Osteoporosis and bone health
Patients usually see a doctor when they have a complaint – chest pain, dizziness, fever or shortness of breath. These are called signs and symptoms and they help doctors figure out what disease a patient may have.
Some diseases, however, have no obvious signs or symptoms. One such disease is osteoporosis, a bone disorder where the bones in the body become weak as the body starts losing too much bone, makes too little bone, or both. Under the microscope, healthy bone looks like a compact sponge but in osteoporosis, the spaces are much larger. These larger spaces make the bone less dense, weaker and more likely to break.
Osteoporosis is different from osteoarthritis, where there is pain in a joint like the knee or hip, and so osteoporosis is called a “silent disease” because you cannot feel that your bones are getting weaker.
Osteoporosis is a serious disease. Unfortunately, many patients only discover that they have osteoporosis after they have a break in a bone, known as a fracture. These fractures can happen after tripping or after a simple fall from a standing height.
In more serious cases, the fracture can even happen by just bending down to pick something up from the floor or from forceful coughing or sneezing. The most common places where these fractures can happen are in the hip, spine and forearm, but bones can break in other places as well. Breaking a bone can cause permanent pain and immobility. It can also cause patients to become shorter and have a hunched posture. Patients can become depressed because they need longterm care and lose their independence. Having one fracture greatly increases the probability of another fracture within the next year. For elderly patients who break a hip there is also an increased chance of dying from complications related to the fracture.
Osteoporosis is common. Around 8.9 million people worldwide suffer from osteoporotic fractures yearly, translating to one osteoporosis-related fracture every three seconds. And it can happen to anyone. Although more common in women after they have reached menopause, it can also occur in men. One in three women, as well as one in five men over the age of 50 will experience a fracture due to osteoporosis.
Other factors that increase the chances of developing osteoporosis and fractures are advancing age, being Asian or Caucasian, being underweight, smoking, excessive alcohol intake, having a parent with osteoporosis or a hip fracture, and if you’ve already had a previous fracture.
Various diseases and medications can also be a cause of osteoporosis. Bones can become weak in patients with cancer, kidney disease, liver disease, thyroid disease and diabetes. Illnesses that affect digestion and malnutrition can also increase the likelihood of developing osteoporosis. Medications that can weaken your bones when taken for a long time include steroids, as well as medications used to treat depression, seizures, and chemotherapy in cancer treatment.
Fortunately, osteoporosis can be managed. Preventing osteoporosis and fractures begins in childhood with a healthy diet and exercise while the bones are developing. This allows for the bones to reach their greatest potential. As we age, our bones tend to weaken slowly, but the healthier your bones are in your youth, the less likely it is for osteoporosis to develop in the future.
Having a diet that has enough calcium and vitamin D is important to help keep the bones strong. These can come from food sources such as milk, cheese, egg yolks, salmon and tuna. You can also get Vitamin D by spending time under the mid-day sun, but with our climate and risk for skin cancer, it’s difficult to get adequate sun exposure. You may need to take supplements if you are at risk for osteoporosis and your levels of calcium and vitamin D should be measured so that you can be prescribed the correct amount.
Weight bearing exercises, such as walking and jogging, are essential in building strong bones. Weight lifting is helpful too, but should be limited to less than 10 pounds per weight if you have osteoporosis. Aim to exercise 3 to 5 days a week for 30 minutes each day.
Osteoporosis can be discovered early. If you have any risk factors for osteoporosis, there are ways to identify if you have a high chance of developing a fracture. There is a web-based tool called FRAX, which is short for Fracture Risk Assessment, from the World Health Organization that helps calculate the likelihood of having an osteoporotic fracture.
Another test is bone mineral density testing that is a simple, painless, outpatient procedure that uses low dose X-rays to measure the amount of mineral found in your bones. The results of these methods should be discussed with your doctor to identify the proper treatment.
Remember that fractures usually occur after a fall. So, take note of your surroundings and avoid slippery and uneven surfaces. Walk with assistance and use a cane for support if needed. Keep your rooms brightly lit and turn on the lights when you get up at night. Install grab bars in your shower and bathroom. Don’t smoke and don’t drink too much alcohol. Being intoxicated can increase your risk for falling. Be careful when bending and lifting heavy objects. Bend at the knees and not from the waist. Lift objects slowly and don’t strain your back. Even better, have someone else do the lifting for you.
Having poor vision can also affect how you walk so have your eyesight checked regularly.
Osteoporosis can be treated with several types of medications, which vary from tablets taken once a week, to an injection in the arm every six months, and a once-a-year medication that is given through the vein. Your doctor will help find the best option for you, depending on the severity of your osteoporosis, or if you’ve already had a fracture and if you have any other health problems. There are always concerns with taking medications for a long time. And although adverse effects are rare, always ask your doctor if you should continue your medication or switch to another type of treatment.
Osteoporosis does not have to be a debilitating disease. If you are over 50 years old and suspect that you may have osteoporosis, if you have had an unusual fracture, fracture frequently, or suspect that your fracture is due to an underlying disease, please see you doctor for further evaluation.
Through the cooperative effort of bone disease specialists at St. Luke’s Medical Center-Global City, we can ensure that all patients are adequately screened, and that all means are exhausted to provide you or your loved ones with the right diagnosis and the appropriate treatment.
To learn more, please join us for a Lay Forum on Osteoporosis Awareness on Oct. 8, Saturday, at the Henry Sy Sr. Auditorium at the 5th floor of St. Luke’s Medical Center-Global City from 8 a.m. to 12 p.m.
Dr. MONICA THERESE CATINGCABRAL is an Endocrinologist. She is the head of the soon to be opened Osteoporosis and Mineral Bone Disease Unit of the Center for Diabetes, Thyroid and Endocrine Diseases at St. Luke’s Medical Center-Global City. She is a graduate of the University of the Philippines College of Medicine and trained in Endocrinology, Diabetes and Metabolism at the Philippine General Hospital. She also completed studies in bone and mineral metabolism at the Mayo Clinic in Rochester, Minnesota under the tutelage of Dr. Bart Clarke, head of the Metabolic Bone Disease Core Group. She is certified by the American Board of Internal Medicine and is a Fellow of the Philippine College of Physicians and the Philippine Society of Endocrinology, Diabetes and Metabolism. For inquiries please call (+632) 789-7700 ext. 2086.