Did you know that there were about 9 million low trauma fractures worldwide in 2000? 3 million of those were either hip or spine fractures which are associated with an increased mortality rate of 10 to 20 percent. These fragility fractures are a result of osteoporosis and may result in limitations in walking, loss of independence, depression, and chronic pain. For women to maintain quality of life as they age, an important goal is to understand how to prevent, assess for, and treat bone loss.
What happens? Healthy girls have the highest rate of bone mass accrual between age 11 and 14. Peak bone mass in the hip is attained by women in their 20s. In the spine and forearm it is closer to age 30. Illness, genetic predisposition or medications that interrupt achievement of peak bone mass will increase the risk for osteoporosis later in life. Between menopause and the age of 75, women lose approximately 22 percent of their total body bone mineral. It has been estimated that of this, 13.3 percent is due to aging and 7.75 percent is due to estrogen deprivation.
What can you do? Some of the most important treatments for preventing osteoporosis and fractures include diet, exercise, and not smoking.
- Calcium intake — Experts recommend that pre-menopausal women and men consume at least 1000 mg of calcium per day; this includes calcium in foods and beverages plus calcium supplements. Postmenopausal women should consume 1200 mg of calcium per day (total of diet plus supplements). However, you should not take more than 2000 mg calcium per day due to the possibility of side effects.
- Vitamin D intake — Experts recommend that men over 70 years and postmenopausal women consume 800 international units (IU) of vitamin D each day. This dose appears to reduce bone loss and fracture rate in older women and men who have adequate calcium intake (described above). Although the optimal intake has not been clearly established in pre-menopausal women or in younger men with osteoporosis, 600 international units of vitamin D daily is generally suggested.
- Protein supplements — Protein supplements may be recommended in some people to ensure sufficient protein intake. This may be particularly important for those who have already had an osteoporotic fracture.
- Alcohol, caffeine, and salt intake — Drinking alcohol excessively (more than two drinks a day) can increase the risk of fracture due to an increased risk of falling, poor nutrition, etc., so it should be avoided. Restricting caffeine or salt has not been proven to prevent bone loss in people who consume an adequate amount of calcium.
- Exercise — Exercise may decrease fracture risk by improving bone mass in pre-menopausal women and helping to maintain bone density for women after menopause. Furthermore, exercise may decrease the tendency to fall due to weakness. Physical activity reduces the risk of hip fracture in older women as a result of increased muscle strength. Most experts recommend exercising for at least 30 minutes three times per week. The benefits of exercise are quickly lost when a person stops exercising. A regular, weight-bearing exercise regimen that a person enjoys improves the chances that the person will continue it over the long term.
- Smoking — Stopping smoking is strongly recommended for bone health because smoking cigarettes is known to speed bone loss. One study suggested that women who smoke one pack per day throughout adulthood have a 5 to 10 percent reduction in bone density by menopause, resulting in an increased risk of fracture.
- Falls — Falling significantly increases the risk of osteoporotic fractures in older adults. Taking measures to prevent falls can decrease the risk of fractures. Such measures may include the following:
- Removing loose rugs and electrical cords or any other loose items in the home that could lead to tripping, slipping, and falling. Providing adequate lighting in all areas inside and around the home, including stairwells and entrance ways.
- Avoiding walking on slippery surfaces, such as ice or wet or polished floors. Avoiding walking in unfamiliar areas outside. Reviewing drug regimens to replace medications that may increase the risk of falls with those that are less likely to do so.
- Visiting an ophthalmologist or optometrist regularly to get the optimal eye glasses.
- Medications — Prolonged therapy with and/or high doses of certain medications can increase bone loss. The use of these medications should be monitored by a healthcare provider and decreased or discontinued when possible. Such medications include the following:
- Glucocorticoid medications (eg, prednisone)
- Heparin, a medication used to prevent and treat abnormal blood clotting (ie, anticoagulant)
- Vitamin A and certain synthetic retinoids (eg, etretinate)
- Certain antiepileptic drugs (eg, phenytoin, carbamazepine, primidone, phenobarbital, and valproate)
Who should be screened for low bone density? Dual-energy x-ray absorptiometry or DXA is the most widely used method for measuring bone mineral density (BMD). We suggest DXA screening in women 65 years and older and postmenopausal women younger than 65 who have other risk factors for fracture which include the following:
- Previous fracture
- Long-term glucocorticoid therapy
- Low body weight (less than 58 kg [127 lb])
- Family history of hip fracture
- Cigarette smoking
- Excess alcohol intake
What is your fracture risk? The FRAX tool can help you and your doctor assess your individual risk and know when to initiate treatment. Navigate to the FRAX site , click on the calculation tool tab, choose your geographic region, and then your race. Answer all of the questions and enter your most recent femoral neck BMD if you have had a bone density test. The output calculates the 10 year probability of hip fracture and major osteoporotic fracture.
How does FRAX influence treatment? The National Osteoporosis Foundation guidelines recommend treatment of postmenopausal women if there is a history of hip or vertebral fracture or if there is osteoporosis based upon BMD measurement (T-score ≤-2.5). With FRAX, the NOF recommends treatment of women with osteopenia (T-score between -1.0 and -2.5) when the 10-year probability of hip fracture reaches 3 percent or the 10-year probability of major osteoporotic fractures combined is ≥20 percent.
Your bone health is important and your provider at Golden Gate will discuss appropriate screening and medication options with you if you meet criteria for treatment. Read about treatment and monitoring of osteoporosis in our next Newsletter.
As an added convenience, you can now schedule your Dual-energy x-ray absorptiometry or DEXA at UCSF Women’s Imaging Center located at 1725 Montgomery St, Suite 250.