Osteoporosis

Happy Monday, and welcome to Medical Mondays! May is National Osteoporosis Awareness Month, so I’m gonna go out on a limb and assume you know what I’m gonna be talking about today! :]

Fun fact! Once upon a time, I used to volunteer as a medical interpreter for a free primary care clinic in Sacramento. I love and miss that place dearly, and I would love to go back someday to volunteer as a physician. <3

Osteoporosis is a topic that is near and dear to me, partly because I gave a presentation on it at a health fair back in 2010. In Cantonese! (+ also because it’s supposed to be a lot more prevalent in Asian females.)

I can’t find my final draft anywhere in the recesses of my email archives (sigh), but this was a rough draft of a tiny part of it!

在美國每年約有超過一百五十萬的骨折的病人是隱性的骨質疏鬆症病人，而其中婦女患者又佔了总数的80%。 骨質疏鬆症有可能会提高骨折的风险，特别是在手腕，背骨,和臀骨. 骨質疏鬆症的徵狀並不明顯, 但是风险因素包罗年级大，钙质和丁种维生素不够，没有运动，吸烟，或者喝很多酒。吃有钙质和丁种维生素的东西或者做运动可以帮助你降低罹患疾病的機會。

If you can’t read that…fear not–I’m reverting back to English!

What is Osteoporosis?

Osteoporosis is the most common metabolic disorder of the bone, and is defined as a lumbar spine (L2-L4) density level that is 2.5 standard deviations below the peak bone mass of a 25-year-old.

It is more commonly found in women because women…

• Tend to live longer than men
• Usually have lower peak bone mass
• Experience rapid bone loss during menopause (secondary to decreased estrogen production)

Osteoporosis is usually asymptomatic, and often isn’t discovered until a fracture has occurred. The most common fractures are found in the vertebral spine or the hip (at the femoral head).

Diagnosis

Osteoporosis can be diagnosed with a DEXA scan (a bone density test) or by the occurrence of characteristic fractures (typically vertebral or hip) when given a consistent history, physical exam, and lab findings.

A DEXA scan is usually indicated as a screening tool for osteoporosis for all >65yo women. Lab tests can be performed to rule out secondary conditions (e.g. hypothyroidism, hyperparathyroidism, renal or hepatic dysfunction).

Lifestyle Changes

• Eat foods with vitamin D, such as milk that has vitamin D added in it, and fish from the ocean!
• Take calcium and vitamin D supplements if you don’t get enough from your diet.
• Try to be active for at least 30 minutes/day for most days of the week, and incorporate weight-bearing exercise!
• Avoid smoking.
• Limit the amount of alcohol you drink to (at most) 1-2 drinks a day.

Fall Prevention

• Make sure all your rugs have a no-slip backing to keep them in place + watch out for slippery floors!
• Wear sturdy, comfortable shoes with rubber soles.
• Tuck away any electrical cords, so they won’t be in your way.
• Keep all walkways well lit.
• Get your vision checked.
• Ask your health care provider to see if any of your medicines might make you dizzy or increase your risk of falling.

Medications For Osteoporosis

If you have osteoporosis or at a high risk for fractures, there are a variety of medications available.

• Bisphosphonates come in pill or shot form, and increase  bone mass + reduce incidence of fractures.
• “Estrogen-like” medicines are selective estrogen receptor modifiers (SERMs) that act like estrogen, which helps to prevent bone loss. These medications are only for women who have undergone menopause. Some SERMs may reduce breast cancer in women at high risk.
• Hormone replacement therapy (HRT) can help to prevent + treat osteoporosis, as well as the symptoms related to menopause…but is also associated with an increased risk of breast cancer, stroke, venous thrombosis, and possibly coronary disease.
• Parathyroid hormone (PTH) stimulates bone formation and activates bone remodeling, but is rather costly. Reserved for patients who have severe osteoporosis.
• Denosumab blocks RANKL (receptor activator of nuclear factor kappa-B ligand), a protein that causes bone to break down. Inhibiting RANKL helps to reduce bone loss. Denosumab is a newer drug and long-term effects are not yet known, so it is not as often prescribed.
• Calcitonin doesn’t work as well as other osteoporosis medications, but can relieve pain from broken bones in the spine. Should not be used for more than 6 months.

Make sure you check out Jen @ Pretty Little Grub’s post on calcium + vitamin D requirements for active people! :]

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)