Osteoporosis

May is National Osteoporosis Awareness and Prevention month. The National Osteoporosis Foundation estimates that 1 out of every 2 women and 1 out of every 4 men, over the age of 50 will break a bone due to osteoporosis. I find that figure staggering.

What are the risk factors?

Well, based on the statistics I just mentioned, being female and over the age of 50 are risk factors. If you have a family history of osteoporosis, statistically you are more likely to break a bone due to this condition. Obviously these are risk factors that cannot be changed; so let’s look at the ones that we can do something about:

Low body weight/dieting – Women tend to have a lower body weight then men, as well as a history of dieting. Unbalanced “trendy” diets lead to poor nutritional status. Diets with severe caloric restriction may trim your waistline but at a cost to your bones.
Inactivity – Exercise strengthens your bones. Aerobic exercise, such as jogging or walking, and weight-bearing exercise, such as strength training, creates micro fractures in weight-bearing bones. These micro fractures trigger your body to rebuild and strengthen bone by recalcifying the micro fractures.
Poor nutrition status – If you are deficient in calcium, your body will not be able to respond to your body’s need to rebuild bone. Calcium, along with co-factor vitamin D, supports recalcification.
Excess salt – High levels of salt in the diet have been linked to excessive levels of calcium in urine. Some researchers believe that the high salt diet in America is a major causative factor in osteoporosis. Read labels when shop; salt is used as a flavor enhancer and a preservative in most processed foods. Many foods that do not taste salty are actually high in sodium.
Smoking – Smoking is bad for us for countless reasons. Smoking interferes with the body’s utilization of calcium and estrogen in bone formation.
Alcohol consumption – Drinking too much alcohol will interfere with the body’s absorption of calcium. It also robs the body of vital nutrients and causes poor nutritional status.
Consumption of Caffeinated or Carbonated drinks – Phosphoric acid and caffeine leach calcium from bones, increasing you risk of osteoporosis. Caffeinated drinks and supplements are often used to suppress appetite during calorie restriction diets. This is another reason why women tend to be more at risk of osteoporosis.

FRAX is a great tool that calculates your risk for a potential fracture. It takes race, age, weight and other risk factors into consideration. Under the menu select Calculation Tool, then follow the menus to select your continent, country, and race. For those of you who do not know your weight in kilograms or your height in centimeters, do not panic. On the right side of the screen is a handy conversion tool for you.

My diet is healthy and I exercise every day. Am I still at risk?

Some of the most commonly prescribed medications actually lead to bone loss. Corticosteroids are anti-inflammatory agents that are commonly prescribed to help control chronic conditions such as asthma and arthritis. Unfortunately, studies show that patients lose an average of 14% of bone mineral content in the first year after starting corticosteroid treatment. Most people achieve peak bone density around age 25. However, for patients who develop asthma at an early age, and use corticosteroids to manage their condition, they may never achieve maximum bone density.

SSRIs such as Lexapro, Prozac and Zoloft have been linked to decreased bone density. Here is a great article from the May 2009 issue of Psychology Today explaining the misuse of these medications. According to Dr. Lane, 80% of patients surveyed who were taking these medications showed no depressive symptoms at all. These medications are often prescribed to women for PMS symptoms or menopause symptoms. This may be another reason that more women than men are diagnosed with osteoporosis.

Here are some other common prescription drugs that affect bone health:

Antibiotics such as tetratcycline, commonly used to treat acne
Proton pump inhibitors (PPIs), including Prilosec, Nexium, Prevacid, and Aciphex used for acid reflux and gastritis
Diuretics that are used to treat high blood pressure
Depo-provera, or the Depo Shot, a form of birth control

When should I request a bone density test?

The US Preventative Screening Task Force (yes, the same task force that caused an uproar with their breast cancer screening recommendations) recommend bone density screenings for the following demographics:

Women aged 65 years or older
Younger women whose risk fracture is equal to or greater than that of a 65 year old white woman with no additional risk factors (use the FRAX tool to assess risk)
No recommendation to screen men for osteoporosis

The National Osteoporosis Foundation recommends bone density testing of:

Women age 65 or older
Postmenopausal women under age 65 with one or more risk factors
Men age 70 or older
Men between age 50 and 70 with one or more risk factors
Anyone older than age 50 and who have experienced a broken bone
Postmenopausal women who discontinue hormone therapy

I utilize the NOF’s guidelines when making recommendations to my patients. However, for patients with long-term SSRI use or corticosteroid use, I encourage them to get a DEXA scan earlier. If you suspect that osteoporosis may be a problem for you, ask your doctor for a bone density test. You may have to pay out of pocket for it, but the sooner you start to reverse bone loss, the better off you will be.