August 21, 2013 11:00 am • Courtesy of The Times
Osteoporosis can effect anyone, but it is never so common as in women and the elderly. According to Dr. Maria Stamp, Professional Physicians Services, an affiliate of Porter Regional Hospital, “Women have a drastic change in hormones in menopause; that’s why we see more osteoporosis in women.”
Similar hormone changes, as well as decreased mobility, also effect the osteoporosis risk in elderly patients. According to Kristy Darnell, clinical nurse practitioner at Methodist Hospital, “Osteoporosis is a silent killer of the elderly. A fracture is often the first sign that they have it.”
Although a broken bone is rarely a cause of death in its own right, “Males have a significantly higher risk of dying within two years after a fracture than women,” says Dr. Keith Reich, chair of rheumatology at Franciscan Medical Specialists in Munster, Ind.
Fortunately, area doctors and nurse practitioners have encouraging news, including people’s ability to reduce some risk factors. That starts with understanding the condition.
Dr. Maria Stamp at Professional Physicians Services defines osteoporosis as a decrease in bone density that can predispose to fractures in women and men. In the elderly and the ill, “fractures can lead to other, life-threatening problems and lead to higher mortality.”
The medical professionals in this story agree risk factors include:
Menopause, hysterectomy, and women over 40 who have experienced early menopause. “Hormones, specifically estrogen, play a big role in bone density. We see more osteoporosis in women because they have such a drastic change in hormones in menopause,” says Stamp.
Low level of calcium and/or low Vitamin D. “In this area we receive less sunlight. Yet with concerns about skin cancer from too much sun exposure, it’s a Catch-22,” says Kristy Darnell, clinical nurse practitioner at Methodist Hospital.
Low weight (less than 20 BMI)
Sedentary lifestyle. “We know that people who don’t bear any weight don’t build bone as well,” says Stamp.
History of fragility or fracture as an adult.
Current smoker. But Dr. Keith Reich adds, “Even if they’re not smokers anymore, if they have COPD, that’s a risk factor.”
Long-term use of a steroid for a medical condition (not the type for body-building)
More than 2 or three alcoholic drinks per day.
Other contributing factors
“Once I see a patient with osteoporosis, then I want to figure out why, what are the secondary causes,” says Reich. “Some people can’t absorb Vitamin D very well because of such conditions as celiac disease, irritable bowel syndrome and other gastrointestinal diseases. Then they need to supplement the diet.”
Stamp cautions, “Men are often forgotten in the equation of osteoporosis, unfortunately.”
Reich, chair of rheumatology for Franciscan Medical Specialists in Munster, Ind., agrees. “Males definitely develop osteoporosis, especially in patients on certain medications, who smoke, who have COPD, and lowered testosterone. People don’t think about screening men for osteoporosis; most are screened after they’ve had a fracture.”
“There are lots of options these days in medications for osteoporosis,” says Stamp, and those can help. Dr. Kimberly Arthur, at Community Care Network-Hessville Family Care Center, notes that “Sally Field (in Boniva commercials) looks so young and healthy and talks about how Boniva will definitely help with osteoporosis” and the risk of fracture, helping to retain calcium in the bones. “But she is probably also doing a lot of other good things, too, for bone health, like a healthy diet and exercise.”
“Bones need minerals. Those are better obtained through diet than artificially,” says Reich, but notes that some can’t maintain the diet due to certain medical conditions. Arthur recommends 1,200 mg of calcium per day and 800 units of Vitamin D.
High- impact exercise like fast walking, jogging, running, aerobics, aerobic dancing can help build bone strength, says Darnell, but she cautions that those at risk for fracture can aggravate that risk, and that others need to increase gradually—and everyone needs to start by consulting with a physician.
“People ask about swimming; that helps the muscles that support the bones, but it’s not a weight-bearing exercise,” explains Reich.
“A reputable organization suggests that bone density screenings in men be done at age 70, or at age 50 and older if an event such as fracture occurs,” says Reich, yet “We’re still not at the point of screening men as much as women.”
For women, “Between the ages of 53 and 65 we start doing bone density screenings,” says Arthur. “But if the patient has risk factors (other than aging), we may do a screening earlier.”
Says Stamp, “If we can prevent fractures by treating bone density, that’s a huge public health quality of life issue.”