapy might also be at risk of osteoporosis, and the doctor must determine the risks. Scans should be done according to the official guidelines, which say that young ladies after menopause, males age 50-69 with risk and all people with risk factors should have a scan. Women over the age of 65 and men over 70 should also be scanned. People should also be scanned If one has suffered fractures or is at risk because of medications.

Let me say a word about medications or those environmental things that place you at risk. Certainly, being a woman, being elderly, and being of the white race puts you at great risk. If you had a first degree relative who had a fracture due to bone loss you are at risk. Those who take cortisone, anticoagulants, aluminum containing antacids, and many forms of chemotherapy should also be examined. Alcoholics, smokers, very skinny people, those with dementia, low calcium diet, or are deficient of estrogen by hysterectomy or for other reasons, should be examined. By examined, I mean they should have a DEXA scan.
Let me define osteopenia and osteoporosis. Osteopenia is determined based on two things after DEXA; comparison of your readings with people of your own age and comparison of your data to young people who are the gold standard of bone health. These are given a score and your doctor determines your status of bone health on a graph. Statistically, your bone health is determined based on how far your density of bone is from the normal. Without getting too technical, if you have bone loss you might be called as one with osteopenia (meaning lacking bone). Osteoporosis is worse than osteopenia because it indicates loss of bone structure and could portend an impending fracture. Generally, the scores are calculated in the hips and spine. Some doctors are good enough to actually see the loss of bone on a plain X-ray of the wrist or the chest, but the real way to determine either condition is to have a DEXA done.

Treatment of osteopenia and osteoporosis is quite advanced today. The doctor traditionally attempts to give medicine that prevents resorption of bone (bisphosphonates) or in one instance actually makes bone (Teriparatide). The problem with the drugs is that they are given intravenously in severe instances or by mouth in most cases. Patients usually find them “hard to swallow” (literally) because they are poorly absorbed and have to be ingested in a certain manner. There are newer agents like Denosumab which is taken twice per year by injection that prevent further bone resorption. All patients on therapy for osteopenia or osteoporosis should ingest calcium or vitamin D in some fashion.

Nutrition is another area of interest. Good nutrition builds bone and by that, I mean a good diet rich with calcium, phosphorus and vitamin D. These are all good components of the diet that are essential for bone health. Almost every other patient asks me about Vitamin D and virtually everyone who has been told they have low levels are taking some sort of supplement. Be careful and take these supplements after your doctor measures your calcium and phosphorus. Ultraviolet light is important to the making of vitamin D, which occurs through the skin. However, you might wish to balance the need for skin induced vitamin D synthesis with the risk of skin cancer. During the winter when we are inside the house, older people in nursing homes who rarely get outside and people who shun light are at risk for low levels of vitamin D. Vitamin D is essential for calcium and phosphorus regulation, which is a major aspect of bone health. Therefore, take vitamin D only if your doctor suggests that you need it.
All in all, bone health is important as we grow older. One of the best ways to maintain bone health is to be active. A daily walk, weight lifting, the treadmill or elliptical and a good diet will keep you and skeleton intact for many years.