What is osteoporosis? How does affects you and people around you? Osteoporosis its a bone mineral disease. Women are most commonly affected by it. It occurs when the body start loosing more bone than it is actually producing it. It then leads to broken bone after minimal trauma or falls. When osteoporosis is very severe, bone can even break by hitting a table or bumping into one. Have you ever seen elderly ladies hunching forward? That is osteoporosis. A severe form of osteoporosis. In this blog I want to discuss how this disease is diagnosed, how to prevent it, what are the causes, who is more likely to develop this disease and what other medical conditions lead to this potentially fatal disease.
What causes osteoporosis?
During your younger years, ( before 30 years old) bone is created faster than what it breaks. Bone is at any given point in a state of what is called remodeling, where new bone is formed and the old one disposed. This is reversed especially in women after menopause, where the same process occurs but at this point bone disposal is faster than bone formation. Women get their peak bone mass by the time they are between their 20’s and 30’s. If you have a strong family history of osteoporosis, you are excessively thin, take medications that decreases bone density and don’t have a proper nutrition you are at risk of developing osteoporosis while you are young or during early menopause.
What are risk factors for Osteoporosis?
1) Your sex: Just the fact that you are a woman, puts you at risk for this disease
2) Race: White women as opposed to African American women get osteoporosis more easily
3) Age: the older we get, the more chances of having osteoporosis
4) Genetics: Family history of osteoporosis
5) Personal History of fracture
6) Your weight: Being too thin ( less than a 100 lb) its a risk factor for this condition
7) Medications: Certain medications for asthma for example or blood thinner medications can lead to it.
8) Medical conditions: Thyroid disease, cancer, parathyroid disease and other endocrine organ are linked with osteoporosis.
9) Sedentary lifestyle/ smoking: Lack of exercise, especially those that involve impact like tennis, jogging , basketball etc
Complications of osteoporosis?
You can have many complications from having osteoporosis. More than 50% of elderly patient that have a hip fracture die within the first year after the event. This is because due to the catastrophic consequences that a hip fracture leads including the lack of mobility to the patient and the surgical challenges it represents. When you have a vertebral fracture, you can have chronic back pain, decreased in height, respiratory difficulty, lack of self esteem, financial burden, lack of independence as help is needed to move from one place to the other.
How is Osteoporosis diagnosed ?
There is a bone density machine, called DEXA scan that can determine the total amount of mineral that is inside the bone. Its a very non invasive machine that hovers over your body while you lie on an exam table. It does not however, measure all the bones in your body. It only assesses the most common bone prone to fractures which are the vertebra and your hip bone. This exam is done every two years.
In addition a simple X ray done for other causes can tell the physician that you have a bone mineral density or even that you have had an asymptomatic vertebral fracture. However after this X ray is done, a more formal test is required like the DEXA scan.
How is Osteoporosis treated?
There are multiple medication on the market called bisphosphonates. They help recover bone loss and establish a balance within the bone itself. They inhibit an enzyme called osteoclast which is part of the normal pathway of the so called bone remodeling – resorption process.
1) Fosamax: This is the most popular one. It contains the ingredient called Alendronate, which help restores mineral content.
2) Actonel: Medication given orally. It can be given once a week or once a month
3) Boniva: It can be given orally or via IV route
4) Reclast: This medication is given via IV route once a year
5) Prolia: This is a new medications given subcutaneously to the patient every 6 months
One way that your doctor can determine how effectively this medication is working is to try to measure how you bone is responding to the medication.
Bone Markers for Osteoporosis
There are bone markers that measure if bone activity is occurring or if there is bone suppression. While using one of those bisphosphonates bone markers levels should decrease . This means that bone medications is interacting with those enzymes called osteoclasts and that bone loosing activity will stop. .Bone markers can be verified more often than a bone density scan or DEXA scan, allowing physicians to determine the effectiveness of these medications.
Bone markers that are checked include N-terminal telopeptides – NTx levels, C-terminal telopeptides – CTx levels, and bone alkaline phosphotase. These tests are obtained from blood and urine. They however cannot substitute a DXA scan since there is a lot of variability. They are checked after fasting and very early in the morning. In addition, they must be done prior to starting a bisphosphonate in order for us to have a baseline.
Pink Women’s Center is a board certified OBGYN group located in Katy and west Houston Texas. We care for normal and high risk pregnancy, gynecologic and menopausal problems, including abnormal vaginal bleeding, abnormal pap smear, stress incontinence, osteoporosis, sexual dysfunction, endometriosis and much more. We are a certified menopause/ osteoporosis OBGYN group, the only one in Houston Texas
Osteoporosis by Joel Rivera MD
Osteoporosis by Joel Rivera MD OBGYN