By Monica Therese Cating-Cabral, MD, FPCP, FPSEDM, CCD (ΜΣΦ 2001)
Doctor visits become more often as we get on in years, but usually only when a patient has a complaint – chest pain, dizziness, fever or shortness of breath. These are called signs and symptoms and they help doctors determine what illness a patient may have.
A silent disease
Some diseases, however, have no obvious signs nor symptoms. One such disease is osteoporosis, a disorder where the bones in the body become weak and porous. Under the microscope, healthy bone looks like a compact sponge but with osteoporosis, the spaces are much larger. These larger spaces make the bone less dense and more likely to break or fracture. Osteoporosis is different from osteoarthritis, where there is pain in a joint, like the knee or hip. With osteoporosis, you cannot feel your bones getting weaker and pain occurs only when a bone has already been broken.
Bones likely to break
Osteoporosis is a common, but serious, disease. Unfortunately, many patients discover they have the condition only after they have had a fracture. Around 8.9 million people worldwide suffer from osteoporotic fractures every year, translating to one osteoporosis-related fracture every three seconds. These fractures can happen after tripping or after a simple fall from a standing height.
In more serious cases, the fracture can even happen by just bending down or from forceful coughing or sneezing. These fractures occur more often in the hip and spine but bones can break in other places as well.
Breaking a bone can cause permanent pain and immobility. Patients may become shorter and have a hunched posture. If immobility causes them to lose their independence results in the need for longterm care, depression may set in.
Having one fracture greatly increases the probability of another fracture within the next year. For elderly patients who break a hip, there is also an increased chance of dying from complications related to the fracture.
Risk factors for osteoporosis
Although more common in women after they have reached menopause, osteoporosis may also occur in men. One in three women, as well as one in five men over the age of 50, will experience a fracture due to osteoporosis.
Other factors that increase the chances of developing osteoporosis and fractures include advancing age, Asian or Caucasian lineage, being underweight, smoking, excessive alcohol intake, having a parent with osteoporosis or a hip fracture, and having a previous fracture.
Some endocrine or hormone problems may also result in osteoporosis, such as hyperthyroidism and hyperparathyroidism. Long-term intake of certain medications, such as steroids and diabetes drugs, may also cause bone-weakening.
Testing for osteoporosis
Osteoporosis is best diagnosed using a test called a bone mineral density or a dual energy X-ray absorptiometry (DXA) scan. Even if previous diagnostic tests, like an X-ray or ultrasound of the wrist or heel, indicate the condition, one will still need to have a DXA scan.
An unusual fracture, frequent fractures or a suspicion that a fracture is caused by an underlying disease will warrant further evaluation with more diagnostic exams.
Proper nutrition and exercise as early as childhood contribute to bone strength. As we age, we slowly lose bone mass, but osteoporosis does not always occur as a consequence of aging. The sturdier our bones are in our youth, the less likely we will develop osteoporosis at a later age.
Get enough calcium and vitamin D in your diet from food sources such as milk, cheese, egg yolks, salmon and tuna, or from supplements. One can also get vitamin D by spending time under the mid-day sun for about 10-15 minutes but, with our climate and risk for skin cancer, we usually do not get enough sun exposure.
If you have bone disease, your levels of calcium and vitamin D should be measured so that you can be prescribed the correct dose of these supplements.
Weight bearing exercise, such as walking and jogging, is essential in building strong bones. Lifting weights is also helpful but should be limited to less than 10 pounds you have osteoporosis. Aim to exercise 3 to 5 days a week, 30 minutes each day.
After attending to other related diseases, fractures can be prevented and osteoporosis can be treated with several types of medications, ranging from tablets to injections. Your physician will advise the best one for you.
There are some concerns that taking these medications for a long time can actually cause more fractures than prevent them. Although this is very rare, it is best to ask your doctor if you should continue your medication or switch to another type of treatment if you have been taking your medication for three years or more.
Another related, but rare, condition may occur after tooth extraction where a section of the jawbone does not heal. Ask your doctor what to do if you need dental work before being treated for osteoporosis or if you are already on medication.
Keep calm and don’t fall
Fractures usually happen after a fall, so take care and pay attention to your surroundings. Avoid slippery surfaces and having loose rugs at home. Keep your rooms brightly lit and turn on the lights if you get up at night to use the bathroom. Walk with a cane for support if needed and install grab bars in your shower and bathroom.
Don’t smoke and don’t drink too much alcohol. Being intoxicated can increase your risk for falling. Also have your eyes checked regularly. Be careful when lifting heavy objects and bend at the knees and not from the waist. Lift objects slowly and do not strain your back. Even better, have someone else do the lifting for you.
When to see your endocrinologist
If you have any of the risk factors mentioned or have suffered an unusual fracture after only minimal trauma, do not hesitate to see your physician for evaluation. Prevention of the first fracture and early identification of osteoporosis, or prevention of another fracture, ultimately lead to better health and quality of life in the later years.