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    Preventing & Treating Osteoporosis

     Dr. Darla Grossman Family Medicine, Deaconess Clinic West 01/12/2021

    Osteoporosis, a condition in which bones become weak and brittle, is a common condition that can have serious consequences—including premature death from complications of broken bones.

    I’ve been practicing family medicine on Evansville’s West Side for nearly 32 years. In that time, I’ve cared for many patients with osteoporosis, and I’ve seen the serious effects it’s had on their lives due to broken bones and loss of mobility. I’ve also experienced this suffering in my own family.

    I want to help you more fully understand osteoporosis so you can make informed decisions about prevention and treatment as needed.

    What is osteoporosis, and why is it serious?
    Osteoporosis is a progressive and usually age-related skeletal disease in which bones become thin, weak, brittle, and prone to fracture. Osteoporosis literally means “porous bones.” Thinning bones are caused by loss of bone density.

    Nearly 60 percent of American adults age 50 and older are at risk of breaking a bone and should be concerned about bone health. For women, the incidence of osteoporosis is greater than that of heart attack, stroke and breast cancer combined.

    One of the greatest risks to the elderly is a hip fracture due to a fall and weakened bones. These types of falls often lead to a person needing to live in a nursing home, and can lead to other medical complications such as pneumonia. In fact, women who experience a hip fracture are twice as likely to die within a year of the fracture.

    Peak bone mass occurs at age 35 and slow bone loss begins afterwards. Because of the aging of our population, osteoporosis and related complications are expected to increase in the coming decades.

    Who is at risk for developing osteoporosis?
    Osteoporosis has some clear risk factors; the more you have, the more likely you are to develop osteoporosis.

    Risk factors include:
    • Older age
    • Family history of osteoporosis
    • Low body weight and small body frame
    • Calcium and vitamin D deficiencies
    • Smoking
    • Heavy alcohol consumption
    • Sedentary lifestyle
    While men develop osteoporosis as well, it is more common in women, especially those who are post-menopausal.

    Diagnosis and Screening
    Screening and diagnosis of osteoporosis are done via imaging scans.

    Initial screening for osteoporosis is sometimes done via a heel ultrasound, which can show bone loss. However, bone density is best measured via a Dexa scan. These scans are a special type of x-ray that measures bone density.

    As far as who should be screened and when:
    • The American College of Obstetricians and Gynecologists (ACOG) recommends that women receive bone mineral density screening beginning at age 65. Postmenopausal women younger than age 65 should be screened only if they have significant risk factors for osteoporosis or bone fracture, or a history of any stress fractures.
    • Current recommendations are to re-test every two years. However, some research suggests that certain women may be able to wait a much longer time between their screening tests, perhaps as long as five-to-fifteen years. Discuss with your doctor how often you should be tested.
    Also, screenings can help diagnose osteopenia. This is a condition where bone density is lower than it should be for age, but not as severe as osteoporosis. Some may think of it as “pre-osteoporosis.”  Identifying osteopenia early can help prevent osteoporosis because bone strengthening treatments can begin.

    Women under age 65 and men ages 50 to 70 may also need bone density testing if they have significant risk factors for osteoporosis related to aging. These additional age-related risk factors include:
    • Fracturing a bone after age 50
    • History of treatment for prostate cancer or breast cancer
    • History of medical conditions such as rheumatoid arthritis, diabetes, thyroid imbalances, or anorexia nervosa
    • Early menopause (either from natural causes or hysterectomy)
    • Long-term use of medications such as corticosteroids, thyroid hormone, or aromatase inhibitors
    • Low body weight (less than 127 pounds) or low body mass index (less than 21)
    • Significant loss of height
    • Long-term tobacco or excessive alcohol use
    • Strong family history of osteoporosis

    Treatment Options
    Treatment for osteoporosis varies, based upon severity, age and ability of the patient, and patient preferences.

    Treatments can include:
    • Weight bearing exercise, such as walking and strength training.
    • Calcium improvements in the diet, and adequate vitamin D
    • Medications that slow bone loss and/or helps build bone. These should be discussed individually between patients and their doctor.

    Taking care of your bones and preventing osteoporosis
    Osteoporosis can be prevented. Because your body builds bone mass until you are in your 30s, prevention should start early. Making sure you get enough calcium and vitamin D (required for your body to use calcium) is essential.

    Calcium is best absorbed from food, such as dairy products, dark green vegetables and fortified beverages.

    Weight bearing exercise, such as walking or lifting weights, strengthens bones. Research shows that exercise early in life boosts bone mass, while exercise later in life helps maintain it. Experts recommend 1/2 hour of weight-bearing exercise daily.

    Exercise also increases muscle strength, coordination, and balance, reducing your risk of a fall. Yoga and tai chi can improve balance, which also helps prevent falls that cause fractures, especially in the elderly.

    Quitting smoking and limiting caffeine to about 3 cups of coffee a day can also improve bone health. Also, limit consumption of soft drinks—regular and diet. The phosphoric acid in carbonated drinks is bad for bones. This is especially important for teenagers, as they tend to drink a lot of soft drinks.  Teenagers should be building bone mass, so encourage water and calcium-rich drinks.

    In Summary
    Osteoporosis can be silent problem, with no signs or symptoms until a serious break occurs.

    If you’re concerned about osteoporosis, bring it up with your doctor, as he or she can answer your questions and help you determine your individual risk and any appropriate testing.

    Additional Resources
    • FrameWorks at The Women's Hospital
    • The National Osteoporosis Foundation
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