Did you know that 1 in 3 women and 1 in 5 men over the age of 50 will experience an osteoporotic fracture in their lifetime? And over 200 million people worldwide are diagnosed with osteoporosis! What is the cause of this global epidemic and what can we do about it?

I will start by defining osteoporosis. It is characterized by decreased bone density and/or bone mass resulting in more brittle bones, increasing the risk of fracture. Bone density gradually starts to decrease after age 35. This is normal but some are at risk for developing osteoporosis.

Osteoporosis is commonly diagnosed by a bone mineral density test (DXA). This test is interpreted with a value called T-score. A normal T-score is zero. The more negative the value the less dense the bone. An osteoporosis diagnosis has a T-score of -2.5 or below.

Risk Factors

1. Women with early menopause (<45 YO)
2. Women with hysterectomy (particularly with removal of ovaries)
3. Absence of menstruation due to health issues (i.e. malnutrition)
4. Hormone disorders (i.e. hyperthyroidism, hyperparathyroidism, pituitary gland disorders)
5. Hypogonadism- reduced production of estrogen or testosterone
6. Family history of osteoporosis
7. BMI <21 or a history of eating disorders
8. Long term, high dose steroid use
9. Alcohol abuse
10.  Smoking
11.  Malabsorption syndromes (i.e. Inflammatory Bowel Disease)
12.  Rheumatoid arthritis
13.  Some anticancer treatments
14.  Long term physical inactivity

As mentioned in the intro, women are more likely to develop osteoporosis than men. Why is that? Estrogen is essential to bone health in females. A decrease in estrogen, particularly during/after menopause, may increase rate of bone density loss.

Prevention and early detection are key in optimizing outcomes.

Prevention

1. Exercise– regular physical activity can not only prevent osteoporosis but potentially increase bone density as well! Be sure to incorporate weight training as this is particularly important for prevention. If you are diagnosed with osteoporosis maintaining mobility is key, but be sure to check with your doctor before making any changes to your exercise regimen. Check out my post on recent guidelines for exercise. https://lrxwellness.com/how-to-exercise-effectively/ 
2. Diet– eating a well-balanced diet rich in protein (for muscle building/maintenance) and calcium + vitamin D (for bone health). The recommended daily calcium intake is at least 700 mg, unless you are perimenopausal or postmenopausal then 1200 mg daily. The recommended daily vitamin D intake is 10 micrograms, which is not as easily attainable in diet.
   • Foods rich in calcium– dairy products, green leafy vegetables, soy products (tofu, edamame), almonds
   • Foods rich in vitamin D– fish (particularly salmon), red meat, egg yolks, mushrooms, vitamin D enriched foods/juices + sunlight!
3. Smoking cessation
4. Alcohol cessation

Early Detection

The National Osteoporosis Foundation recommends the population below receive bone density testing:

1. Females >65 years old
2. Males >70 years old
3. Bone fracture at 50 years or older
4. Perimenopausal + risk factors
5. Postmenopausal (<65 YO) + risk factors
6. Males 50-69 years old + risk factors
7. Back pain with possible spine fracture
8. Height loss of 0.5 inch or more in 1 year
9. Height loss of 1.5 inches or more of original height

It is controversial if osteoporosis can be reversed. While you can increase bone density it is highly unlikely to reverse osteoporosis. This is why it is important to identify if you are at risk, implement prevention strategies, and detect bone density loss early. Preventative strategies mentioned above are also part of treatment.

Treatment

1. Exercise
2. Diet
3. Medications– There are a few classes of medications that are very effective in managing osteoporosis and improving bone density. However, each has a list of potential undesirable side effects. It is important to talk to your healthcare provider about a patient specific treatment plan, carefully weighing risk and benefit.

In Conclusion

Osteoporosis is the loss of bone density resulting in brittle bones and increased risk of fracture. There is a rising prevalence with an aging population. Fortunately, there are effective, overlapping prevention and treatment strategies. Identifying if you are at risk and early detection may aid in preventing osteoporosis related complications. Implementing regular exercise, a well-balanced diet, and smoking and alcohol cessation are non-negotiables. If you are diagnosed with osteoporosis you are not alone! It is important to discuss your specific treatment plan with your healthcare team. There are many options and it does not have to be medication focused.

As always, reach out with questions, comments and for further discussion.

Lindsey, PharmD, BCPS

References:

Evaluation of Bone Health/Bone Density Testing. Bone Health & Osteoporosis Foundation. (2022, March 8). https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/

NHS. (2022, October 13). Osteoporosis. NHS . https://www.nhs.uk/conditions/osteoporosis/

Sozen, T., Ozisik, L., & Calik Basaran, N. (2017). An overview and management of osteoporosis. European Journal of Rheumatology, 4(1), 46–56. https://doi.org/10.5152/eurjrheum.2016.048

U.S. Department of Health and Human Services. (2023, September 25). Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis