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Wednesday, Sep 19, 2018
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Ask the Expert: Am I destined to get osteoporosis as I age?

Osteoporosis is not a foregone fate just because we’re getting older. But the risk of getting the disease does increase with age, because our bones become thinner and weaker as we age.

Overall, by 2020, more than half of Americans over age 50 will suffer from either osteoporosis or low bone mass, putting them at risk for life-limiting fractures. And while women make up the majority of cases, more than 2 million American men suffer from osteoporosis, and millions more are at risk.

Bone is a living, dynamic organ system that constantly rebuilds new bones and removes old bones. Osteoporosis occurs when this balance is disturbed, causing more bone to be removed than rebuilt, which leads to frail bones and an increased risk of fractures of the hip, spine, and wrist.

Our bones are usually very healthy and reach a peak bone mass around our second decade of life. But peak bone mass can occur at different times for some people, depending on genes and lifestyle.

There are uncontrollable risk factors that predispose a person to developing osteoporosis or osteoporosis-related fractures. These include being female, old age, small body build, family history and ethnicity. (Caucasian and Asian women are at highest risk, while African-American and Hispanic women have a relatively lower risk.)

There are also controllable risk factors, such as an unhealthy lifestyle (lack of exercise, smoking), poor diet, increased caffeine and excessive alcoholic consumption, lack of calcium-rich foods, lack of vitamin D/sun exposure, certain medications, and history of bowel surgery.

Osteoporosis is often called the “silent disease,” because bone loss occurs without symptoms — until a fracture occurs in the spine, hips or wrist after only minor trauma (such as a fall from standing height). Spine fractures can cause some people to have a more pronounced stooped posture (dowager’s hump), while others can have loss of height.

To help delay, and possibly prevent, osteoporosis, be proactive in maintaining a healthy lifestyle by doing regular weight-bearing exercises (dancing, jogging, aerobic classes, hiking), muscle strengthening exercises, and posture/balance training, consuming foods rich in calcium (milk, cheese, broccoli, kale, sardines, prunes, almond, cereal), and getting adequate vitamin D from food and sunlight (1,000 to 1,200 milligrams of calcium and 800 to 1,000 international units of vitamin D daily).

Exercise is especially important because, like muscle, bone is living tissue that responds to exercise by becoming stronger. Exercising also allows us to maintain muscle strength, coordination and balance, which can help prevent falls.

While there is no treatment that can return osteoporotic bone to normal bone, there are two groups of medications that doctors can prescribe: one prevents further loss of bone (antiresorptive drugs) and the other enhances bone formation (anabolic drugs).

Only a bone density test can accurately determine your bone mass. Called DXA, the 10- to 15-minute test uses a dual energy X-ray absorptiometry machine and has minimal radiation exposure. All females age 65 and older, men age 70 and older, and those at higher risk for osteoporosis should have a bone density test performed.

Dr. Lin is assistant professor of medicine in the Division of Rheumatology at the USF Morsani College of Medicine.

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