Employee & Community Health

Are you at risk for osteoporosis?

6/6/2017 by Rozalina McCoy, MD

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Chances are, you or someone you know has or will develop osteoporosis. Osteoporosis can significantly impact your quality of life and ability to remain independent as you age. Certain factors put both women and men at greater risk for developing this disease and experiencing a fracture as a result. 

What it is

Osteoporosis is the most common bone disease. Bones become brittle (thin) and more likely to break (fracture). They can be so weak that a minor fall or stress, such as bending over or coughing, can cause them to break. The weaker and more brittle the bones are, the higher the risk of fracture. The most common fractures from osteoporosis are of the hip (femur), wrist (radius) and spine (vertebrae). 

Osteoporosis develops slowly, so it is important to detect bone loss early and prevent it from progressing. Osteopenia is a related condition - bone density is lower than normal, but not low enough to be called osteoporosis. People with osteopenia also are at risk for fractures, but the risk is lower than with osteoporosis. 

Everyone is at risk for developing osteoporosis, although post-menopausal older women are at highest risk: 

  • Men and women. Women after menopause are at highest risk
  • Race and ethnicity. White and Asian people are at higher risk than those of Hispanic/Latino, African-American, African and Native-American origin 
  • Age. Older age is the strongest risk factor
  • Genetics. Family history of osteoporosis or hip fracture increases your chances of having the disease. 

Protecting your bones

Throughout our lives, our bodies use minerals, including calcium and phosphorus, to make new bone that replaces older, less healthy bone. These factors affect bone health: 

  • Vitamin D. Helps maintain a normal calcium balance. Our bodies make vitamin D, but need sunlight to activate it. People who live in northern climates or spend a lot of time indoors are at high risk for vitamin D deficiency. It is not usually found in food, but many dairy products are fortified with it. You can take a daily, over-the-counter vitamin D2 or D3 supplement of 800-1,000 IU per day to reach adequate levels. 
  • Calcium. Found in many foods: dairy products, dark-green vegetables, beans, fish, nuts. Most adults need 1,000 mg per day; women older than 50 and men older than 70 generally need 1,200 mg daily. If you do not get enough calcium from your food, take a supplement, such as calcium carbonate or calcium citrate. Certain medications affect calcium absorption, so you may need a higher dose. 
  • Smoking.
  • Consuming alcohol.
  • Being active. Gravity keeps bones healthy, so at least 30 minutes of weight-bearing activity, such as walking, every day helps reduce the risk of osteoporosis. 
  • Falls. Greatest risk factor for fractures. Help prevent falls by being careful, paying attention, and:
    •  Wearing safe shoes, keep laces tied
    • Reducing clutter, loose rugs and cords that could be tripped on
    • Taking care when walking on ice, snow and other slippery surfaces
    • Using a cane or walker to help with stability

Why it's important to be diagnosed

These statistics underscore the importance of maintaining bone health and detecting bone loss early:

  • Over a lifetime, half of all women will suffer a fracture of the spine, hip or wrist due to osteoporosis. 
  • Of women over 60 who have osteoporosis, 16% will fracture a hip or spine. 
  • Up to one in four men over age 50 will fracture their hip or spine. 
  • For those who break a hip, 10-20% of women and 33% of men will die within one year from either the fracture or related complications. 
  • Only four of 10 women who sustain a hip fracture will be able to return to their prior level of functioning and independence. 

Additional risk factors 

If you are a women younger than 65 or a man younger than 70 and have any of these major risk factors, you should talk with your care team about early osteoporosis testing: 

  • Premature menopause due to removal of the uterus and both ovaries, or loss of estrogen production at a young age
  • Medical conditions such as rheumatoid arthritis, Cushing's disease, osteogenesis imperfecta, hyperparathyroidism, hyperthyroidism (untreated), multiple myeloma or celiac disease
  • History of anorexia, malnutrition or rapid weight loss, even if current weight is normal
  • Steroid use for a long time, such as prednisone, dexamethasone or hydrocortisone
  • Even high doses of topical or inhaled steroids, if used for a long time, may worsen bone density
  • Weight-loss surgery
  • Anti-estrogen medications for breast cancer (tamoxifen, Arimidex, Aromasin, Femara) or anti-androgen medication for prostate cancer (Lupron)
  • Immobility, such as from paralysis, multiple sclerosis or stroke
  • Prior low-impact fractures

There are other risk factors for osteoporosis, although they may not call for early testing: 

  • Long-time use of Coumadin/warfarin
  • Use of some anti-seizure medications
  • Long-time use of heart burn medications/antacids
  • Taking some oral diabetes medications for type 2 diabetes or having type 1 diabetes

Visit the Mayo Clinic website to learn more about osteoporosis and osteopenia. Part two of this story will address testing and treatment for osteoporosis. Watch for it in July. 

Dr. Rozalina McCoy is an endocrinologist and primary care physician in the Division of Community Internal Medicine in Rochester. She specializes in the management of type 1 and type 2 diabetes, osteoporosis and thyroid disorders. Dr. McCoy also is a health services researcher who is passionate about improving the care of patients with diabetes, reducing their burden of treatment and hypoglycemia, and working with community-based organizations to help everyone access evidence-based health-promotion programs.