It can happen in an instant: a misstep over an upturned edge of living room carpet, a stumble, and then a light fall to the ground — no more severe than abruptly assuming a sitting position on the floor. You use your hands to brace yourself and immediately hear a grinding noise, followed by waves of cold sweat, nausea, and a pain in your wrist that is far greater than what such a trivial tumble should have produced. A trip to the doctor confirms what you already suspected — you’ve suffered a bone fracture. Left untreated, a fracture increases the risk of blood clots, infections, damaged skin and muscle, and of course, impaired movement and intense pain in the infected area. How did such a slight jarring of the body lead to an excruciating injury requiring weeks of medical attention? Often the culprit is not the fall itself but rather an undiagnosed progressive bone disease called osteoporosis.
Osteoporosis, ominously known as the “silent disease,” is an incurable affliction that reduces the quality and density of bones, making them more susceptible to breaks and fractures. Approximately 10.2 million Americans have this disorder, while a whopping 43.4 million have what is known as osteopenia, the precursor to osteoporosis, in which bones have begun to weaken and substantial bone loss is evident. These two afflictions account for more than 1.5 million breaks and fractures every year.
Sadly, most people are unaware that they even have osteoporosis until they suffer a fracture because significant bone loss occurs “silently,” without any noticeable symptoms. Rather than rock hard, impenetrable entities, bones are actually living tissues, comprised of collagen and calcium phosphate, engaged in a lifetime process of expelling old bone cells and growing new ones. In children, bone tissue is formed faster than it is lost, but that advantageous increase in bone mass peaks somewhere between the ages of 18 and 25. After that, more bone is lost than replaced, and this decline of bone mass amplifies as we age.
Some mistakenly think of osteoporosis as an “old lady disease” because women’s bones are usually thinner than a man’s and women experience a rapid decrease in bone density after menopause. However, 10 to 25 percent of men will be diagnosed with osteoporosis in their lifetime, and younger women with particular risk factors can be vulnerable to the disorder as well.
Back pain that increases when walking or standing, trouble bending, height loss or a curved spine can all suggest a diagnosis of osteoporosis, but a fracture, typically in the wrist, hip, or vertebrae, is usually the first sign of decreased bone mass. With substantial bone loss, injuries can occur from simple, everyday movements, such as getting out of a car, tripping over a curb, or even enjoying a good, hard sneeze.
Who Is At Risk
While being a slim, petite female might be cosmetically appealing, thin woman have a greater chance of developing osteoporosis because their overall bone mass starts smaller. And research shows that simply being female, regardless of size, puts you more at risk of developing bone mass deficiency than the males in your orbit. This is especially true after menopause, when estrogen, the hormone that actually protects our bodies from bone depletion, decreases dramatically. With each passing year, the propensity to lose bone density increases, making women over the age of 50 the group most likely to be stricken with osteoporosis.
Other genetic precursors include being of Asian, Caucasian, or Latino descent, as these ethnicities have a higher percentage of people suffering from bone mass loss. Likewise, any family history of osteoporosis increases the chances of contracting the disease. Other inborn risk factors include thyroid-related ailments, disorders that lead to the removal of the ovaries, and the early onset of menopause. While none of these conditions are controllable, a whole host of other behaviors can lead to osteoporosis, such as smoking, alcohol abuse, a lack of calcium and vitamin D in the diet, and insufficient exercise.
Men might feel themselves immune to this predominately female disease, but approximately 2 million men are in the full blown stages of osteoporosis, while another 12 million have experienced a noticeable decline in bone mass. While men share the same behavioral risk factors as women, male osteoporosis is most commonly caused by testosterone deficiency. Other male related reasons for substantial bone loss include use of steroids, asthma and prostate cancer medications, and low levels of estrogen.
While lifestyle changes may help slow down the rate of bone loss and lower the risk of fractures, bone tissue that has already been lost cannot be retrieved, so early diagnosis of osteoporosis is essential.
Bone density tests, known as DXA or DEXA scans, are noninvasive, painless, and require no preparation. The patient lies on a padded table, and a small, portable machine measures bone density in different parts of his or her body, then compares those measurements to the bones of an average young adult. For men over the age of 50 and postmenopausal women, the results are reported as T-scores, and any score above -1.0 is good. Scores between -1.1 to -2.4 indicate low bone mass, and anything lower than -2.4 is indicative of osteoporosis.
