Osteoporosis Day: Take Precautions Against Bone Loss as You Age

As baby boomers age, more older adults are at risk for fracture, often the first sign of osteoporosis, a silent condition that has been compared to a "heart attack of the bones." Stacey Rothwell, PA-C, the Fracture Liaison Clinician and Coordinator for MUSC Health's Bone Health Program, says the importance of screening for osteoporosis cannot be overemphasized. "A fracture can rob people of their independence and mobility," she says.

We talked with Rothwell, a certified physician assistant, to learn about the importance of screening, who is at risk for this stealth condition, what treatments are available and how older adults can reduce their risk for fracture.

What is osteoporosis?

Osteoporosis is a disease that weakens the bones, causing them to become brittle and thinner. It occurs when bone mineral density and bone mass decrease, putting people at risk for fracture.

Why is screening important?

Often someone isn't diagnosed with osteoporosis until after they have a fracture caused by a ground-level fall. In extreme cases, a fracture can occur when someone is merely standing or turns over in bed.

The mortality risk associated with fractures increases depending on a patient's age and other medical issues, which is why it's important to identify these patients before they have a fracture. Women 65 years old and older and men over 70 should be screened for osteoporosis, or each as young as age 50 if they have a family history or other risk factors for osteoporosis.

What are risk factors for osteoporosis?

• Thin, Caucasian and Asian post-menopausal women who are over 60 and have a small frame
• Men and women who have a family history of osteoporosis
• Men who are taking androgen blockers for prostate cancer or have hypogonadism
• Heavy alcohol use or malnutrition
• Immobility from paralysis, previous stroke, etc.
• Diabetes, kidney disease, liver disease
• Roux en Y gastric bypass surgery
• Chronic steroid use
• Smoking
• Chemotherapy from cancer treatment

How is osteoporosis diagnosed?

Osteoporosis is diagnosed in three ways:

1. Having a DEXA scan that measures bone density with findings of a T score less than negative 2.5 (-2.5)
2. After sustaining a fracture anywhere in the body that is associated with a ground-level fall "Fragility Fracture"
3. A high FRAX score (Fracture Risk Assessment tool) — FRAX can calculate a patient's 10-year probability for any major fracture as well as hip fracture
   When someone is diagnosed with osteoporosis, we do bloodwork to look for secondary causes of osteoporosis, which include Vitamin D25, thyroid, parathyroid and chemistry panels. We also measure testosterone levels in men under 65

What does the DEXA scan measure?

The DEXA scan measures a person's bone mineral density, which is calculated using a T-score. The test does not require any dyes or special preparation. Patients with osteoporosis should have a bone density scan every two years.

What is a T-score?

The T-score measures the difference between the bone density of a healthy adult and someone with weak bones. A T-score for a healthy score is 0 to negative 0.9 (-0.9). From negative one to negative 2.4 (-2.4) is osteopenia, a precursor to osteoporosis. A score of negative 2.5 (-2.5) or less is osteoporotic.

What treatments are available to treat osteoporosis?

The good news is that we have medications that are beneficial and effective for improving bone health and decreasing fractures. These medications are very well tolerated and can restore a patient's confidence in their ability to move and be active, which is essential for good bone health.

It is important for a patient to be fully informed about these medications, so I emphasize shared decision-making when discussing treatment options with my patients. It is worth noting that certain medications received negative publicity for side effects when they first came on the market, but research has shown that those are rare. Many times, I refer patients to physical therapy to improve their balance and core strengthening to decrease their fall risk.

Medications include:

• Oral medications (bisphosphonates) – Bisphosphates can be taken up to five years. These include Fosamax, Boniva and Actonel.
• Infusion – Reclast is an infusion bisphosphonate medication and can be administered annually for up to three years.
• Injections – Several types of injection medications are available.
  • The bone-building cells. In the first months, bone growth is visible under a microscope. The injections are self-administered with a small needle that is replaced daily on a prefilled pen with the appropriate dosage.
  • Evenity, a sclerostin inhibitor medication, is the fastest acting and stimulates the bone-building cells while slowing the activity of the osteoclasts, which destroy old bone. Patients have an injection monthly for a year.
  • Prolia, a third-injection medication, is very effective for maintenance. It works on the osteoclasts to slow down their activity. It is administered every six months and can be taken indefinitely.

Osteoporosis is a chronic disease and must be treated long term or any benefits obtained from medications will eventually be lost.

What else can people do to preserve bone health?

Diet and exercise are important. I tell my patients that Vitamin D3, calcium and protein are essential for good bone health. Adults should take 2,000 units of Vitamin D3 and get 1200 milligrams of calcium daily between diet and supplement.

It is best to get calcium through your diet. Important foods for bone health are those rich in calcium, protein and vitamin D3. These include dairy or almond milk, yogurt (preferably Greek), cheese, protein shakes, green vegetables, such as spinach and broccoli, salmon, tuna, eggs and almonds.

I remind them to avoid high-carbohydrate and sugary foods, excessive diet drinks, smoking and to drink alcohol only in moderation. That is the cornerstone of any healthy diet.

I recommend weight-bearing exercises three to five times a week for 20 to 30 minutes. Walking with wrist weights, lifting light weights, using resistance bands, practicing yoga and using an elliptical are all great options and build muscle mass that protect bones.

What patients should be referred to the team at MUSC Health's Bone Health clinic?

MUSC Health has the state's largest and most complete center for osteoporosis treatment. Our clinic team treats patients who have suffered a fragility fracture and patients who have risk factors and want to be screened for osteoporosis.

We also work with patients before they have elective spine or total joint replacement surgery to get them optimized for their procedure.

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MUSC Health's bone health clinic is conveniently located in:

• Downtown Charleston at Rutledge Tower, 135 Rutledge Avenue.
• Mount Pleasant at East Cooper Medical Pavilion,1600 Midtown Avenue.
• West Ashley at West Ashley Medical Pavilion, 2060 Sam Rittenberg Boulevard.
• Summerville at Nexton Medical Park, 5500 Front Street, Suite 320.

To make an appointment, call 843- 876-0111.