What do you call a funny bone? A humerus

Doctor of Pharmacy Candidate, 2022 University of the Sciences Philadelphia College of Pharmacy

WHAT DO YOU CALL A FUNNY BONE? A HUMERUS

The humerus is just one of the 206 bones that make up the human skeleton. Bones provide support for our body to be able to walk and to perform daily physical tasks like brushing our teeth. Bones also protect internal organs like the skull around our brains and the ribs around our lungs and hearts. Although many people know how bones function physically, many do not know what goes on internally. Bones undergo continuous remodeling to be able to keep our skeletons strong and functional.

Remodeling bone requires old or damaged bone to be broken down and new bone to be created, a constant process that must be in balance. This is done by a complex network of bone cells. An imbalance in any of these processes can result in bone diseases.

OSTEOPOROSIS: “OSTEO” MEANING BONE AND “POROSIS” DESCRIBING THE POROUS, OR HONEYCOMB, APPEARANCE OF BONE

Osteoporosis is a bone disease where bones become weaker and are at a greater risk of breaks. As we age, the rate of bone breakdown is greater than bone formation. It is often a silent disease since many people may not notice any signs until they break a bone. The bones at greatest risk are the hips, spine, and wrists. It is important to be aware of the risk factors, since over 53 million Americans are at risk for osteoporosis. Although it may sound like a scary problem, osteoporosis is a preventable and treatable disease!

Osteoporosis is most common among older people, and more often in women. Asian and white women were found to be more likely to develop osteoporosis. There is a greater risk if you have broken a bone after the age of 50, have low body weight, or have a history of osteoporosis or broken bones in your close relatives.

STICKS AND STONES CAN BREAK YOUR BONES… ARE THERE OTHER THINGS THAT COULD HURT ME?

There are some other risk factors for osteoporosis that are lifestyle related. These can include: smoking, alcohol, physical inactivity, diet poor in calcium and vitamin D, as well as certain medications such as corticosteroids.

Women’s health and hormone changes can also be factors affecting osteoporosis with an increased risk for those who experienced an early menopause or had ovary removal surgery before menopause.

Luckily, before fractures occur we can now provide testing, diagnose, treat and often even prevent osteoporosis.

Prevention strategies “BONE APPETIT”

Can your diet help you to prevent the risk of osteoporosis? It is recommended to have a diet rich in calcium to support bone health. This can come from low fat dairy products or foods enriched with calcium. Vitamin D is another essential part of a bone healthy diet. Vitamin D can be found in many milks, egg yolks, and certain saltwater fish. Sometimes

you may need to take supplements of calcium or Vitamin D.

DON’T HAVE “LAZY BONES”

Exercise! Incorporating activities that involve regular weight bearing as well as moderate muscle strengthening. These types of exercises help to keep your bones and muscles active. Try to avoid movements that can hurt the spine such as sit-ups and toe touches.

It is also important to take precautions to prevent falls. A simple trip or fall could cause an injury like a broken bone. Make sure you stand up slowly after sitting or lying down; it is important to make sure you have good balance before walking in addition to wearing supportive shoes. Securing carpets, ensuring effective lighting and eliminating room clutter are important considerations too.

Speak with your primary care doctor. Make sure your height is being measured at least annually, and keep track of any changes. Getting shorter over time could be an early sign of osteoporosis. Also make sure to let your doctor know if you have fallen, it is important to keep your doctor informed about your physical as well as your medical needs.

Testing Bone Strength

Your doctor can recommend bone mineral density testing (BMD). A BMD test is a screening tool to see how strong your bones are. The test is done on the hip and spine areas since they are at the greatest risk of fracture in someone with osteoporosis. This noninvasive test (DEXA Scan) takes about 15 minutes. Your results are given in terms of a “T score” comparing your bones against an average 30 year old adult. The lower the bone density score, the greater your fracture risk. The image below visually shows how your T score results can help your doctor to make a diagnosis. Any T score less than -2.5, in the red box in the image, is a confirmed diagnosis of osteoporosis. If you have a score of -1 to -2.5, your doctor may tell you that you have low bone density or osteopenia.

Your score will help your doctor make decisions about treatment. It is recommended that someone diagnosed with osteoporosis or osteopenia be started on medications.

Treatment is individualized with options including oral daily or weekly pills, injections and yearly infusions. Most commonly, bisphosphonates or certain types of hormones, help slow bone breakdown, reducing the risk of fractures. Other categories of medications are available to treat osteoporosis. One medication does not fit all and many factors are considered when a medication is prescribed.

How can a pharmacist help you?

An important question that is often asked of pharmacists and pharmacy students is what side effects or risks are associated with taking medications for osteoporosis. Weighing the risks is an important step in deciding with your doctor about your treatment plan.

Bisphosphonate Medications Side Effects

STOMACH AND ESOPHAGUS UPSET AND IRRITATION

It is recommended to sit or stand upright for at least 30 to 60 minutes after taking the medication; take medication only with water first thing in the morning, 30 minutes before food or other medications.

LOW CALCIUM LEVELS

Be sure to get the recommended amount of calcium as well as Vitamin D in your diet. Contact your doctor or pharmacist with any questions about your diet or supplement needs.

UNUSUAL FEMUR FRACTURES

Rare complication

ONJ (OSTEONECROSIS OF THE JAW)

An uncommon side effect of treatment, mostly associated in rare cases to poor dental hygiene. Seek dental care right away if mouth pain is detected. It may be best to delay starting the drug therapy until after a scheduled dental procedure.

MUSCLE OR SKELETAL PAIN

Contact physician The risk of these uncommon effects should be weighed against the risk of breaking other more fragile bones if not treated. Just to put this in perspective, 500 out of 1,000 women will experience a fracture if they do not receive treatment for their diagnosis of osteoporosis.

It is now common practice for doctors to recommend a break from medications after continuous use of about 3 to 5 years of bisphosphonate therapy. This is to help reduce any side effects from occurring. The medication can still have residual beneficial effects after discontinuation. Your doctor will weigh the risks and benefits of this “drug holiday” based on individual circumstances.

ALTHOUGH THERE ARE RISKS, OSTEOPOROSIS MEDICATIONS ARE NOT “BAD TO THE BONE”

There are countless benefits to medication therapy. But overall, treating osteoporosis has two goals: preventing further bone loss and rebuilding bone. This is to help prevent breaking bones especially in the hip, spine, and wrist. A simple trip or fall could turn disastrous causing fractures, hospitalizations and immobilization. Although during treatment, you may not physically feel your bones getting stronger, it is important to know that the medication is preventing your bones from becoming weaker. As we get older, our bones start to wear down faster than we can repair them. But, with the help of a healthy lifestyle, a balanced diet rich in calcium and vitamin D, and medication therapy, you can lead a more active and fulfilling life!

Always remember that your local pharmacist is here to help you answer any questions you may have about your medications and treatment decisions!