OSTEOPOROSIS EDUCATION

What You Should Know About Osteoporosis

The Bone & Joint Health and Osteoporosis Center wants all people to learn as much about osteoporosis, and our website offers a plethora of information — much from the Surgeon General’s webpage on osteoporosis and The National Osteoporosis Foundation. Please take your time to learn about.

 

 

 

Ideal attendees may include patients who have been diagnosed with osteoporosis, individuals who believe they may be at risk, or family members of an osteoporosis patient. Call 718-667-3577 or email Help@SpinePainNY.com for more information and appointments.

Our goal is to educate patients at an earlier age about bone health and osteoporosis.

Bone Facts

  • The adult human body has 206 bones.
  • There are 26 bones in the human foot.
  • The human hand, including the wrist, contains 54 bones.
  • Arms are among the most commonly broken bones, accounting for almost half of all adults’ broken bones. The collarbone is the most commonly broken bone among children.
  • Bones stop growing in length during puberty. However, bone density and strength will change over the course of life.
  • Bones are made up of calcium, phosphorus, sodium, and other minerals, as well as the protein, collagen.

Bones function as the skeleton of the human body, allow body parts to move and protect organs from impact damage. They also produce red and white blood cells.

The Osteoporosis Process

Bone is living tissue that is constantly renewed throughout life, as old bone gets replaced with new. Osteoporosis occurs when too much bone is lost, too little new bone is produced, or both.

Children and teens make more bone than they lose, with peak bone mass usually reached in the early 20s. The denser the bones are at their peak mass, the less likely it is that osteoporosis will develop later in life. After bone mass peaks, bone production slows down but continues to about age 30. After that, bone mass shrinks about 1% annually. Certain factors can accelerate the loss. The rate at which bone density declines depends on several factors, such as age, gender, bone structure family history and lifestyle.

Strong bones begin in childhood. With good habits and medical attention when needed, we can have strong bones throughout our lives. People who have weak bones are at higher risk for fractures.

You can improve your bone health by getting enough calcium, vitamin D, and physical activity. If you have osteoporosis or another bone disease, your doctor can detect and treat it. This can help prevent painful fractures.

Broken bones are very painful at any age. For older people, weak bones can be deadly. One in five people with a hip fracture dies within a year of their injury. One in three adults who lived independently before their hip fracture remains in a nursing home for a least a year after their injury. Many others become isolated, depressed, or frightened to leave home because they fear they will fall.

Rick Factors

  • Gender – Both men and women can develop osteoporosis, but women are four times more likely to have it.
  • Age – Osteoporosis can develop at any age, but risk increases with age. Women over 50 are the most susceptible to bone loss and fractures.
  • Race – Osteoporosis is most common among people who are white or of Asian descent.
  • Family history – A person whose parent or sibling had a hip fracture or spinal collapse fracture is at a higher risk for osteoporosis.
  • Personal history – A person who has had a broken bone is at greater risk for another fracture.
  • Bone structure & body weight – Petite and thin women have less bone mass to begin with. Weight loss after age 50 seems to increase women’s risk of hip fractures, while weight gain decreases the risk. Small-boned, thin men are at greater risk than large men.
  • Hormones (female) –Reduction of estrogen associated with menopause or absence of menstruation (amenorrhea) for long periods contributes to loss of bone density.
  • Hormones (male) – A drop in testosterone decreases bone density.
  • Lack of physical exercise is detrimental to bones.
  • Eating disorders (anorexia or bulimia) or gastrointestinal surgery can lead to inadequate nutritional absorption and hormonal imbalances. Also, eating disorders cause a “starved” body to produce excessive amounts of the adrenal hormone cortisol, which is known to trigger bone loss.
  • Low calcium and Vitamin D intake results in loss of bone.
  • Smoking – Studies show that current or former smokers have lower bone densities. Women smokers have lower levels of estrogen, which is necessary for healthy bones. Women smokers often go through menopause at a younger age, as well.
  • Alcohol – excessive consumption is detrimental to bone density
  • Medications – Bone density can be negatively affected by current or former long-term use of corticosteroid medications (e.g., prednisone, cortisone), thyroid drugs, anticonvulsants, antacids, or medications used to combat or prevent cancer, depression, or transplant rejection.

