Current Efforts to Address Osteoporosis
Osteoporosis (decreased bone density) is a common problem for “older” adults — and for many who don’t consider themselves “older”. For example, some people over age 50 who have risk factors for osteoporosis may find themselves facing this brittle bone disease much sooner than expected.
Who should be screened? How can osteoporosis be prevented? Who should be treated and how? These are the questions addressed by the authors of this review article. The rise in numbers of older adults at risk has captured our attention. The sheer number of Baby Boomers (born between 1946 and 1964) makes the information presented in this special focus feature all the more important.
First, who should be screened and why? The ‘why’ question is easier to answer: because osteoporosis increases the risk of bone fractures. Hip fractures are especially common. And such injuries often require surgery and puts the affected adult at increased risk for a move from home into a long-term care facility (nursing home).
Now comes the trickier part: who should be screened? Despite all the research, debate, and discussion on this point, we still don’t have agreement among major groups. The National Osteoporosis Foundation, American College of Physicians, U.S. Preventative Task Force, and the Canadian Medical Association have all made recommendations. But they differ in their proposed guidelines.
Everyone agrees that risk assessment is a huge part of osteoporosis screening. Anyone with known risk factors (poor diet, inactivity, postmenopausal women, advancing age, use of certain medications) should be evaluated.
If you are interested in knowing your risk for osteoporosis-related fractures, a simple place to start is with the Fracture Risk Assessment Calculator known as FRAX. Anyone can assess their risk at any time with this tool. It is available at the World Health Organization’s website (www.shef.ac.uk/FRAX/tool.jsp). A nice feature of this test is its ability to take into account your individual risk fracture for fracture (not just bone mineral density).
So what’s the hold up in making straightforward recommendations on who should be screened for osteoporosis? Simply stated: an absence of evidence showing that screening via bone mineral density testing is effective in reducing fractures.
Being at increased risk of a fracture doesn’t mean you’ll actually break a bone. For example, some studies show that the FRAX only predicted 43 per cent of fractures that did occur. And half the people who did fracture a bone were considered at low risk for fracture. And there are really several different groups to be considered: postmenopausal women, older men, and younger men and women who have risk factors for osteoporosis.
What can be done if you are at increased risk for osteoporosis-related fractures? First, reduce your risk of falls because unexpected loss of balance, falls, and the force of a fall are what lead to bone fractures. How can you do this?
Balance training and exercise are still the number one tool for falls and fracture prevention. Strength training and weight-bearing exercises are the key to osteoporosis prevention. Studies show that simple movements taught in gentle yoga, tai chi, and Qi Gong can be very effective in reducing the risk of falls and fractures.
Second, pay attention to your diet and supplementation. It’s important to get the right amount of calcium (based on age and gender), vitamin D, and protein. Your primary care physician is the best one to advise you about your risk and individual needs as well as the best way to get those needs met.
And finally, there are certain medications (e.g., bisphosphonates, Denosumab, Estrogen, parathyroid hormone, nitroglycerin) that may be beneficial for some people. Each of these groups of medications is under investigation.
What we know so far is that each of these chemicals works in different ways. For example, bisphosphonates prevent bone resorption and prevent fractures. Denosumab (a human monoclonal antibody) decreases bone resorption AND increases bone density. Estrogen may help prevent osteoporosis but doesn’t treat decreased bone mineral density. Nitroglycerin inhibits the breakdown of bone while also stimulating bone growth.
All of these medications have potential adverse side effects, which can increase the risk for other kinds of problems. That’s why scientists are continuing their search for the ideal way to prevent and treat osteoporosis.
In the meantime, hospital staff are lending their efforts to help patients with hip fractures get the right care early on. The goal is to reduce the risk of mortality (death) and morbidity (loss of function, increased disability) during hospitalization for hip fracture. This is done by approaching the problem as a team, getting the patient evaluated quickly, and into surgery as soon as possible when that treatment approach is warranted. Improved quality of care in this fashion has been shown to create better outcomes with fewer long-term problems.
Reference: Jill C. Flanagan, et al. Management of Osteoporosis — Fragility of the Pelvis and Femur. In Current Orthopaedic Practice. September/October 2011. Vol. 22. No. 5. Pp. 386-391.