You can prevent osteoporosis

While many diseases have warning signs, osteoporosis isn’t one of them. The decrease in bone mineral density and bone mass often causes fractures in older adults, resulting in a broken bone from a split-second fall or even a sneeze, depending on the severity of the bone loss.

For many, this is the first sign of osteoporosis.

“Fifty percent of all fractures coming into the emergency department in patients over 70 are related to osteoporosis,” said Donald E. O’Malley MD, an orthopedic surgeon at Falmouth Orthopedic Center. “The prevalence is huge. We usually see wrist fractures in patients in their 50s, vertebral compression fractures in the 60s, and hip fractures in the 70s age groups.”

One of the telltale signs of osteoporosis is the type of fracture. When Dr. O’Malley sees a fragility fracture, such as a broken wrist, ankle, or hip resulting from a low energy fall, he knows it is osteoporosis.

The National Osteoporosis Foundation reports that 54 million Americans have low bone density or osteoporosis. The foundation predicts that one in two women and one in four men over 50 will break a bone due to the disease, with an estimated two million broken bones every year. 

The only way to test for osteoporosis before a bone fracture occurs is a bone density test. The National Osteoporosis Foundation recommends this testing for the following groups:

• Women 60 years and older.
• Men 70 years and older.
• If you have a fracture after age 50.
• Women at menopausal age with risk factors.
• Postmenopausal women under age 65 with risk factors.
• Men between age 50-69 with risk factors.

Risk Factors

There are some uncontrollable risk factors that contribute to developing osteoporosis, such as age, gender, race, reproductive status, and genetics.

In post-menopausal women, the lack of estrogen triggers osteoplastic activity, which eats up bone. That is when women start losing bone density, according to Dr. O’Malley. This also happens in men when they have low estrogen, especially along with other risks, such as drinking alcohol and smoking.

Preventable risks that can be addressed include a sedentary lifestyle, smoking, drinking alcohol, and vitamin D and calcium deficiencies.

“Exercise has been shown to be a preventative measure in study after study,” said Dr. O’Malley.

His prescription for healthy bones includes:

• Start an exercise program, walk every day.
• Do strengthening exercises to help prevent falls.
• Quit smoking.
• Quit drinking alcohol.
• Take Vitamin D3, 800 mg. daily by the age of 60.
• Take calcium - 1200 mg. daily by the age of 60.

Vitamin D and calcium play a large role in the development of bone density and maintaining it over the years. Dr. O’Malley likes to use the analogy of putting money in the bank.

“You start making deposits into the bank at age 12 when you have your first babysitting job. The bank allows you to put money in until you are 25. At age 25, they stop taking deposits. The teller is Vitamin D and calcium is the money in this analogy, the bank is bone. Without the teller, you can’t make deposits. Without Vitamin D, calcium can’t get absorbed into the bone. Thereafter, somebody else comes along and just takes withdrawals out of your bank. They take withdrawals the rest of your life. If they take a lot of money out of the bank, then you will be in trouble. We want to slow down the rate of money taken out of the bank. After age 25, we want to slow down the reabsorption of bone, so it doesn’t get reabsorbed fast, and you have great bone density when you are 50.”

These are also the steps he includes in the treatment of osteoporosis, with some additional requirements.

“I prefer not to talk about treatment with medications as a first line because there are a lot of side effects,” said Dr. O’Malley. “I like to talk about quitting smoking and alcohol, getting out once a day to build on walking up to three miles a day every other day and one mile per day between those days. If you have a fracture, I will bump up the calcium to 2000 mg. per day and Vitamin D3 to 1200 mg per day.”

After six months of treatment using diet that includes foods high in calcium and Vitamin D, exercise, Vitamin D3 and Calcium supplements, and a review of the patient’s bone mass density test, he will then prescribe medication, if necessary.

Treatment with Medications

There are two types of treatment, anti-resorptive agents, which prevent the reabsorption of bone, and anabolic agents that stimulate new bone formation, said Dr. O’Malley.

Anti-resorptive agents include bisphosphonates, which slow down or inhibit the loss of bone, according to the Federal Drug Administration (FDA). They include Actonel, Atelvia, Boniva and Fosamax and generic products. Dr. O’Malley also prescribes Prolia, which is an injection every six months.

Estrogen hormone replacement therapy and SERMS (Selective Estrogen Receptor Modulators) help to maintain bone density.

One of the anabolic agents recently approved for use in 2019 is Evenity, said Dr. O’Malley. It is an injection given every month for 12 months and it blocks the critical protein that breaks down bone, so it allows new bone formation and an increase in bone density. “It’s a great medication,” he said.

Patients are on an anabolic agent for two years followed by an anti-resorptive agent like a bisphosphonate for five years.

“The trick of good osteoporosis treatment is utilizing both,” said Dr. O’Malley. “We want to turn on bone formation for two years and then we want to shut that off, so we stop the reabsorption of bone for five years. It’s critical to have regular follow-ups. Patients should be seen every six months by a healthcare provider with experience in osteoporosis.”