Categorized | Features, Healthy Lifestyle

What to look for if you think you have osteoporosis

By Dr. Gary Blanchard

Q: I was diagnosed with osteopenia. I have been faithful with my diet, vitamin D, calcium and a strict walking routine. At 64, I have had very few other health issues. A few weeks ago I suddenly developed severe back pain. I was told that I have a broken bone in my lower back as a result of my osteoporosis. What is the difference between osteoporosis and osteopenia? How will my treatment now change? What are my options for treating this new pain?

A: Dear Lynn, I have referred your question to my colleague, Dr. Nitin Trivedi, an endocrinologist.

Osteoporosis is a condition characterized by loss of bone and compromised bone strength. Due to weak bones, patients with osteoporosis have a tendency for bone fractures with minimal injury (low trauma fractures) or sometimes spontaneously without any injury. Osteoporosis is diagnosed by measuring bone density using a machine commonly referred to as DEXA or DXA. The bone density is measured in terms of T scores. Normal T scores are -1.0 and higher. If the patient’s T score is below -2.5, then the patient has osteoporosis.

Osteopenia (low bone density) is a condition when the bone density is between normal and osteoporotic range. Patients with osteopenia are also at risk for low trauma bone fractures. Bone density measurement is recommended by the National Osteoporosis Foundation in females over 65 years and males over 70 years of age. Bone density can be performed in selected younger patients if there are risk factors for bone loss, for instance, long-term treatment with prednisone.

Osteoporosis is a very common medical condition. According to the National Health and Nutrition Examination Survey III (NHANES III) about 10 million Americans have osteoporosis and about 34 millions have osteopenia or low bone density.

Osteoporosis is a silent disease unless bone fracture occurs. Although osteoporosis is more common in women, it is also not uncommon in men. Osteoporosis in men is generally not appropriately screened, diagnosed and treated. Fracture of vertebra (back bone) generally causes pain and loss of height.

Once diagnosed with osteoporosis, prescription medication becomes necessary in addition to adequate daily calcium and vitamin D intake. Furthermore, most patients with osteopenia should also be treated with prescription medications if the calculated future fracture risk is high by using the FRAX score calculator (www.NOF.org and www.shef.ac.uk/FRAX).

Currently the Food and Drug Administration-approved medications for osteoporosis treatment are alendronate (Fosamax), ibandronate (Boniva), risedronate (Sctonel) and zoledronic acid (Reclast), calcitonin (Miacalcin), teriparatide (Forteo), raloxifene and danuzumab (Prolia).

Treatment for back pain due to osteoporosis related spine fracture is typically done by pain medications used for other painful medical conditions. Physical training could be very helpful to learn adequate posturing and balance. A back brace, corset, etc. could also be useful in pain relief as these devices reduce loads on the fracture sites. Long-term use of these devices can cause muscle de-conditioning. Patients with back pain refractory to these measures may be candidates for kyphoplasty or verteboplasty. Pain generally takes few weeks to get better.

Normal people accumulate bone up to certain age to reach peak bone mass, which is typically in the late 20s and early 30s. Highest bone mass is called the peak bone mass. After attainment of the peak bone mass most subjects will lose bone to certain extent. This loss of bone is dependent on many factors including genetic makeup, nutrition, smoking, physical activity, medical illnesses and medications. Calcium and vitamin D supplementation can prevent rapid bone loss; nonetheless, some patients continue to lose bone despite using adequate calcium and vitamin D.

Dr. Trivedi practices at Saint Vincent Hospital. His office is located at Grove Medical Associates, 26 Queen St., Worcester, 508-753-2060. Dr. Gary Blanchard is a geriatrician at Saint Vincent Hospital as part of the Saint Vincent Medical Group. He is accepting new patients and can be reached at 508-363-5630. To submit a question for next month’s “Ask A Geriatrician” column, email it to diane.forte@stvincenthospital.com.

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