Menopause & Osteoporosis

At menopause, women experience a drastic decline in the hormone estrogen. The drop-in estrogen levels slows the replacement of old bone with new, resulting in a faster rate of bone loss. About ten years after the onset of menopause, the rapid bone loss subsides and the rate of loss returns to pre-menopausal levels. Even though the loss slows down, however, the formation of new bone does not increase. That is why postmenopausal women have a greater chance of a fracture.

Women who have early menopause (before age 40) have even greater risk of osteoporosis and fractures.

Symptoms

There are no symptoms in the early stages of osteoporosis. Bone loss occurs over a period of many years and sometimes the first evidence of it comes when a fracture occurs – most commonly in the hip, spine or wrist. If a bone fracture occurs more easily than one would expect, it may be a sign of osteoporosis.

Other possible indications are loss in height or stooped posture.  There may be pain in the spine caused by compression fractures. The pain may occur suddenly or over a period of time.

 

 

 

 

Diagnosis

Medical evaluation to diagnose osteoporosis may include one or more of the following:

  • Medical & Personal History: Age, gender, menopause, previous fractures, smoking and drinking habits, diet (including intake of calcium and Vitamin D), physical activity/exercise, current or previous eating disorder, medications taken currently or previously.
  • Physical Exam: A look at the spine and measurement of height. A loss in height may indicate osteoporosis. After age 50, it is recommended that height be measured annually, without shoes.
  • Laboratory Tests: Measurement of blood calcium levels, thyroid function, parathyroid hormone levels, testosterone levels in men, 25-hydroxyvitamin D, 24-hour urine calcium and biochemical marker tests (NTX, which bone resorption in urine, and CTX, which measures bone resorption in the blood).
  • FRAX® Tool: A method of evaluating a patient’s fracture risk over the next 10 years based on bone mineral density results from a DEXA scan at the femoral neck and assessment of the following risk factors: age, sex, weight, height, previous fracture, parent had a fractured hip, current smoking, alcohol use, use of glucocorticoids, if diagnosed with rheumatoid arthritis, if diagnosed with an illness strongly associated with osteoporosis such as diabetes or hyperthyroidism. The FRAX® tool is useful for postmenopausal women or men age 50 or older, people who have low bone density and those who have not taken osteoporosis medication.
  • Bone Density Test (DEXA Scan): The only test that can diagnose osteoporosis, the DEXA scan is a low-level X-ray that measures the proportion of mineral contained in the bones. The results are used to estimate the density of the bones and the probability that a bone will break. Usually the hip and spine are checked. The National Osteoporosis Foundation recommends bone density scans for women age 65 or older and men age 70 or older, or earlier if there are other risk factors.

If the bone density test shows early signs of bone loss it is called osteopenia. When bone loss becomes more severe, it is osteoporosis.

Prevention

While osteoporosis is common as one ages, getting older doesn’t mean osteoporosis will develop.

Throughout life, eating a balanced diet and getting adequate amounts of calcium and Vitamin D from food and/or supplements helps to keep bones strong.

  • Calcium: In addition to milk, cheese and yogurt, good sources of calcium are canned sardines and salmon (with bones), and dark green vegetables such as kale and broccoli. Calcium-fortified foods, such as some types of bread and juices, are also available. Experts recommend 1,000 milligrams of calcium each day for premenopausal women and 1,200 milligrams for postmenopausal women. For men age 70 and younger, the recommended total daily intake of elemental calcium is 1,000 milligrams and men age 71 and over should consume 1,200 milligrams daily.

Supplements are only advised when the recommended amount of daily calcium cannot be obtained through diet. If your diet does not provide enough calcium, ask your doctor if calcium supplements are right for you.