The same procedure is used for younger men and women, but results are converted to Z-scores for which any number below -2.0 denotes a problematic level of bone loss. The entire process is quick, lasting only 15 to 20 minutes, and typically costs around $125. Bone density tests are covered by Medicare for women over the age of 64 and men over the age of 69, and many insurance carriers will pay the cost of the test for younger patients if certain risk factors are in play.
The best way to combat osteoporosis is not to contract it in the first place. Taking care of bones at a young age is preferable because the more bone mass attained in your youth, the less susceptible you are to extreme bone loss later in life. However, it is never too late to make lifestyle changes that can dramatically improve the quality of your bones.
The first step in fighting bone loss is a healthy diet. Remember that bones are made of calcium, so any food rich in calcium, such as green leafy vegetables, low-fat dairy products, and calcium-enriched cereals and orange juice, are ideal for bone health. Some foods may actually impede the absorption of calcium, so if you are trying to build better bones, cut back on raw beans, spinach, wheat bran, and salt. Research also indicates a link between osteoporosis and alcohol, caffeine, and cola-type beverages, so these should be consumed in moderation.
Vitamin D, which improves your ability to absorb calcium, can be obtained from sunlight, but if you are not outside frequently or you are wisely taking care of your skin by applying sunscreen, then vitamin D supplements can fill that gap. Do not take high levels of D supplements without consulting your physician. If you do not have a vitamin D deficiency, high levels can cause serious problems.
Adequate exercise is also an essential ingredient in the fight against osteoporosis, but be advised that not all types of exercise will improve bone health. While activities that are not weight-bearing, such as swimming or cycling, might improve your cardiovascular system, they will not combat bone loss. Exercises such as walking or jogging — anything done on your feet — will help prevent osteoporosis, especially when combined with a regular routine of weightlifting or other resistance types of strength training.
Avoid becoming overweight or underweight, as both these extremes have been linked to osteoporosis. Obesity and type 2 diabetes can increase bone loss as can the severe restrictions in calorie intake that are often observed in people suffering from eating disorders.
Finally, if you smoke, stop. Just stop. Not only is smoking linked to a decrease in bone density, it also increases your risk of lung cancer, lung disease, coronary heart disease, strokes, aortic aneurysms, and a whole host of other equally nasty diseases. So, stop.
Currently no cure exists for osteoporosis, and bone that is lost can never be recovered. However, people who live with this disease can take steps to slow down the rate at which their bone density is compromised and make lifestyles changes that may reduce their risk of fractures.
It is especially important for those who live with osteoporosis to follow the same guidelines used in the prevention of the disease, such as maintaining a healthy diet, having a regular routine of weight-bearing and resistance type exercises, keeping alcohol to a minimum, and bringing smoking to a halt. Osteoporosis patients may also have access to several prescription-only medications, some of which have been shown to slow down bone loss and others that appear to activate bone growth. The resulting bone tissue, while not as strong as the original, is certainly better than weaker tissue and may provide some relief to those with severe osteoporosis.
While there are prescription medications for treatment, these need to be monitored closely and only taken for a short period of time. There can be severe consequences to certain prescription management of osteoporosis, including avascular necrosis of the mandible and subtrochanteric stress fractures. Many doctors recommend that a specialist treat osteoporosis, usually an endocrinologist.
Those who live with compromised bones also live with the fear of falling because even a minor spill can lead to a significant fracture. Home adaptations can be useful, such as installing handrails in the bathroom, securing carpets to the floor, making sure that low furniture and other debris are kept out of walkways, and using nonskid mats or strips on any surface that may get wet. If pain from lifting or carrying items, even small grocery bags, becomes an issue, enlisting the help of a friend or relative might become necessary.
Whether you have the disease, are at risk of contracting it, or simply want to improve your already marvelously mighty bones, now is the time to take action. Put out that cigarette (forever, please), set down the cola, grab an orange juice and a vitamin D supplement, then run or walk to the gym for some resistance training. Hopefully, with consistent and proper care of your bones, any tumble you take over your living room carpet will only result in a mild case of embarrassment.