Osteoporosis: Risk Factors, Diagnosis, Prevention, and Treatment

Date:

January 10, 2023

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Osteoporosis 101

Older adults are at highest risk of osteoporosis, with nearly 75% of hip, spine, and wrist fractures occurring in people aged 65 years old or over.

One of the most important steps for prevention is to be alert to any risk factors you may have for osteoporosis and broken bones. Knowing what your risk factors are will help you to take action to reduce bone loss and encourage you to request testing if needed.

Osteoporosis Risk Factors

A risk factor is anything that increases your chance of getting a disease. Having one or more risk factors does not mean that you will have osteoporosis. However, the more risk factors you have, the greater your chance of developing the disease.

Bone loss due to osteoporosis happens without any symptoms. The only two ‘visible’ signs that may suggest that you have osteoporosis include a loss of height of 4 cm or more and development of a stoop or curved upper back. 

Osteoporosis_RiskFactors

These are signs of possible spine fractures (your doctor may call them ‘vertebral fractures’). Spine fractures are often extremely painful, but sometimes aren’t. In that case, height loss and curved back may be the only tell-tale signs.  

In most cases a doctor will recommend diagnostic testing depending on your age and if you have other risk factors for the disease. You can also take this Osteoporosis Risk Check.

Diagnosis of Osteoporosis

If you have risk factors for osteoporosis it is important that you ask your doctor for a bone health assessment. 

As part of your bone health ‘check-up’ your doctor should take a complete medical history that includes information on any recent fractures. As well your doctor will likely estimate your future risk by using a fracture risk assessment tool such as FRAX®

Depending on the results of your fracture risk assessment, a Bone Mineral Density (BMD) test may be recommended. In some countries (e.g. U.S.A.), BMD testing is recommended for all women and men at age 65, regardless of whether they have risk factors.

Bone Mineral Density (BMD) Test

BMD testing is a safe, fast and painless method to measure whether you have osteoporosis or how likely you are to develop it in the future. 

Traditional X-rays used to identify broken bones (for example spine fractures) cannot measure BMD. BMD has to be measured by more specialized techniques. Different types of BMD tests are available, but the most commonly used and recommended method is called DXA, which stands for dual-energy X-ray absorptiometry. DXA is a type of X-ray capable of detecting quite small percentages of bone loss. 
 
DXA Test Results

The T-score on your bone density report shows how much your bone mass differs from the bone mass of an average healthy adult in their twenties.The T-score is measured in standard deviations (SD) and defines whether your bone mass is in the normal range, or whether you have osteopenia (an intermediate stage of bone loss between normal bone density and osteoporosis) or osteoporosis (a T-score of -2.5 or lower). 

BMD Test Results

If the results of your BMD test show osteopenia or osteoporosis, it does not automatically mean that you will have a fracture. There are lifestyle changes and a number of available therapies that your doctor might prescribe to slow down bone loss and help prevent fractures.

Prevention of Osteoporosis

The prevention advice listed below applies to all adults, but at older age one should pay special attention to the following:

  • Ensuring enough calcium, protein, vitamin D and other nutrients: 
    With age, your ability to absorb vitamins and minerals may be reduced. In fact, older adults often suffer from malnutrition as they may not be eating enough and getting enough protein and vitamins in their diets. A calcium and vitamin D supplement should be considered when dairy consumption is low, and little time is spent outdoors. 
  • Participating in exercise activities that improve balance, posture, coordination, and muscle strength: as we age we lose both bone and muscle mass faster so exercise becomes even more important. In addition to regular weight-bearing physical activity, older adults should choose exercises which help improve balance and muscle strength. 
  • Be cautious about preventing falls, inside the home and out.

Treatment of Osteoporosis

For patients at high risk, drug treatments are needed to effectively reduce the risk of broken bones due to osteoporosis. 

Today there is a wider variety of osteoporosis treatment options than ever before. The type of treatment you are prescribed will depend on your individual risk profile. This includes the risk for a specific type of fracture (spine versus hip), other medical conditions, or medications you may take. Finally, cost and cost-effectiveness considerations, insurance plans and reimbursement policies will undoubtedly also influence your doctor’s recommendations of therapeutic options.

Treatments have been shown to reduce the risk of hip fracture by up to 40%, vertebral fractures by 30-70% and, with some medications, reduce the risk for non-vertebral fractures by 15-20%. 

There are two main types of treatment: anti-resorptive agents reduce bone destruction and therefore preserve bone mineral density (BMD), while anabolic agents stimulate bone formation, thereby increasing BMD.

Medically approved drug therapies for the treatment of osteoporosis and prevention of fractures include:

  • Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid)
  • Raloxifene and bazedoxifene 
  • Teriparatide and abaloparatide
  • Denosumab
  • Romosozumab
  • Menopausal Hormone Therapy (MHT)*

Not all of these drugs are available in every country. 

*MHT (estrogen with or without progestin) is not a primary treatment for osteoporosis but has been shown to increase BMD and lower fracture risk in women after menopause. MHT is only recommended for younger postmenopausal women for the treatment of menopausal symptoms, with no contra-indications to its use, and for a limited period of time of approximately 10 years.

Overall, the common medically approved therapies have been shown to be safe and effective. There are potential side effects with any medication, and it is important to be aware of these. Each type of medication has different mechanisms of action and a distinct profile of side effects. For people at high risk of fracture, the benefit of a treatment in decreasing the risk of fracture far outweighs the rare occurrence of serious side effects. If you have any concerns, don’t stop taking medication without discussing with your doctor.
 
Like all medication, osteoporosis treatments can work only if they are taken properly. As reported for other chronic diseases, up to half of patients with osteoporosis stop their treatment after only one year. If you have been prescribed osteoporosis medication, you should keep in mind that by adhering to your treatment, you can benefit from larger increases in BMD, lose less bone mass, and reduce your fracture risk. 

Unlike when you take medication for an infection, you will not be able to tell if the osteoporosis treatment is effective. That’s why good communication between you and your doctor is important. Again, if you have any questions or concerns, don’t stop medication without discussing options with your doctor.  Stopping the treatment will increase your chances of having a fracture, which can have life-changing consequences.

In addition to drug therapy, calcium and vitamin D supplements can be prescribed to ensure maximum effectiveness of your medication. You should be aware that attention to lifestyle factors (including risk factors, nutrition and exercise) must go hand in hand with any drug treatment prescribed.

Practical and emotional support is important for anyone on osteoporosis treatment. This can be provided by health professionals, osteoporosis patient support groups, family and friends. Such support will help you manage your osteoporosis, and lessen any feelings of isolation and depression (experienced by many patients with severe osteoporosis). Contact your local osteoporosis society to find support and to ask about local support groups.

Source: International Osteoporosis Foundation


We hope this information is helpful to you in the important work you do as a family caregiver.
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