Osteoporosis (OP) is the most common type of bone disease characterized by a decrease in bone density, which can lead to fracture. Bone is living tissue and existing bone is constantly being replaced by new bone. OP occurs when the body fails to form enough new bone or when too much bone is reabsorbed by the body, or both. OP is silent until you fracture. Fractures are most likely to occur in the hip, spine and wrist. Because of osteoporosis about half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra during their lifetime.
Who is at risk for OP?
People think of osteoporosis occurring only in the elderly or postmenopausal women, but this is not true. Risk factors for OP include:
- Patients taking certain medications, such as corticosteroids, aromatase inhibitors, certain anti-seizure medications, anti-androgen therapy, blood thinners, PPIs.
- Patients with celiac disease or other malabsorption disorders, chronic liver disease, inflammatory bowel disease, hyperparathyroidism, hyperthyroidism, kidney disease.
- Patients with a family history of a parent breaking a hip
- Patients with a history of anorexia nervosa or low body weight
- Patients with Rheumatoid Arthritis
- Patients with history of cigarette use or excessive alcohol use
- In men, sex hormone levels also decline after middle age. These declines probably also contribute to bone loss in men after around age 50.
How is Osteoporosis Diagnosed?
Your doctor may use one or all of the following:
- DEXA-The most widely used bone mineral density test is called a dual-energy x-ray absorptiometry, or DEXA test. Although no bone density test is 100% accurate, this type of test is the single most important predictor of whether a person will have a fracture in the future.
- FRAX- In 2008, a World Health Organization (WHO) task force introduced a Fracture Risk Assessment Tool, FRAX which estimates the 10-year probability of hip fracture or major osteoporotic fractures combined (hip, spine, shoulder, or wrist) for an untreated woman or man using easily obtainable clinical risk factors for fracture. Your doctor may use FRAX in conjunction with DEXA results to determine if treatment is warranted.
- X-Ray of the Spine- An x-ray of your spine may be ordered to determine whether you have had a fracture.
Who should have a DEXA?
- Younger postmenopausal women and men age 50-69 with clinical risk factors for fracture, as outlined above
- Adults who have had a fracture after age 50
- Women aged 65 years and older and men age 70 and older, regardless of risk factors
Osteoporosis is largely preventable and people who already have osteoporosis can slow its progression and reduce their risk of developing fractures.
The primary goal in treating people with osteoporosis is preventing bone fractures. A comprehensive treatment program includes a focus on proper nutrition, exercise, and prevention of falls that may result in fractures. Your doctor may also prescribe one of several medications that have been shown to slow or stop bone loss or build new bone, increase bone density, and reduce fracture risk.
If you take medication to prevent or treat osteoporosis, it is still essential that you also obtain the recommended amounts of calcium and vitamin D.
Remember to discuss with your rheumatologist whether a DEXA is indicated as part of your comprehensive health program.
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