Osteoporosis

Osteoporosis is a skeletal bone disorder that results in compromised bone strength and an increased risk of fracture.  The bone loss is most marked in the menopause transition and the early menopause years.  Bone resorption (bone loss) during this transition time exceeds the ability of the body to produce new bone.  The average rate of bone loss is 2% beginning in the 1-3 years prior to menopause and continuing for 5-10 years.  Osteoporosis is often a silent illness until a fracture occurs. 

Risk factors

Risk factors for low bone density are age, thinness (BMI <21 kg/m²), smoking, genetics, chronic illness, and certain medications.  Genetics account for 50-85% of variance in bone density.

Risk factors for fracture are age, previous fracture, history of hip fracture in a parent, smoking, glucocorticoid use, rheumatoid arthritis and daily alcohol consumption of greater than 3 drinks per day. 

Prevention

Prevention of osteoporosis needs to begin decades before the menopause transition.  Calcium and vitamin D are very important for the formation of skeletal bone in childhood and adolescence.  Peak bone density is reached around age 30.  Avoiding smoking and limiting alcohol intake can also help reduce the risk of osteoporosis.  Exercise (high intensity aerobic exercise, weight bearing and resistance training) can also help reduce the risk of osteoporosis. 

Diagnosis

Osteoporosis is diagnosed with a DXA (dual energy x ray absorptiometry) scan.  This is a simple x-ray test of the bones. Usually, the x-ray is of the bones located in the hip and spine.  It is indicated for all women over 65 and for women over 50 who have other risk factors for low bone density

Once osteoporosis is present, lifestyle interventions will not reverse it.  Women with osteoporosis do not require more calcium or vitamin D than women with normal bone density.  Fall prevention is one strategy to reduce the risk of fracture.  Exercises that improve balance can reduce the risk of falling which can then reduce the risk of fracture.

Treatments

Medications can be divided into the categories of antiresorptive (prevent bone loss) and osteoanabolic (build bone).  Antiresorptive medications maintain or improve bone density and reduce fracture risk.  Osteoanabolic medications increase bone formation.  All medications indicated for osteoporosis reduce the risk of fracture. 

Bisphosphonates are included in the category of antiresorptive medications.  There is some confusion about the duration of use of these medications.  When a bisphosphonate is stopped, the protection will fade slowly over 1-5 years.  So, women with a low to moderate risk of fracture can consider discontinuing the medication after 3-5 years.  The fracture risk will rise again after approximately 2 years so repeat DXA scans are indicated. 

Estrogen is also considered an antiresorptive medication.  The primary role of estrogen is to relieve vasomotor symptoms (hot flashes/night sweats).  A secondary benefit of estrogen therapy is bone protection.  This may be particularly beneficial during the years of perimenopause/menopause as the rate of bone loss is rapid.  The benefits of estrogen therapy quickly fade over a few months once the medication is discontinued. 

The providers at Northside-Northpoint OB-GYN are skilled in screening, diagnosing, and treating women with osteoporosis.