Osteoporosis

I have written many articles on osteoporosis over the past 29 years in which tremendous changes have occurred in both the diagnosis and treatment of the disease. Today I would like to focus on the latest things you should know about osteoporosis.

When I first started in the area of osteoporosis, the diagnosis was made using an extremely primitive method of bone biopsy. This was a painful, time consuming and very impractical procedure. There was very little reason to do this diagnostic procedure because other than calcium and sodium fluoride, the treatment was extremely limited with very limited benefits.

However, little did I know how an area that I had chosen to be involved in over the years would become one of the most exciting areas in the field of medicine. Today we can diagnose osteoporosis with minimal time, effort and cost. Osteoporosis is by definition characterized by low bone mass and structural deterioration of bone tissue, which leads to an increased susceptibility of fractures of all the bones, in particular the hips, spine, and wrist. The diagnostic procedure of choice is bone densitometry. This is performed in about twenty minutes and the procedure can show as little as a 1% change in bone mass over one year either for better or for worse. The procedure is now readily available in multiple locations and essentially there is no excuse for every female who has reached menopause not to have a bone density in the same fashion that they would have a mammogram or PAP smear. There are indications to do bone densitometry on women prior to menopause, for example, if they have a history or thyroid or other hormonal imbalances, if they have had an eating disorder, or if they have a strong family history or are on long term medications, which affect the bones. Males may also benefit from a bone density because osteoporosis is not a disease limited to women alone.

Males who have similar problems to the ones I just mentioned, including hormonal issues such as thyroid disease, chronic illness and use chronic medications for other conditions, for example, corticosteroids, may also be at a high osteoporosis fracture risk.

I make a plea that everybody that has bone densitometry should have both the hip and spine measured. The use of bone density models that simply analyze a finger or a heel is a very primitive screening process. In this day and age and certainly in areas of Miami and Aventura, there is no reason not to get a complete bone density of the hip and spine as the cost is minimally different for a more complete test result.

Furthermore, it is very important to emphasize that the interpretation of the bone density is as important as the test itself. I would strongly suggest that when having a bone density test you find out who will be interpreting the test result. Unfortunately, there are many very marginal reports generated which even when bone loss is present are being interpreted as within normal limits. No bone loss should be regarded as within normal limits. One bone density by itself is also really of little benefit. It is the ability to compare the changes in bone mass from year to year, which ultimately makes the most difference in deciding therapy changes. Ideally, the individual reading bone densities should be certified by one of the two national bodies of technical competencies of bone densitometry.

At the moment, probably close to 28 million Americans are affected by osteoporosis. This is almost one out of every two women over the age of 50. By the age of 75, 1/3 of all men will be affected by osteoporosis. Osteoporosis causes nearly 1.6 million fractures annually resulting in costs directly and indirectly of nearly $10 billion dollars.

The truth is that individuals suffering hip fractures have a 5 to 20% greater risk of dying within their first year following an injury than other individuals in their age group. A woman’s risk of hip fractures is equal to her combined risk of breast, uterine and ovarian cancer. The point is that, this can be totally prevented and ultimately osteoporosis is a disease that can be eradicated if we make an early diagnosis and aggressively treat people who have bone loss.

We now have a number of different prescription drug treatments. All these drugs help to stop bone loss, reverse bone loss and/or aid in the making of new bone. These treatments are tailored individually to the patients’ needs and have reduced the incidence of bone fractures dramatically.

Author: Norman B. Gaylis, MD, FACP, FACR

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