  • Vitamin D: In order for the body to absorb calcium, Vitamin D is needed. Twenty minutes of exposure to the sun each day helps ensure that the body produces Vitamin D, but not everyone can get sun exposure – especially in the winter. Dietary sources of Vitamin D include eggs, fatty fish like salmon, fortified milk and cereal and Vitamin D supplements. To optimize bone health, the The National Osteoporosis Foundation recommends both men and women under the age 50 take 400–800 international units (IU) of Vitamin D daily. Men and women aged 50 and over are recommended to take 800-1000 IU daily.

Limit Caffeine & Alcohol: Coffee, tea and soft drinks with caffeine can decrease calcium absorption. Excess alcohol consumption has also been shown to have an adverse effect on bone health.

Exercise: Regular exercise makes bones and muscles stronger and helps to prevent bone loss. Both weight-bearing and muscle-strengthening exercises can help prevent osteoporosis and promote the ability to stay active.

Weight-Bearing Exercise, which should be done at least three or four times a week, includes such activities as walking, jogging/running, dancing, high-impact aerobics, playing tennis, jumping rope, hiking and stair-climbing. Lower impact exercises can also help keep bones strong and are a safe alternative for people who cannot do high-impact exercises. Some examples of low-impact weight-bearing exercises are elliptical training machines, low-impact aerobics, stair-step machines and fast walking.

Muscle-Strengthening Exercises, such as lifting weights or using elastic exercise bands, cause skeletal muscle to pull against the bone, which results in the bone rebuilding and becoming denser. Muscle-strengthening exercises should be done two to three days per week.

Tai Chi can help improve balance and prevent falls; and posture exercises are good for reducing rounded shoulders, which decreases the chance of breaking a bone. Yoga and Pilates may be beneficial for some people – but before beginning either, a physical therapist should be consulted .

Note that too much exercise can be detrimental for women, however, because it can cause a drop in estrogen, which is needed for bone health.

Pharmacologic Treatment: The most common medications to prevent and treat osteoporosis are medicines that slow the loss of bone called antiresorptive medicines. These include bisphosphonates (Fosamax, Boniva, Actonel), calcitonin, estrogen, estrogen agonists/antagonists (SERM) and RANK ligand inhibitor (Prolia).

It is also recommended that the preventative measures listed above be adopted to preserve bone density as much as possible.

Falls Prevention

Tripping and falling are not just the result of getting older. However as you age, falls become much more dangerous and potentially fatal. As a patient, caregiver, or family member you need to know that most falls can be prevented; it is up to us to minimize the changes of it happening. Review the list below and by changing some small things in your daily life, you can lower the chances of falling for you or someone you love.

  1. Begin a regular exercise program.
    Exercise is one of the most important ways to reduce your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination, like dancing and Tai Chi, are the most helpful. Consider joining an organized program at your local community center or gym.
  2. Make your home safer.
  • Remove things you can trip over from stairs and places where you walk.
  • Remove all small rugs.
  • Don’t use step stools. Keep items you need within easy reach.
  • Have grab bars put in next to your toilet and in the bathtub or shower.
  • Use nonslip mats in the bathtub and shower.
  • Use brighter light bulbs in your home.
  • Add handrails and light in all staircases.
  • Wear shoes that give good support and have nonslip soles.
  1. Ask a health care professional to review your medicines.
    We will assist in coordinating your care with your primary care physician, nurse, pharmacist, or other health care professional to review all the medicines you are taking. Make sure to mention over-the-counter medicine, such as cold medicine. As you get older, the way some medicines work in your body can change. Some medicines, or combinations of medicines, can make you drowsy or light-headed, which can lead to a fall.
  2. Have your vision checked.
    Poor vision increases your risk of falling. You could be wearing the wrong glasses or have a condition such as glaucoma or cataracts that limits your vision. You need to let your physician know if you feel like your vision is not what it used to be. This problem is correctable!
  1. Acceptance of aging.
    One of the toughest parts of getting older is accepting the fact that our body has changed and that we no longer have the independence and physical ability to do the daily activities that we used to. Things like assistive walking devices and grab bars placed strategically are vital to prevent falling.

