Osteoporosis is a threat to many women, especially after menopause. But the lead up to weak, brittle bones can start much earlier in life.
When bone density drops but isn’t yet at the level of osteoporosis, it’s called osteopenia. Osteopenia affects more than 33 million Americans over age 50, men and women, while 10 million have osteoporosis.
Yet the DEXA scan, the painless X-ray-based test that measures bone density, isn’t recommended for women until age 65, when they may need bone-building drugs to avoid fractures. For men, the prevalence of osteoporosis doesn’t increase with age until 80, but even then, there are no screening guidelines. So, what’s the answer?
Cost versus benefit is one reason insurers don’t universally cover the scan for women under 65. But you may be a candidate for earlier testing if you broke a bone after age 45, are losing height, are developing a slumped or hunched posture, or have sudden, unexplained back pain.
If you’re healthy but have concerns about bone health or risk factors for osteoporosis, you can talk to your doctor about earlier testing.
Factors that can increase your fracture risk include your height and weight — very thin women are at greater risk. Not getting enough exercise, smoking, drinking alcohol, a family history of osteoporosis or having a parent who broke a hip are others. Having a disease or taking medications associated with an increased risk of osteoporosis also increases your risk of fractures.
For better bone health, make sure your diet includes good sources of calcium-rich foods, that you get enough vitamin D through sunlight or a supplement, and that you get regular, weight-bearing exercise. That includes activities done while standing, like walking, which helps develop bone. Limit alcohol to one drink a day and don’t smoke.
Harvard Health has more on osteopenia and osteoporosis.
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FRIDAY, Feb. 15, 2019 (HealthDay News) — Osteoporosis is typically thought of as a woman’s disease, but elderly men are also prone to bone loss — even though they often aren’t treated for it, a new study finds.
Among men and women aged 80 and older, women were three times more likely to get osteoporosis treatment, researchers reported.
Ten million Americans have osteoporosis, according to the study. Each year, the disease causes 2 million fractures, costing $19 million. As the population ages, this could rise to 3 million fractures at a cost of $25 million by 2025.
Osteoporosis is a serious condition for men, too, the researchers added. After breaking a hip, the risk of illness and death is greater among men than women, they noted.
For the study, researchers led by Dr. Radhika Rao Narla, from the Division of Metabolism, Endocrinology and Nutrition at the University of Washington in Seattle, compared screening and treatment for osteoporosis among more than 13,700 men and women aged 70 and older.
Managing the disease included scans of bone mineral density, measuring levels of vitamin D, and treatment with vitamin D, calcium supplements and bisphosphonates (some brand names include Boniva, Actonel and Fosamax).
The investigators looked at more than 11,600 men and 460 women where age alone was a risk factor for hip fracture, and another group of more than 1,600 men at risk for osteoporosis due to previous fracture or treatment that weakened bones.
About 50 percent of the men aged 75 to 79 had a risk of breaking a hip that qualified them for osteoporosis treatment, as did 88 percent of the men aged 80 and older.
The researchers found that men were much less likely than women to be tested and treated for osteoporosis, especially those aged 80 and older.
Looking at age alone, the researchers found that more women than men had their bone density measured (63 percent versus 12 percent) and had their vitamin D levels measured (39 percent versus 18 percent).
Women were more than three times as likely to be given calcium and vitamin D supplements (63 percent versus 20 percent) and to be treated with bisphosphonates (44 percent versus 5 percent), the researchers found.
Among men aged 80 and older, only 10 to 13 percent had bone density measured and fewer than 1 in 10 were treated with bisphosphonates.
Men at higher risk for hip fractures or those who had already suffered from a broken hip were often overlooked for diagnosis and treatment, the researchers noted.
Narla and her team could not say why men are not assessed for osteoporosis. It might be a lack of awareness of screening guidelines or doctors are busy dealing with other medical problems, they said.
These findings suggest that guidelines are “inadequate in effectively identifying older men who might benefit from evaluation for osteoporosis and fracture prevention treatment,” the researchers said.
The report was published online Feb. 14 in the Journal of Investigative Medicine.
“We believe that there is a need for developing strategies to improve the evaluation and management for all older men, particularly among elderly men with a very high risk of fracture,” Narla’s group said in a journal news release.
The National Osteoporosis Foundation offers more on osteoporosis.
SOURCE: Journal of Investigative Medicine, news release, Feb. 14, 2019
THURSDAY, Oct. 4, 2018 (HealthDay News) — Vitamin D supplements have long been touted as a way to improve bone health and possibly ward off the bone-thinning disease osteoporosis in older adults.
But a new study contends that claims of benefits from supplements of the “sunshine vitamin” fall flat.
A review of previously published studies found that taking either high or low doses of vitamin D supplements didn’t prevent fractures or falls, or improve bone density.
Vitamin D is found in very few foods. One of the biggest sources of the vitamin is exposure to sunlight.
“Vitamin D supplement use is common, particularly in North America,” where up to 40 percent of older people take them, said lead researcher Dr. Alison Avenell. She is clinical chair in health services research at the University of Aberdeen in Scotland.
“Most adults don’t need to take vitamin D supplements, although they are unlikely to do harm if taken in low doses,” she added.
Vitamin D supplements do prevent rare conditions, such as rickets in children and osteomalacia (softening of bones) in adults. People at risk of vitamin D deficiency include those with little or no sun exposure, such as nursing home residents who are indoors all the time, or those who always cover their skin when outside, Avenell said.
There’s also existing evidence that vitamin D helps prevent cancer or heart disease, she added.
“Preserving bone strength involves keeping active, not smoking, not being too thin, and taking medications for osteoporosis,” Avenell said.
