FAQs for detecting, treating osteoporosis
10/8/2020 by Dr. Rozalina McCoy
Osteoporosis is the most-common bone disease. Bones become brittle (“thin”) and more likely to break (fracture). Everyone is at risk for developing this disease, although older, post-menopausal women are at highest risk. Some diseases, medications, smoking, and personal and family history of fractures also increase your risk. You can read more about these risk factors and how to prevent osteoporosis in this recent article.
Over a lifetime, half of all women will suffer a fracture of the spine, hip or wrist due to osteoporosis, while up to one-quarter of men over age 50 will fracture their hip or spine. Given these statistics, it’s important to maintain bone health and detect and treat bone loss early. Here are answers to questions patients frequently ask about screening and treatment of osteoporosis.
Q: When should I be screened?
A: In our practice, we recommend that women who are post-menopausal and age 65 or older should be tested. We also screen men age 70 and older. Younger women and men also may need to be screened if they have risk factors for osteoporosis or fractures.
Q: What does testing for osteoporosis entail?
A: A bone-density test is the most common way to diagnose bone loss. The test is an x-ray of the spine and hip, taken at a certified radiology center. If you have an artificial hip or arthritis in your hip or spine, another option is to use the wrist. It is possible to measure bone density at other sites, like the heel or finger, but these tests, along with ultrasounds, are a lot less useful and reliable.
Q: What results will I get from the test?
A: A bone-density test will provide your actual bone density at each measured location, and calculate a T-score and a Z-score.
T-score tells how your bone density compares to an average healthy young adult of your sex. A normal T-score falls between -1 and +1. Anything outside of that range is abnormal, and fracture risk increases as the T-score decreases:
- -1 to -2.5 indicates osteopenia (at risk for osteoporosis)
- -2.6 and more negative indicates osteoporosis
Z-score compares your bone density with what is normal for someone of your age, sex, weight and race/ethnicity.
Q: How is osteoporosis treated?
A: Treating osteoporosis, as well as osteopenia, involves lifestyle, diet and medications. I recommend lifestyle and dietary modifications to everyone with, or at risk for, osteoporosis. These include:
- Get enough Vitamin D. Have your Vitamin D level tested. It should be between 30-50 ng/mL. If low, you can eat more D-fortified foods such as dairy products and usually also take over-the-counter supplements of 800-1000 international units/day of Vitamin D2 or D3.
- Get enough calcium. Calcium is the building block for bone. If you have been diagnosed with osteoporosis, you should be getting about 1,200 mg/day through diet or a supplement.
- Get at least 30 minutes of weight-bearing exercise/day. This can be as simple as walking and does not need to be vigorous. Activities that do not work against gravity, such as biking or swimming, are not weight-bearing.
- Stop smoking.
- Limit alcohol.
- Be cautious and avoid falls.
The decision to start a medication is more difficult because, even though medications for treating osteoporosis generally are very safe, effective and affordable, they still have some risks. They may be started if their benefits (much lower risk of fractures) outweigh these risks. You should discuss all options with your health care provider.
Q: What drugs are used for treating osteoporosis?
A: There are several prescription medications that treat osteoporosis and reduce risk of fractures. There are advantages and disadvantages to each one. You’ll need to discuss these options with your provider to determine what will work best for you.
- Bisphosphonate medications have the best scientific evidence for effectively reducing vertebral, nonvertebral (wrist, etc.), and hip fractures in both men and women. These include alendronate (Fosamax), a tablet taken one time/week; risedronate (Actonel), a tablet usually taken weekly or monthly; and zoledronic acid (Reclast), a quick intravenous infusion that is given once a year.
- Denosumab (Prolia) is an injection given once every six months and can be used safely by patients with more advanced chronic kidney disease.
- Teriparatide (Forteo) is the only medication that builds new bone. It is a self-administered injection given two times/day. It must be followed by either a bisphosphonate or denosumab to solidify the newly built bone.
- Raloxifene (Evista) is a non-hormonal, estrogen-like medication that can reduce risk of vertebral fractures in women. However, it does not lower risk of non-vertebral or hip fractures.
- Estrogen therapy for post-menopausal women, and testosterone therapy for men, is controversial and not recommended for treatment of osteoporosis because of the potential harm for older women and men. This is different for young women who experienced early menopause, and men who experienced hypogonadism; in these cases, hormone therapy may be beneficial for reasons other than bone health.
Q: Do I need to take osteoporosis medications for the rest of my life?
A: Just like the decision to start an osteoporosis medication, the decision of when to stop it – take a “drug holiday” – is a personal one and should be discussed in depth with your provider. I generally advise that lifestyle and dietary approaches continue indefinitely.
To learn more about risk factors, prevention, diagnosis and treatment of osteoporosis and osteopenia, visit the Mayo Clinic website.
Dr. Rozalina McCoy is an endocrinologist and primary care physician in the Primary Care in Rochester and Kasson's Division of Community Internal Medicine (CIM) 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.