By Riva Preil
Osteoporosis is one of the aging-related changes that occurs over the course of time. It is a disease characterized by decreased bone mineral density (BMD) which is evident on dual energy X-ray absorptiometry (DEXA scan). Bones are in a constant state of remodeling, and they typically undergo changes through a balance of osteoclast and osteoblast activity. Osteoclasts are bone cells created by the bone marrow, and its primary function is to reabsorb (or destroy) bone. On the other hand, osteoblasts deposit and create new bone. If the delicate balance between these two systems is altered, either through increased osteoclast activity (too much breakdown) or decreased osteoblast activity (insufficient remodeling), the result will be decreased bone density. Decreased bone density between 1.0 and 2.5 standard deviations below average is considered osteopenia (a milder form of osteoporosis), and decreased density of more than 2.5 standard deviations below average is classified as osteoporosis.
A recent study published in the New England Journal of Medicine recommends that DEXA testing should be performed once every 15 years in healthy individuals who have previously been tested and found to have normal bone densities or even mild osteopenia. However, women with moderate osteopenia should be tested every five years, and women with advanced osteopenia should be tested annually.
Osteoporosis increases one’s risk of sustaining a fracture, especially in the spine, ribs, hip, and wrist. It also can create collapse of the vertebrae known as compression fractures which result in pain and a stooped posture (called Dowager hump). Fractures result in pain as well as decreased mobility and/or activity, which may lead to muscle atrophy and other associated health complications. In addition, certain medications increase the risk of developing osteoporosis, including steroids, barbiturates, L-thyroxine, anticoagulants (blood thinners), proton pump inhibitors, and thiazolidinediones (a diabetes medication). Management of osteoporosis includes participating in weight bearing endurance exercise (ex. walking) and resistance training exercise, which maintains and may even increase bone density in post-menopausal women. A physical therapist can help create an exercise program best suited for you and your needs.
Maintaining a safe home with guard rails can help prevent falls and fractures. Some medications, such as bisphosphonates, are useful in decreasing future fractures (amongst those who have sustained a previous fracture).