No Bad Breaks

Now is the Best Time to Bone Up on Osteoporosis

Osteoporosis is a completely silent disease that affects millions of people, yet many of us won’t know we have it until we break a bone. And that will happen to many of us: An estimated one in two women, and one in four men, over age 50 are at risk of a bone fracture. For older adults, those breaks are very serious.

“Your life is never the same afterward,” says Dr. Julie Carkin, director of the Strong Bones Program at UW Medicine. She says there’s a crisis in osteoporosis care, and that people are often undertreated for breaks that happen with a fall that’s from no higher than standing height, or as a result of a very low impact. Low-trauma fractures and fragility fractures are indicators of osteoporosis, so just treating the fracture isn’t enough.

“That’s a big warning sign, it’s a bone attack, and if you have one of those you need to get evaluated,” says Carkin. Ideally, she adds, it’s best to assess your risk before a first fracture, “because bone health is a lifelong thing to pay attention to.”

When we’re young, good health and nutrition help build a strong “bone bank.” We reach peak bone mass at around 25 to 30 years old. Then, if we stay healthy, bone density decreases slowly over time. While osteoporosis is a disease and not part of normal aging, we are more at risk as we age. Women take a big hit in bone density after menopause, due to the loss of estrogen. Men, who have a higher peak bone mass than women to begin with, are less at risk until around 70.

Besides age and being female, fixed risk factors for developing osteoporosis include family history, having a small frame, long-term steroid use, and a number of health problems such as rheumatoid arthritis, leukemia, and hyperparathyroidism. Other risk factors are more in our control, such as alcohol use, smoking, Vitamin D deficiency, poor nutrition, low calcium intake, and lack of exercise.

So how do we pay attention to bone health? If you’re a postmenopausal woman over 50, or a man over 70, ask your doctor about getting a DEXA scan (dual-energy X-ray absorptiometry) if you’ve never had one. It measures bone mineral density in your hip, spine, and forearm, and can detect osteoporosis (or its forerunner, osteopenia) at any stage. “Bone scans are very low radiation—the technician is in the room—there are no needles, and it’s surprisingly precise,” says Carkin.

If you’re diagnosed with bone loss, consider consulting a practice specializing in bone health. Then you, the specialist, and your physician can determine whether it’s time for treatment. First, explains Dr. Chris Shuhart of the Swedish Bone Health and Osteoporosis Program, “I talk to patients about their risk for fracture. There are patients with osteoporosis who are not at risk for fracture. We work on understanding fracture risk to decide on treatment.”

Tools have been developed to help assess fracture risk. For example, FRAX (fracture risk assessment tool) is one of several models that ask a series of questions that determine risk level together with whether there are secondary causes for bone loss that should be addressed, such as kidney disease or a variety of other medications.

Shuhart explains that treatment of the skeleton has two parts: foundational and pharmacologic. Foundational treatment includes calcium, Vitamin D, no smoking, no excessive alcohol use, and correct exercise. Pharmacologic treatment includes two categories of medication: antiresorptive (to stop bone loss) and anabolic (to form bone), and a recently FDA-approved medication that includes both functions. If you do take medication, you must also get enough calcium and Vitamin D to make it effective. “Medications are like a brick mason: they need materials to work with,” says Carkin.

Jane’s mother and aunt both had osteoporosis, so she has always known she could be at risk. She’s had three DEXA scans in the last 10 years, and she’s lost about an inch of her height. “All of a sudden chairs don’t take me high enough—I feel like a child who can’t reach the table,” says Jane. She also cracked a bone while stepping off a sidewalk. She worries constantly about developing a “dowager hump.”

Every Tuesday morning, Jane takes an antiresorptive oral medication. She hasn’t had side effects, but she does have to watch for reflux afterward, waiting 30 minutes to have coffee or food. She’s working with her osteoporosis specialist to track her meds, and to make lifestyle changes that include weight-bearing exercises and swimming. And while she has never been a heavy drinker, “Now I make sure I have only one four-ounce glass of wine a day, max.” Jane’s next bone scan will be in September 2019.

Medications for osteoporosis have been available since the mid-1990s. They reduce the probability of a fracture by about 40 to 50 percent and are commonly used for three to five years. It’s essential to work closely with your doctor to determine which medication will be most effective for you, based on possible interactions and your own health. While some patients may have issues with a particular medication, serious side effects are rare. Bone fractures, on the other hand, are very common, and would be far more debilitating in most cases.

“Treatments generally are effective even when bone density doesn’t increase. As long as it doesn’t decline, patients are protected from fractures,” says Shuhart. However, he adds that if patients don’t take bone-boosting lifestyle steps, too, “medical treatment is probably going to be less effective.”

It’s tough to get people to exercise unless they’re already in the habit. Any exercise is good, but weight-bearing exercises strengthen the skeleton, and anything that improves flexibility and balance, like tai chi, helps prevent falls. Medicare Advantage plans often include free gym access, and senior exercise programs are available in many communities. Before choosing a program, ask if the instructor has specific training in working with people who have osteoporosis.

Victoria has osteoporosis in her spine. She’s in good shape, very active, and a downhill skier, which she’s not ready to give up. Her FRAX evaluation puts her at fairly low risk for fractures in the next 10 years, but she’s being aggressive in her approach to taking care of herself. “While I was disappointed to learn I have osteoporosis, that knowledge also gives me the ability to take action,” says Victoria. She uses a combined approach of medication to prevent bone loss, weight-lifting and balance exercises, and specialized body armor to protect her spine when skiing. Her goal is to extend the years that she can ski, and to continue to live the life she loves in a way that will protect her health. And she’s exploring other options for strengthening her bones. One of those is OsteoStrong, a system of resistance exercise that uses stationary machines.

Brent Jordan, owner of OsteoStrong on Mercer Island, explains that clients use OsteoStrong’s proprietary machines to push or pull against resistance that targets specific muscle/skeletal groups, “putting compression in a controlled manner that provides a trigger.” When a certain trigger point has been met for stress, he says, “the body has no choice but to make that particular system, in this case, the skeletal system, stronger.” Using machines for wrists, hips, core, and spine, clients exert as much pressure as they can, or as much as they feel comfortable doing. OsteoStrong describes this as “self-loading,” meaning no external weights are used in the exercises. The circuit of four machines takes about 10 minutes, once a week. The goal is to build or rebuild bone density; results are measured by comparing yearly bone scans. “I’m very excited about adding OsteoStrong to my regimen,” says Victoria. “Their data is encouraging.”

Whatever way you choose to treat osteoporosis, it’s critical not to ignore it. Get a bone density scan to start. Consult your doctor, or a specialist if you’d like, about fracture risk and underlying problems. (You can find and print a list of questions on the National Osteoporosis Foundation website; search for “doctor visit checklist” at nof.org.) Make a plan for diet, exercise, calcium, and Vitamin D. Keep an open mind about medication. Ask your doctor about the variety of medication types out there, and maybe do some research on your own. Whatever you do, don’t simply wait for a first break that could change your life as you know it.

Priscilla Charlie Hinckley has been a writer and producer in Seattle television and video for 35 years, with a primary interest in stories covering health and medicine, women’s and children’s issues, social justice, and education. She enjoys taking a light-hearted approach to serious topics.