Osteoporosis Prevention and Treatment

Charity Robinson, MD_editedBy Charity Robinson, MD

 

Prevention is the foundation for good health care for all ages.  We are most familiar with vaccinations and cancer screening, but this includes prevention of fractures in our older population.  Osteoporosis is a diagnosis when bones become too thin which can lead to fractures during our retirement years.  Measures to help reduce osteoporosis include healthy eating habits with calcium and vitamin D, regular physical activity with weight bearing exercise, and smoking cessation.  Older adults should be aware of factors which increase the risk for fractures, such as falls from poor balance or intoxication, walking on slick floors or ground covered in snow or ice, and progressive weakness due to inactivity.

Screening for osteoporosis starts with imaging technology known as bone mineral density or DEXA scan, which is a painless low level x-ray typically of the hips and spine.  We use an absolute number for osteoporosis on the DEXA scan, -2.5, but we take other risk factors into account (FRAX score) such as age, gender, body mass, prior fractures, smoking history, medications, medical conditions, alcohol, and family history of fractures to calculate the risk of overall and specific hip fractures for those with early bone thinning, or osteopenia.  These two values are an objective measure to know if a patient is a candidate for increased screening frequency or for medical treatment to help reduce the rate of bone loss and prevent fractures.

Treatment for osteoporosis or those with osteopenia at high risk for fractures includes continued dietary and supplemental calcium and vitamin D, weight bearing exercise, smoking cessation, and medications to help reduce the rate of bone loss and stabilize the existing bone structure such as bisphosphonates, Denosumab injections, hormone related therapy, and bone building medications which resemble parathyroid hormone to stimulate new bone growth.  Your provider will help you decide which treatment would be best for you depending on other health conditions, the levels of osteoporosis, and insurance coverage.  The best intervention is early adult prevention with diet, supplements, exercise, and fall risk reduction.