Treatment Options

The Bone & Joint Health and Osteoporosis Center at The Spine & Pain Institute of New York has established the Center to provide comprehensive diagnosis, treatment and support for patients with osteopenia and osteoporosis. It is a multi-disciplinary program under the medical direction of Board Certified Rheumatologist — Maggie Cadet, M.D.

Each patient is given a thorough medical examination and is interviewed to determine possible risk factors. Lab tests and a DEXA bone density scan may be recommended. Results are assessed, and an individual treatment plan is developed for each patient.

The treatment plan for patients who are diagnosed with osteopenia or osteoporosis may include any of the following:

  • Medication
  • Physical Therapy Evaluation – A physiatrist will work on posture with patients who have structural problems, such as sloping upper back.
  • Nutrition Counseling
  • Pain Management – Referral to the SPINY for patients who have back pain caused by compression fractures
  • Group Programs
    • Group Exercise Programs
    • A physical therapist helps participants increase strength, reduce back pain, and improve posture and balance to prevent falls.
    • An occupational therapist teaches ways to perform activities of daily living that are less likely to result in falls or fractures.
  • Nutrition Information Session
  • Education Sessions
  • Support Group led by a social worker

Monthly education, nutrition and exercise programs will begin soon in 2017. Follow us on Facebook for educational program updates.

Calcium & Vitamin D (Dietary & Supplemental)

Calcium

To keep your bones strong, eat foods rich in calcium. Some people have trouble digesting the lactose found in milk and other dairy foods, including cheese and yogurt. Most supermarkets sell lactose-reduced dairy foods. Many nondairy foods are also calcium-rich.

Calcium-Rich Foods
Help your bones. Choose foods that are high in calcium. Here are some examples.
Food Calcium (mg)
Fortified oatmeal, 1 packet 350
Sardines, canned in oil, with edible bones, 3 oz. 324
Cheddar cheese, 1 ½ oz. shredded 306
Milk, nonfat, 1 cup 302
Milkshake, 1 cup 300
Yogurt, plain, low-fat, 1 cup 300
Soybeans, cooked, 1 cup 261
Tofu, firm, with calcium, ½ cup 204
Orange juice, fortified with calcium, 6 oz. 200–260 (varies)
Salmon, canned, with edible bones, 3 oz. 181
Pudding, instant (chocolate, banana, etc.) made with 2% milk, ½ cup 153
Baked beans, 1 cup 142
Cottage cheese, 1% milk fat, 1 cup 138
Spaghetti or lasagna, 1 cup 125
Frozen yogurt, vanilla, soft-serve, ½ cup 103
Ready-to-eat cereal, fortified with calcium, 1 cup 100–1000 (varies)
Cheese pizza, 1 slice 100
Fortified waffles (2) 100
Turnip greens, boiled, ½ cup 99
Broccoli, raw, 1 cup 90
Ice cream, vanilla, ½ cup 85
Soy or rice milk, fortified with calcium, 1 cup 80–500 (varies)

Vitamin D

Vitamin D helps your body absorb calcium. As you grow older, your need for vitamin D goes up. Vitamin D is made by your skin when you are in the sun. For many, especially seniors, getting enough vitamin D from sunlight is not practical. Almost all milk and some other foods are fortified with vitamin D. If you are not getting enough calcium and vitamin D in your diet, supplements can be bone savers.

 

 

 

Your body needs calcium and vitamin D.

If this is your age, then you need this much calcium and vitamin D each day.
Calcium (mg) Vitamin D (IU)
mg = milligrams; IU = International Units (40 IU = 1 mcg)
Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.
Infants 0 to 6 months 200 400
Infants 6 to 12 months 260 400
1 to 3 years 700 600
4 to 8 years 1,000 600
9 to 13 years 1,300 600
14 to 18 years 1,300 600
19 to 30 years 1,000 600
31 to 50 years 1,000 600
51- to 70-year-old males 1,000 600
51- to 70-year-old females 1,200 600
>70 years 1,200 800
14 to 18 years, pregnant/lactating 1,300 600
19 to 50 years, pregnant/lactating 1,000 600