The Hidden Risk of Osteoporosis
Jay Shapiro, MD
Board-certified Endocrinologist and Internist at Suburban Hospital
Osteoporosis, or the weakening of bones, doesn’t have any symptoms until there’s a fracture. Diagnosis is simple and treatment success is very high — but most people don’t get treated after a minor break or stick with their treatment long enough to fully recover. Recently, Dr. Jay Shapiro, a board-certified endocrinologist and internist, answered questions about osteoporosis risk, testing and treatment, and how to avoid this silent, dangerous and under-diagnosed condition.
At what age should I start paying attention to possible symptoms of osteoporosis?
Osteoporosis is one of those conditions where an ounce of prevention is worth a pound of cure, so in general, it’s a good idea to make sure you’re getting enough calcium and vitamin D in order to keep your bones strong. That said, if you are a woman, your risk increases once you are over 50 or post menopause. The age for men is after 60.
I heard that osteoporosis mainly affects women; am I at risk since I am a man?
Yes, men are at risk of getting osteoporosis. Many people believe because osteoporosis is linked to hormonal changes in women, men do not need to worry about it…which is not the case. Men do have different risk factors, which include:
- Having had cortisone treatments
- High alcohol intake
- Diabetes Mellitus
- A high bone turnover rate – meaning a relatively fast loss of bone, which is tracked in a urine test.
- Being underweight (with a BMI of less that 18)
I’m unfamiliar with osteoporosis; what kind of symptoms should I be paying attention to?
Osteoporosis is a silent disease, and there are no symptoms (other than breaking bones). However, breaking a bone when falling from a standing height should definitely be taken as a symptom. Anyone who has this kind of break should ask his or her general physician for a bone density scan. Doctors may need to be reminded to test patients with these fractures for osteoporosis, so make sure you speak to your physician before matters get much worse.
If my bone density scan shows I do have osteoporosis, should I go see an orthopedic specialist?
Osteoporosis is caused by bone loss due to hormones, so you’d actually want to see an endocrinologist to manage your care. While orthopedists do deal with other issues of the bone like joint problems and bone injuries that are symptoms of osteoporosis, endocrinologists treat the root cause.
I don’t like to take many supplements. Is there a difference between taking a vitamin D supplement and getting my vitamin D intake naturally through foods? If so, which is better?
No, there is no difference between the supplement and getting vitamin D naturally through food. If you are still getting at least a total of 1000- 1200 milligrams a day through what you are eating, then there’s no need to take a supplement.
I have arthritis – does that mean I have osteoporosis as well? What is the relationship between osteoporosis and arthritis?
There is no relationship between the two; osteoporosis and arthritis are very different other than both affecting the bones and joints. Everyone has some sort of arthritis, but not everyone has osteoporosis. If you believe you could have osteoporosis, ask your general physician for a bone density scan.
I used to exercise frequently, but stopped when I was diagnosed with osteoporosis because I did not want to make it worse. Is it okay if I slowly get back into exercising? If so, what type of exercise is good if I have osteoporosis?
Yes, exercise is great for osteoporosis treatment and prevention. Muscles “hold on” to bone, and bones react and “stick to” muscles in order to avoid injury, so any way to increase that tension is good for you. Any type of strengthening exercise that will cause muscle tension is what you should be doing when working out, and high impact exercises like running are actually good for bones (although they may not be good for your joints). Make sure you check with your doctor before planning any new exercise routine.
What are the treatment options for osteoporosis? How effective is treatment? Does it differ for men and women?
There are now different groups of drug treatment available for osteoporosis. These consist of oral or intravenous agents, including bisphosphonates and a somewhat newer agent called denusomab (Prolia). There is no difference in treatment options for men and women. If you are compliant with your treatment plan, there is a 70 percent success rate of avoiding future fractures.
There are a lot of drugs to treat osteoporosis – which one is the best? How are they different?
While most of the drugs work similarly, some types work better with certain forms of osteoporosis. They are also differences in how they’re taken (orally or intravenously) and in the common side effects. Your primary care physician or endocrinologist will be able to help pick the best drug for your particular case.
My mom has been taking really high doses of calcium and vitamin D supplements, is this a situation where it’s better to be safe and get more than you need?
Taking more than you need is not beneficial at all and will actually cause other problems. You can overdose on vitamin D, which will lead to kidney stones among other problems, so the recommended dose of 1000-1200 international units a day is what you should stick to. For calcium, one should know that there are different recommendations for calcium intake coming from different organizations, but 1000-1200 milligrams is the maximum recommended range. There is some evidence that taking large amounts of calcium may increase the risk of coronary artery disease.
How dangerous is osteoporosis? I see how breaking a bone would be unpleasant, but that’s not such a big deal, is it?
Osteoporosis can end in death if not properly taken care of. When someone breaks a hip and needs orthopedic surgery, there can be up to a 20 percent mortality rate following surgery. Thirty percent of people who have surgery never return to their previous lives and need medical help for the remainder of their lives. So, really, if you have osteoporosis and break your hip, you have only a 50 percent chance of returning to your former life. For a condition that’s very preventable and, even when diagnosed is usually successfully treated, osteoporosis is definitely not taken seriously enough!