You can prevent osteoporosis related fractures:
Osteoporosis is a growing problem in our maturing population. It is the most common bone disease in humans. It is commonly confused with osteoarthritis because it starts with the greek prefix “osteo” which means “bone”. Osteo-arthritis is the wear and tear arthritis that loudly announces itself with achy sore joints. Osteo-porosis is the word used to describe thin or porous bones. Osteoporosis is known as a “silent disease” because it has no warning symptoms. The underlying problem in osteoporosis is the decrease in the amount of calcium structure in the bone. When looked at through a microscope bone looks a lot like a sponge with many tiny bridges forming the stuff of bone. Bones with osteoporosis have fewer bridges and thinner bridges. As a result, thin bones are at risk to fail when overstressed. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites. Patients with osteoporosis are literally “one trip away from a fracture”. What starts as a “silent disease” can lead to major life altering fractures of the hip, spine and wrist. One out of every two white women will experience an osteoporotic fracture at some point in her lifetime. After a hip fracture only half of patients return to the same level of performance. If you walk without a cane or a walker before your fracture, it’s a flip of the coin as to whether you will need one after your fracture. If you use a cane or a walker, a hip fracture could put you into a wheelchair. About 1 in 5 patients who have a hip fracture die within a year. Fractures are certainly not limited to a major joint like your hip. Fractures are even more common in the bones of your back – the vertebrae.
Osteoporotic fractures of the spine can lead to height loss, round back deformity, chronic pain and death.
Fractures of the wrist come from attempts at breaking the fall using your hands. Wrist fractures can lead to deformity and arthritis that make the routine daily activities of the hands painful and difficult. These common fractures can also cause psychological symptoms, most notably depression and loss of self-esteem, as patients grapple with pain, physical limitations, and lifestyle and cosmetic changes. Anxiety, fear, and anger may also impede recovery. These difficulties and the loss of independence that goes along with these fractures strain interpersonal relationships and social roles for patients and their families.
There is also a great cost to society for the fractures of osteoporosis. The National Osteoporosis Foundation reports that the average cost for a hip fracture is $40,000. The estimated cost of osteoporotic fractures to the health system is $17 billion each year. Some estimate that this cost will triple by 2040 as our population continues to age. There is great incentive from a personal and public perspective to prevent the problems of osteoporosis.
It is clear that as we all become “less young” the amount of calcium in our bodies goes down. As our bones’ density decreases the risk of fracture climbs exponentially. This is much more of problem for women. As women go through menopause, their bones can lose as much as 3% of their calcium per year. Overly thin women have less bone to lose and are at even higher risk.
Until the last 5 – 10 years most doctors were given little information on osteoporosis other than to recognize that it is a problem. Newer medicines have caused increased interest in the diagnosis and management of this public health problem. Fosamax, Actonel, Miacalcin, Fortéo, Boniva, Reclast and other medicines have made it possible to increase the calcium density of your bones and to decrease the likelihood of having an osteoporotic fracture. The first step is become aware of your risk. The risk factors for fractures due to osteoporosis are not difficult to identify:
MAJOR RISK FACTORS FOR OSTEOPOROSIS RELATED FRACTURES
Postmenopausal white female
Fracture as an adult
Osteoporotic fracture in mother or sister
Low body weight (< about 127 lbs)
Current smoking
Use of Prednisone for > 3 months
OTHER RISK FACTORS
Poor vision
Estrogen deficiency at an early age (<45 yrs)
Dementia
Poor health/frailty
Recent falls
Low calcium intake (lifelong)
Low physical activity
Alcohol >2 drinks per day
A simple painless test exists which measures the amount of calcium in your bone. A bone density scan (or DEXA scan) gives a number that establishes or confirms the diagnosis of osteoporosis. Bone density predicts fracture risk just like blood pressure predicts the risk of stroke or heart trouble. The lower your number is, the more likely you are to get a fracture. Because of the high numbers of hip and spine fractures, these are the two most frequent locations scanned. The bone density scan can produce a pretty graphic that shows where you stand compared to normal (T score) and to folks your own age (Z score). You may have thought that being graded on a bell curve was something you left back in highschool or college, but when doctors measure the amount of calcium in our bones they compare the amount of calcium in your bone to normal bones as measured on a curve. If you score -2.5 or less on your bone density scan then you have osteoporosis and are at high risk of a fracture.
A T score between -1 and -2.5 signifies osteopenia, indicating some increase risk of fracture and you should be working hard not to fall any lower.
The National Osteoporosis Foundation recommends BMD testing should be performed on: 1. All women aged 65 and older regardless of risk factors.
2. Younger postmenopausal women with one or more risk factors
(Other than being white, postmenopausal, and female).
