Osteoporosis: Bone health

These are my opinions and does not reflect my employer. Please consult your primary care provider for diagnosis and treatment regimens

Being in an orthopaedic speciality it gives me a first hand account on catching osteoporosis. For example, Ms. Sally Mae is a 62 year old grandmother who rarely goes to the doctor, she is healthy. While she is out in her garden, she trips over the water hose and lands on an outstretched hand (FOOSH – fall on outstretched hand). She comes to ortho to have it checked out. Xray reveals a non-comminuted, non-displaced distal radius fracture. I advise her that it isn’t a critical fracture, but a fracture nonetheless.

She is relieved that she does not require surgical intervention. We put her in an immobilized waterproof cast because she is very active and wants to continue to tend to her garden. I asked her about her bone density and she states she’s never had a test done. This is her second fracture in the year. The first, she had a stress fracture in her ankle while on one of her routine morning jogs.

Had Ms. Mae not come in for her wrist injury, she would’ve fallen through the cracks for osteoporosis screening.

What is Osteoporosis

According to the National Institute of Health (NIH) “osteoporosis is a disease of low bone mass and structural deterioration of bone tissue leading to fragility fractures and an increase in fracture risk to the spine, hip, and wrist (NIH, page 1)”.

Risk Factors

There are many risk factors associated with osteoporosis. Risk factors fall into two main categories: modifiable and non-modifiable.

Non-Modifiable

1. Sex
   • It is scientifically proven that women are at greater risk for developing osteoporosis. Changes in hormones and post-menopause increases that risk.
2. Age
   • The older we get, the thinner and weaker our bones get
3. Ethnicity
   • White and Asian women top the charts with the highest risk. African American and Hispanic women have a lower risk.
4. Family history
   • There are some research that shows that low bone mass and fracture risks are hereditary traits.

Modifiable

1. Calcium and vitamin D intake
   • Having adequate calcium and Vitamin D will build strong bones. They both work synergistically. Consult your provider to figure out which amount is right for you. The recommended goal is to achieve numbers with diet and supplements.
2. Smoking
   • Smoking, in general, is bad for our health (heart and lungs mostly), but smoking actually pulls calcium out of the bones. This makes them brittle and prone to fractures.
3. Medications
   • Long term use of certain medications can actually increase fracture risk. Medications such as glucocorticoids (used improperly), anti-convulsants, and some proton pump inhibitors (ex: Prilosec, Nexium, Protonix, ect…)
4. Diet
   • A balanced diet of calcium and Vitamin d is very important. It is preferred that we get our nutrients through our diet, but that isn’t always possible. As we get older, our digestion slows and our stomach becomes less acidic. This makes it hard to get adequate amounts through our diet, therefore, that’s where supplements comes into play. Consult with your provider for the best options
   • Here’s a shocker: “1 cup of coffee loses 45mg of calcium; 4 cups increase hip fracture risk by 3x (Tosi, L., 2020)
5. Exercise
   • Long periods of inactivity can dead to bone loss. The more we move, the healthier our bone matrix becomes. If you don’t use it, you loose it

Treatments

There are tons of treatments on the market for osteoporosis. It is very important to talk about bone health with your primary care provider to choose the best options for you.

The best treatment is preventative. Make sure you’re getting adquate inatake of calcium and vitamin D. Although Vitamin D source is mostly thorugh the sun, it is not reccommend to sun bathe as this can lead to skin canacer. Again, this is why it so important to see your primary care provider to discuss treamtnet options.

Although, orthopedics are more likely to catch osteoporosis, I’d rather avoid it altogether (no broken bones) by consulting with your provider to maintain healthy bones 🙂

References

Tosi, L. & Boineau, L. (Presenters). (2020). Own the Bone Symposium: Bone Health and Fragility Fractures. https://www.ownthebone.org/OTB/Events/2020_Virtual_Own_the_Bone_Symposium_Resources.aspx

NIH (2018, October). Osteoporosis Overview. https://www.bones.nih.gov/sites/bones/files/pdfs/osteopoverview-508.pdf