22Mar 2017

osteoporosis2“Osteoporosis is my passion. It is important to know the facts about this common disease, which can affect the quality of life for so many individuals, particularly post-menopausal females.”
– Magdalena Cadet, M.D. – Rheumatologist

Osteoporosis, is defined as a disorder of low bone mass causing bones to become thin, weak and brittle. This condition is not acutely life threatening, but can lead to debilitating fractures of the hip, spine and wrist along with various complications. Some of these fractures result from low trauma such as coughing, sneezing or tripping after losing balance. Complications from an osteoporotic fracture may significantly impact a person’s daily activities and quality of life.

Some of the risk factors for osteoporosis include age, family history, history of previous fracture, race, vitamin D deficiency, low body mass index, excessive alcohol intake and smoking history, certain medications like steroids and specific diseases such as rheumatoid arthritis. Males are also at risk as well as some younger individuals who may have medical conditions such as lupus, seizures, inflammatory bowel disease or thyroid disorder, and are taking treatment that may affect bone quality.

ostoeporosisAt the American Society for Bone and Mineral Research Annual Meeting in 2016, there was a discussion focusing on the “call to action” by numerous bone health-related organizations to increase the screening, diagnosis and treatment of individuals who are at high risk for fractures. The annual meeting emphasized the need to adequately treat osteoporosis around the country and the world. Dr. Kenneth Saag, the president of the National Osteoporosis Foundation spoke about the upward projection of increases in hip fracture in men and women by 2050 as compared to the past. This increase will be likely due to a significant decline in the rate of bone density (DXA) testing therefore resulting in the decline in diagnosis and treatment of high risk patients. Dr. Saag also pointed out that 2016 data surprisingly showed half as many patients were placed on an osteoporosis regimen compared to the mid-2000s.

As a rheumatologist, it is imperative to assess an individual’s risk for osteoporosis and fracture. This is done by:
• Obtaining a thorough clinical personal and family history
• Performing bone density testing (DEXA)
• Obtaining blood work to check for calcium, vitamin D, parathyroid and thyroid levels
• Using an online tool called FRAX to quantify an UNTREATED individual’s ten-year probability of a hip or major osteoporotic fracture.

Once this assessment is completed, physicians should discuss lifestyle changes to help prevent this bone disorder. A few of these tips include:

• Stop smoking today! Get on some type of nicotine replacement with the advice of your doctor as soon as you can. It is no surprise that nicotine consumption can generate free radicals that destroy bone cells and increase cortisol levels that accelerate bone deterioration.
• Limit the excessive (more than 2-3 ounces a day) alcohol intake. Alcohol interacts with bone forming cells and can affect the liver and pancreas which play a role in calcium and vitamin D absorption.
• Engage in balance and flexibility training and strengthening (weight bearing) exercises to stimulate estrogen production and bone formation. Swimming, walking, yoga and Tai Chiu are encouraged.
• Get some adequate calcium and vitamin D into the diet. Good sources of calcium can be found in milk, yogurt, nuts (almonds), cheese, dark green vegetables, orange juice, sardines and soy milk. Vitamin D sources may include cod liver oil, fish oil, eggs, fortified dairy products and over the counter supplements.

Sometimes women and men may develop worsening bone density despite their participation in good lifestyle modifications, and may require medications to increase their bone density and strength. Some of these medications aim to help build bone mass and increase bone strength, and other medications aim to prevent further bone loss. Other drugs affect the interaction of the different cells involved in the bone remodeling process. Estrogen has also been used to help protect the skeleton by promoting calcium absorption and preventing the death of bone forming cells. Every person is different and must discuss the options with his or her physician and evaluate the comfort level with the drug side effect profile before making a final decision. Keep in mind that not treating osteoporosis is risky and may lead to disability. No therapy is permanent.

“I hope that with more education about this public health concern, people will empower themselves to take measures to improve their bone health!” – Magdalena Cadet, M.D. – Rheumatologist

For more info on Dr. Cadet and the Bone & Joint Health and Osteoporosis Center of The Spine & Pain Institute of New York, please visit: www.OsteoCenterNY.com

www.nof.org (National osteoporosis Foundation)
www.rheumatology.org (American College of Rheumatology)
Highlights from American Society for Bone and Mineral Research Annual Meeting September 16-19; Atlanta