3. Postmenopausal women who present with fractures
(To confirm diagnosis and determine disease severity)
Once you know you are at risk then you can improve your bone density and work to prevent the costly consequences of osteoporotic fractures. Steps that nearly all patients can start to prevent fractures include adequate daily calcium and vitamin D in your diet and regular weight bearing exercise. The recommended dietary allowance for calcium for patients over age 50 is at least 1200 mg per day of elemental calcium. The safe upper limit for total calcium intake has been set at 2500 mg/day. But just taking calcium supplements isn’t enough. Eating calcium only puts the calcium in your gut. Equally important is getting enough vitamin D in the diet. Vitamin D helps your gut absorb the calcium and gets the calcium into you blood where it can be used. For patients at high risk for osteoporosis 400 – 800 IU of Vitamin D is usually enough. Spending time outside in the sunshine also helps your body make its own Vitamin D. You might think that just popping the extra calcium and vitamins would be good enough to protect you from fractures. However, to get the calcium out of the blood and into the bone the most important step in prevention is regular weight-bearing exercise. The stress of the body’s weight against gravity stimulates the bone to become stronger. Walking, jogging, stair climbing, dancing, and tennis are all good forms of exercise. Besides building stronger bones, strengthening muscles can also help prevent falls. Before beginning a vigorous exercise program it is prudent to visit your family practice or internal medicine physician for their guidance. A good source to begin an exercise program for seniors can be found free online at the National Institute on Aging. For patients at risk, a bone density scan will confirm the diagnosis of osteoporosis. If the T-score is less than -2 then you should make an appointment with a primary care physician who cares for patients with osteoporosis or an endocrinologist for the selection of one of the newer drugs that can increase your bone mass.
Osteoporosis is a “silent disease” that can have major impact on your overall health and you can help prevent the fractures.
To start preventing osteoporosis fractures:
Calcium 1200mg/day
Vitamin D 400 – 800 IU/day
Weight-Bearing Exercise
Bone Density Scan when at risk
Drug therapy if Osteoporosis
Dr. DeHart is a board certified orthopaedic surgeon who practices in the Austin, Cedar Park and Central Texas area. He is a specialist in the treatment of hip and knee arthritis and sports medicine. He completedafellowship in adult hip and knee surgery at JohnsHopkinsHospital. He holds a certificate of added qualification for sports medicine and is a fellow in the AmericanAcademy of Orthopaedic Surgeons, the American Association of Hip and Knee Surgeons, and the American Orthopaedic Association. He is available for group talks on topics relating to orthopaedic surgery including sports injuries, arthritis, osteoporosis and joint replacement. You can learn more about Dr. DeHart or make and appointment by visiting our website at or by calling (512) 439-1000.
For more information on osteoporosis and exercise, check out the following links:
NIH: National Institute of HealthOsteoporosisResourceCenter
WHO calculation of 10 year fracture risk:
National Osteoporosis Foundation
Alliance for Aging Research – good computer videos on osteoporosis and prevention.
National Institute of Aging: Exercise recommendations for those at risk
Institute of Medicine: Look under food and nutrition for recommended daily allowances
General information on many orthopaedic topics:
Calcium and the food we eat:
Dairy products / Serving Size / Calcium (mg)American cheese / 1 oz. / 174
Blue cheese / 1 oz. / 150
Buttermilk(<1% fat) / 1 cup / 657
Cheddar cheese / 1 oz. / 204
Cottage cheese / 1 cup / 126
Frozen yogurt / 1 cup / 200
Ice cream / 1 cup / 176
Milk / 1 cup / 300
Parmesan cheese / 1 oz. / 390
Soy milk (calcium fortified) / 1 cup / 200-300
Soy milk (not calcium fortified) / 1 cup / 10
Yogurt (non-fat) / 8 oz. / 294
Fruits / Serving Size / Calcium (mg)
Cantaloupe / 1 cup / 18
Dried figs / 10 / 269
Orange juice (calcium-fortified) / 1 cup / 300
Orange (medium) / 1 / 52
Raisins / 1/2 cup / 35
Vegetables / Serving Size / Calcium (mg)
Asparagus (cooked) / 1 cup / 43
Broccoli (cooked) / 1 cup / 70
Carrots (cooked) / 1 cup / 48
Chickpeas (cooked) / 1 cup / 80
Collard greens (cooked) / 1 cup / 148
Green beans (cooked) / 1 cup / 58
Kidney beans (cooked) / 1 cup / 74
Lima beans (cooked) / 1 cup / 55
Potatoes(mashed w/milk) / 1 cup / 292
Soybeans (cooked) / 1 cup / 131
Spinach (cooked) / 1 cup / 245
Grains / Serving Size / Calcium (mg)
Cereals (calcium-fortified) / 1 cup / 300
Total® cereal / 1 cup / 1000
Oatmeal (cooked) / 1 cup / 300
Rice (cooked) / 1 cup / 21
Wheat bread (enriched) / 1 slice / 32
Others / Serving Size / Calcium (mg)
Almonds / 1/2 cup / 150
Salmon / 4 oz. / 300