Based on the new findings, Avenell thinks guidelines that recommend vitamin D supplements for bone health should be changed.
For the new report, Avenell and her colleagues reviewed 81 studies, most of which dealt with vitamin D alone, not in combination with the mineral calcium.
“Calcium supplements on their own have minimal effect on bone mineral density and fracture, and may increase the risk of cardiovascular disease,” Avenell said.
The only evidence that calcium and vitamin D together prevent fractures comes from a trial of older people with very low vitamin D levels in nursing homes. But calcium and vitamin D may also increase the risk of cardiovascular disease, Avenell said.
In addition, most of the studies covered in the new review included women aged 65 and older who took more than 800 IUs (international units) of vitamin D daily.
The new study found no meaningful effect of vitamin D supplementation when it came to reducing any fracture, hip fractures or falls.
This type of study, called a meta-analysis, tries to find common elements among previously published studies. This kind or research, however, is limited by differences in the methods and conclusions of the different studies analyzed by researchers, so the findings may not be consistent across the board.
Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, said this new study should convince doctors that vitamin D supplements don’t have a role in maintaining healthy bones, but they do have other benefits.
Previous research suggests that vitamin D, when taken in tandem with calcium, may help prevent certain cancers and protect against age-related declines in thinking and memory.
“What is important to keep in mind is that those with low vitamin D were not represented in this meta-analysis, and vitamin D supplementation — repletion, actually — is still necessary for those with low vitamin D levels, regardless of age,” Sood said.
The findings were published online Oct. 4 in The Lancet Diabetes and Endocrinology.
For more on vitamin D, visit the U.S. National Institutes of Health.
SOURCES: Alison Avenell, M.D., clinical chair, health services research, University of Aberdeen, Scotland; Minisha Sood, M.D., endocrinologist, Lenox Hill Hospital, New York City; Oct. 4, 2018, The Lancet Diabetes and Endocrinology, online
Osteoporosis patients who take “holidays” from bisphosphonate drugs are at increased risk for fractures, a new study finds.
A six-year follow-up of patients who took a break from the bone-building drugs found 15 percent of them suffered fractures, according to researchers at Loyola University in Maywood, Ill.
“Fracture risk needs to be regularly assessed during the drug holiday and treatment resumed accordingly,” said Dr. Pauline Camacho and her colleagues.
Bisphosphonates, such as alendronate (Fosamax) and risedronate (Actonel), are the most widely prescribed osteoporosis drugs. They are designed to slow or prevent bone loss.
But patients who take these drugs for long periods are typically told to take temporary breaks to prevent rare but serious side effects to the jaw and thighs.
However, there is little data on how long these breaks should last, the researchers explained.
To shed light on the issue, they examined the medical records of patients (371 women, 30 men) with osteoporosis or osteopenia (weak bones but not osteoporosis). Patients took bisphosphonates for an average of 6.3 years before beginning breaks from the drugs.
Over six years, 15.4 percent of the patients suffered fractures after going on their drug holiday. The most common fracture sites were the wrist, foot, ribs and spine. However, foot fractures are not currently considered osteoporosis-related fractures, the researchers noted.
The patients most likely to suffer fractures were older and had lower bone mineral density at the beginning of the study. Patients who suffered fractures were put back on bisphosphonates.
The yearly incidence of fractures ranged from about 4 percent to almost 10 percent, with most occurring during the fourth and fifth years.
“Patients who begin drug holidays at high risk for fracture based on bone mineral density, age or other clinical risk factors warrant close follow-up during the holiday, especially as its duration lengthens,” the researchers said in a university news release.
The study was published recently in Endocrine Practice.
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on osteoporosis.
SOURCE: Loyola University Health System, news release, May 4, 2018
What is osteoporosis?
Osteoporosis is a disease that causes rapid thinning of bones. Over time, this weakens the bones and can make them more likely to break. It can affect any bone, but the hip, spine, and wrist are most often involved.
What are the risk factors for osteoporosis?
Women are more likely than men to develop osteoporosis. This happens partly because men have larger, stronger bones. Men and women older than age 50 are at the greatest risk for developing osteoporosis. One in 2 women and 1 in 4 men in this age group will fracture a bone because of osteoporosis. People who are white or Asian are more likely to develop osteoporosis than people who are Hispanic or African-American.
Other risk factors that may increase your chances for developing osteoporosis include:
- Having small bones
- Lack of physical activity or exercise
- Drinking too much alcohol
- Have a diet low in calcium and vitamin D
- Previous fracture, especially after age 50
- Being postmenopausal
- Taking certain medications, for example long-term use of corticosteroids
- Family history of osteoporosis
Many people are unaware they have osteoporosis until they have advanced symptoms. These may include a broken hip or wrist, low back pain, or a hunched back.
How is osteoporosis diagnosed?
If your health care provider thinks that you have osteoporosis, a simple, painless test to measure bone mineral density can confirm it. The test is called a bone density test.
If you’re diagnosed with osteoporosis, a number of medications are available to treat it. Talk to your health care provider about the type of treatment that’s best for you.
Can osteoporosis be prevented?
To help prevent osteoporosis:
- Talk with your health care provider about screening tests for osteoporosis.
- Do regular weight-bearing exercise. This means activities that work your legs against gravity. The best exercises are walking, dancing, jogging, stair-climbing, playing racquet sports, and hiking. If you’ve been inactive, be sure to check with your health care provider before beginning any exercise.
- Talk with your health care provider about your diet and whether or not you need to take a vitamin and mineral supplement important site.
- Don’t smoke. If you smoke, get help from your health care provider to quit.
- Don’t drink alcohol in excess.