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Winning the bone battle

Changes in diagnosis and treatment of osteoporosis

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March 22nd, 2011

Osteoporosis is a disease that weakens your bones and is more of a widespread problem than you may think. According to the National Osteoporosis Foundation, women in the U.S. have a higher incidence of osteoporosis than that of heart attacks, strokes, and breast cancer combined, says JoAnn Caudill, R.T., B.D., C.D.T., bone health program manager for Erickson Living. Of people age 50 and older, up to one in two women and one in four men will have an osteoporosis-related fracture at some point in their lives. Risk factors for the disease include age, a small and thin frame, family history, certain medicines, or having osteopenia (low bone mass). Recently, Harvard researchers showed that having extra weight around the midsection may also increase a woman s risk.

Not for women only

Although more women break their hips, more men will die as a result of a hip fracture later in life, Caudill says. One study showed that 30% of men who fractured their hip died within one year. The reasons for this are unclear, but it could be due to complications like pneumonia, infections, weakness, loss of a will to live, or fear of going to a nursing home. Up to 45% of men in the U.S. have low bone density, but many do not know about it. We conducted a survey in Baltimore County senior centers and our Charlestown and Oak Crest Erickson Living communities. The survey showed that approximately 50% of men knew about women s risk of osteoporosis but weren t aware of their own risk factors such as treatments for prostate cancer or other cancers, use of steroids or other medications, or reduced testosterone levels, Caudill explains .

Raising awareness

Studies have shown that some medical providers don t properly diagnose osteoporosis, even in an older adult who has suffered a fracture. But things are changing with regard to osteoporosis awareness. Many primary care and orthopedic doctors are becoming more involved in research and prevention, Caudill says. In many states, a hospital-based initiative called Own the Bone is checking people with hip fractures to ensure that there is an osteoporosis treatment protocol in place before the patient goes home.

Screening changes

The U.S. Preventive Services Task Force has recently changed its osteoporosis screening recommendations to include all women 65 and older as well as younger women at increased risk of bone fractures like those who smoke, drink alcohol, or who have a family history. Getting screened is vital for prevention and diagnosis of osteoporosis, says Janice Gable, M.D. DXA scans [dual energy X-ray absorptiometry] have always been the gold standard for osteoporosis detection, but even a simple heel ultrasound scan can give us an idea of someone s risk and whether or not they need further testing, Caudill says.

Are calcium and vitamin D still important?

A diet rich in calcium and vitamin D (or the use of supplements) has long been thought to be an essential part of osteoporosis prevention and treatment. But last year, the Institute of Medicine (IOM) released new guidelines for calcium and vitamin D intake, indicating that many Americans didn t need as much as the medical community once thought. The need for calcium and vitamin D is very individualized based on factors like sunlight exposure, medications, and risk of disease. I do laboratory tests to determine someone s need for vitamin D, Gable says. Older adults still need to make sure they are getting enough of these essential nutrients and shouldn t stop taking anything without discussing it with their doctor. The National Osteoporosis Foundation released a statement that their recommendations haven t changed despite the IOM report, Caudill adds. A bone healthy diet should include calcium-rich foods, dairy products, fruits and vegetables, and whole grains.

Exercise is essential

Exercise not only improves your bone health, but it also increases muscle strength, coordination, balance, and leads to better overall health. Although exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. Sometimes people are concerned about exercising especially if they have advanced osteoporosis, Gable says. But you can t get stronger by resting. Exercise will not sap your strength but increase it. Check with your doctor to be sure that the exercise program you choose is safe for you. There is a growing movement, especially in the United Kingdom, encouraging people to dance to prevent the disease or its progression.

New medication

For prevention or treatment of osteoporosis, medications like bisphosphonates are often used. In some cases, hormones like estrogen or parathyroid hormone might be prescribed. As of 2010, there s a new drug called denosumab (Prolia). It is given as a subcutaneous [under the skin] injection every six months, which tends to be more convenient for people rather than a daily or even a monthly oral dose, Caudill adds. Your doctor can determine if you are a candidate for this new drug.

Prevention and treatment work

At Charlestown [an Erickson Living community in Catonsville, Md.], we ve had a significant reduction in hip fractures due to our bone health initiatives such as more screening, education, and falls prevention measures, Caudill says. The rates of fracture have also decreased nationwide, but the cost of treating fractures has increased. This may be due to the high cost of some preventive measures, like certain medications. Caudill adds, Although some treatments can be expensive, people should know that prevention is manageable if you focus on diet, exercise, and screening.

Choose your weapons wisely

  • Awareness: Own the Bone hospital initiative is ensuring those with hip fractures have an osteoporosis program in place.
  • Exercise: Improves bone health and muscle strength.
  • New medication: You might want to ask your doctor about a new drug called denosumab.

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