MY ACHING BONES!
I can still remember the day I experienced my first real injury; I was about twelve years old. It was another ordinary early morning at the ice rink. I was running late for practice for an upcoming show and quickly got on the ice and started gliding. It usually took me twenty minutes to warm up on the ice but that morning I had no time. My music came on suddenly and I started to skate to my program. As I came to the end of my performance, I started to prepare for my final move which was a split on the ice.
I attempted the split but heard a startling “cracking noise” and immediately felt immense pain. The sound and feeling of my aching pelvic bone like it was yesterday. I was not able to move and needed assistance off the ice. After spending hours at the hospital, I was diagnosed with a hairline pelvic fracture which kept me off the ice for several months while I was in my last year of elementary school. As a skater and competitive runner, I am always now concerned about my bone health.
WHAT IS OSTEOPOROSIS?
This injury was a consequence of trauma but there are many individuals who suffer from non-traumatic fractures from osteoporosis.
Osteoporosis, is defined as a disorder of low bone mass causing bones to become thin, weak, and brittle. This condition is not acutely life threatening but can lead to debilitating fractures of the hip, spine and wrist along with various complications.
Can you believe that some of these fractures result from low trauma such as coughing, sneezing, or tripping after losing balance?
Most of us have seen an old lady or man with a severe curved spine or upper back walking down the street at some point. This rounding of the back ( kyphosis or “dowager‘s hump) is a sign of advanced osteoporosis and can be a consequence of compression fractures of the vertebrae.
Complications from an osteoporotic fracture may significantly impact a person’s daily activities and quality of life.
Some of the risk factors for osteoporosis include age, family history, history of previous fracture, race, vitamin D deficiency, low body mass index, excessive alcohol intake and smoking history.
Certain medications like steroids, antacids, and antidepressants can increase fracture risk.
Individuals who may have medical conditions such as rheumatoid arthritis, lupus, seizures, inflammatory bowel disease or thyroid disorder are at higher risks for bone loss especially if they are taking treatment that may affect bone quality. This condition can also affect other individuals who have electrolyte and vitamin deficiencies, like in anorexia.
CALL TO ACTION
At the American Society for Bone and Mineral Research Annual Meeting in 2016, there was a discussion focusing on the “call to action” by numerous bone health related organizations to increase the screening, diagnosis, and treatment of individuals who are at high risk for fractures. The annual meeting emphasized the need to adequately treat osteoporosis around the country and the world. Dr. Kenneth Saag, the president of the National Osteoporosis Foundation spoke about the upward projection of increases in hip fracture in men and women by 2050 as compared to the past. This increase will be likely due to a significant decline in the rate of bone density (DXA) testing therefore resulting in the decline in diagnosis and treatment of high risk patients. He also points out that surprising current data shows half as many patients are placed on osteoporosis regimen today compared to the mid-2000s.
ASSESS RISK OF FRACTURE
As a rheumatologist, it is imperative to assess an individual’s risk for osteoporosis and fracture. This is done by:
a) Obtaining a thorough clinical personal and family history
b) Performing bone density testing (DXA)
c) Obtaining blood work to check for calcium, vitamin D, parathyroid and thyroid levels
d) Using an online tool called FRAX to quantify an UNTREATED individual’s ten year probability of a hip or major osteoporotic fracture.
Once this assessment is completed, physicians should discuss lifestyle changes to help prevent this bone disorder. A few of these tips include:
1) Stop smoking today! Get on some type of nicotine replacement with the advice of your doctor as soon as you can. It is no surprise that nicotine consumption can generate free radicals that destroy bone cells and increase cortisol levels that accelerate bone deterioration.
2) Limit the excessive (more than 2-3 ounces a day) alcohol intake. Alcohol interacts with bone forming cells and can affect the liver and pancreas which play a role in calcium and vitamin D absorption.
3) Engage in balance and flexibility training and strengthening (weight bearing) exercises to stimulate estrogen production and bone formation. Swimming, walking, yoga and Tai Chiu are encouraged.
It is time to practice those warrior poses and butterfly strokes!
4) Get some adequate calcium and vitamin D into that diet! It may be a good idea to substitute that half and half in your coffee with soy or almond milk!
Good sources of calcium can be found in milk, yogurt, nuts (almonds), cheese, dark green vegetables, orange juice, sardines and soy milk.
Vitamin D sources may include cod liver oil, fish oil, eggs, fortified dairy products and over the counter supplements.
WHAT ABOUT MEDICATIONS?
Sometimes women and men may develop worsening bone density despite their participation in good lifestyle modifications and may require medications to increase their bone density and strength. Some of these medications aim to help build bone mass and increase bone strength and other medications aim to prevent further bone loss.
Other drugs affect the interaction of the different cells involved in the bone remodeling process. Estrogen has also been used to help protect the skeleton by promoting calcium absorption and preventing the death of bone forming cells.
Currently bisphosphonates, denosumab, teriparatide and abaloparatide are some options for treating osteoporosis. No therapy is permanent.
Every person is different and must discuss the options with his or her physician and evaluate the comfort level with the drug side effect profile before making a final decision.
Keep in mind that NOT TREATING osteoporosis can be risky and may lead to disability.
I hope that with more education about this public health concern, people will empower themselves to take measures to improve their bone health! TAKE CARE OF YOUR BONES!!
www.nof.org (National osteoporosis Foundation)
www.rheumatology.org (American College of Rheumatology)
Highlights from American Society for Bone and Mineral Research Annual Meeting September 16-19; Atlanta