Boning Up on Osteoporosis – Early Diagnosis Is Key to Effectively Treating the Disease

W
hile most women know that osteoporosis weakens bones over time, often to the extent that simple daily activities can cause fractures, most people aren’t aware of exactly how dangerous the disease can be.

According to the National Osteoporosis Foundation, an estimated 10 million Americans are living with osteoporosis — 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of them women.

As bones continue to weaken, the likelihood of fractures rises, but the risks of osteoporosis are far greater than hospitalization. Dr. Jeanine Martin, a rheumatologist at Mercy Medical Center, points to studies indicating that approximately one in two women age 50 and over will break a bone due to osteoporosis. Another study predicts that about 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of seniors who break a hip die within one year of the injury from problems related to the broken bone itself or surgery to repair it.

“Many of those who survive need long-term nursing-home care,” Martin told HCN. “In 2010, there were 258,000 hospital admissions for hip fractures among people age 65 and older.”

That number, Martin added, is projected to increase by 12{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} by the year 2030. There are several risk factors for the disease, including excessive consumption of alcohol, smoking, low body weight, immobility, family history of hip fractures, chronic steroid therapy, and rheumatoid arthritis, among others. Additionally, some medications can contribute to decreased bone mass, he said.

These statistics are alarming, but doctors are also concerned with late diagnoses.

“Just over 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of women age 67 or over who sustain an osteoporotic fracture will receive a bone-density scan or treatment for their osteoporosis six months following the fracture,” Martin said.

For these reasons — not to mention the fact that women are five times more likely to be affected by osteoporosis than men, according to Dr. Kamal Shoukri, a diabetologist and endocrinologist with Baystate Medical Center — screenings, accurate diagnoses, and effective treatment options are integral to the battle against the disease.

Staying Ahead of the Curve

Martin follows the International Society of Clinical Densitometry guidelines for osteoporosis screening. She recommends that people get screened if they:

• Are a woman age 65 or older;

• Are a man age 70 or older;

• Break a bone after age 50;

• Are a woman of menopausal or post-menopausal age with risk factors; or

• Are a man age 50 to 69 with risk factors.

In addition, Martin recommends a bone-density test for people who display certain warning signs, including losing one and a half inches from their original height or confirming through an X-ray that their spine shows a break or bone loss. Hundreds of factors can contribute to the disease, which can often make it a challenge to diagnose.

“With regard to risk factors, there are both lifestyle and disease states,” said Martin, who explained that everything from smoking to celiac disease can lead to osteoporosis.

Shoukri, who practices in Baystate’s Endocrinology and Diabetes Division, added that the diagnosis process is critical to determining further courses of action. While fractures are often the painful giveaway for seniors, bone-density measurements can indicate osteoporosis before it reaches the stage where bones are weakened to the point of fractures.

“It’s diagnosed in a variety of ways; you have to find out if there are secondary causes,” said Shoukri, who specializes in osteoporosis, as well as thyroid, pituitary, and adrenal diseases.

Doctors recommend combating osteoporosis by getting enough calcium and vitamin D, in addition to eating a balanced diet and engaging in regular exercise. Martin suggests loading up on foods that are good for bone health, including fruits and vegetables.

Targeted Treatments

If it becomes clear that eliminating certain potential causes of osteoporosis will not be sufficient for patients battling the disease, there are several treatment avenues available to doctors. Every patient is different, though, and plans must be geared specifically toward each individual’s needs.

In recent years, treatments have been heavily affected by the expansion of a class of bisphosphonate drugs intended to slow or stop the natural process that dissolves bone tissue. By decelerating the negative momentum, these drugs can prevent fractures and improve quality of life for patients.

“Osteoporosis occurs when your bones break down, but these new medications inhibit the cells that break bones down,” said Shoukri, who served an endocrinology fellowship at the University of Connecticut Health Center and previously studied medicine in Cairo, Egypt. “They can reduce your risk of fractures by up to 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.”

Like any drug, there are concerns associated with bisphosphonates, including worries about a potential link between the drugs and esophageal cancer. Shoukri said it’s important to avoid excessive suppression of cells, and that the medications may not be appropriate for every patient.

An array of other drugs have been approved to prevent or treat osteoporosis, including zolendronic acid as a once-yearly bisphosphonate. More recently, Denosumab was approved in 2010, the first biologic therapy that can be given subcutaneously every six months for individuals who cannot tolerate oral medications.

Additionally, Shoukri said targeted therapies have come a long way in recent years. Designed to activate cells that inhibit bone breakdown, they have been used with success at Baystate.

“The medications being developed are far more targeted,” he added. “There are many more in the pipeline.”

Moreover, medications like Forteo can be used by people who have had a fracture related to osteoporosis, or who display several risk factors for fractures and cannot use other osteoporosis treatments. Shoukri said the medication is among the most potent products available, to the extent that a patient can use it only for a maximum of two years.

As new medications have been developed and released, doctors have gotten a better idea of which type of products work for individuals with specific needs. Extensive studies must first be completed, however, and lengthy series of tests and trials are finished prior to the emergence of each medication.

“Other options are estrogen therapy or hormone therapy, which can be effective in the right patient population,” said Martin, who has been on staff with Mercy for almost a year. “There is one drug, Teraperatide, that was approved in 2002 and is the only anabolic therapy for osteoporosis.”

Treatment for osteoporosis does not differ by gender, with the exception of hormone therapy, Martin added.

Ultimately, the decisions boil down to the specific circumstances. One option may have strong results for one patient and a disappointing efficacy with another. It’s all about the individual symptoms and factors, doctors say, when determining a plan of attack.

Reverse the Curse

Of course, the best way to combat osteoporosis is prevention. By maintaining healthy habits and avoiding pitfalls, women — and men, too — can put themselves in a position to keep their bones strong in the later stages of life. In addition to eating nutritiously and getting daily exercise, doctors recommend limiting alcohol and avoiding smoking.

Bone health is especially crucial for seniors’ quality of life, because injuries can prove far more dangerous for individuals over 60.

“A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine, and ovarian cancer,” Martin said, emphasizing that weakened bones is a major problem that can be accelerated by certain risk factors.

For older adults, it is also more challenging to rehab injuries after suffering fractures. In many situations, seniors are never able to regain their pre-injury condition following a fracture due to osteoporosis.

In short, said the doctors who spoke with HCN, anyone experiencing what they believe to be signs of osteoporosis should see a doctor right away, because early diagnosis can quicken the path to recovery.