Diseases We Treat

Osteoporosis is a relatively common disease that represents bone weakness in our skeletons with a risk for bone fractures. The name Osteoporosis comes from the  Latin for “porous bone”.

Our bones can be considered as remarkable organs not so different from other complex body organs (lung, liver, heart). The properties of bones cannot really be compared to other similarly hard materials in our environment like wood, steel, stone, etc. Bone tissue is equal in tensile strength to steel, yet is ten times more flexible and as light as wood. Additionally, our bones contain bone cells (Osteocytes) and blood vessels. Remember that bone marrow, the spongy part of bone that fills the center of various bones in the body, is the source of our blood cells. These include red blood cells (carry oxygen), white blood cells (form our immune system), and platelets (allow blood to clot). Without bone marrow we couldn’t move oxygen through the body, fight infections, or form blood clots to prevent bleeding.

Bone certainly contain bone cells but is surrounded by a matrix. This is the substance that contributes to the tissue’s unique properties. This matrix is complex but most importantly consists of collagen (imparts flexibility) and calcium/phosphorous mineral salts (provide firmness). The calcium and phosphorous in bone help regulate the entire body’s mineral homeostasis.  Certain parts of bones contains a matrix structure that resembles a honeycomb. Osteoporosis increases the size of these spaces, causing bone to lose strength and density.

The matrix of bone is constantly changing and is termed remodeling. The rate of remodeling (sometimes referred to as bone turnover) changes in response to the presence or absence of physiologic loads with marked reduction in bone turnover in response to immobilization, bed rest, and anti-gravity environments. Bone remodeling is highly active during childhood with an overall positive balance supporting bone growth, reaches a steady state in adulthood and then declines in postmenopausal women and older adults resulting in a progressive loss of bone as we age.

Osteoporosis is a relatively common disease. Approximately 54 million adults are affected by Osteoporosis or low bone mass. About 80% of Americans with Osteoporosis or significant bone loss are women, though men make up 20%. More importantly one in two women and up to one in four men above the age of 50 and over will break a bone related to Osteoporosis. Osteoporosis is a serious, even deadly disease. A woman’s risk of fracture is equal to her combined risk of breast, uterine and ovarian cancer. A man is more likely to break a bone due to osteoporosis than he is to get prostate cancer. 24% of hip fracture patients 50 and over die in the year following the fracture. Six months after a hip fracture, only 15 percent of patients can walk across a room unaided.

Women lose bone sooner than men due to the loss of bone protective hormone estrogen at menopause.  Other important risk factors for bone loss and fractures include family history of Osteoporosis, previous history of Osteoporotic bone fracture, advanced age, smoking, excess alcohol intake, small body frame or loss of weight/height. Certain medical conditions including Rheumatoid Arthritis, Lupus, Multiple Sclerosis, Hyperthyroidism, Hyperparathyroidism, and loss of testosterone can reduce bone strength and increase risk of fractures. Many medications can be associated with bone loss, including corticosteroids (prednisone), certain seizure medications, hormonal treatments for breast cancer (aromatase inhibitors), and even common heartburn medications (proton pump inhibitors like Omeprazole).

Our providers know that Osteoporosis is considered a ‘silent disease’. Although some subtle symptoms can present (height loss, ‘Dowager’s hump’) before diagnosis, most patients won’t have any symptoms. Unfortunately many patients first realize they have the disease after a major fracture. This is why screening for the disease with a bone density (Dual Energy X-ray absorptiometry, DXA) scan is highly recommended. DXA scans are very simple non-invasive tests involving very low levels of x-rays to estimate the density of bone. The DXA scan can assist in the diagnosis of Osteoporosis by identifying those patients whose score falls below an accepted threshold of bone strength. Patients who have low bone density by DXA scan have a higher risk of fracture. In general terms, the following groups of individuals should consider screening bone density testing: Women age 65 years and older; Men age 70 years and older; anyone who has broken a bone after the age of 50 years, women age 50-64 with risk factors for bone loss, men age 50-69 with risk factors for bone loss. At AOC we take pride in performing our own DXA scans with our state of the art Hologic Bone Density machine. We are also able to measure Vertebral Fracture Assessment (VFA) and Trabecular Bone Score (TBS). VFA is a technology that allows our providers to get a detailed picture of the entire spinal vertebrae. Our providers use computer assisted volumetric software to help screen for occult Vertebral fractures. TBS can be done simultaneous to the DXA. TBS is a measurement of bone texture that ultimately gives us insight into the quality of the bone microarchitecture.

Our providers know that DXA / bone density testing is an important but not the only factor we use to estimate fracture risk. All patients at risk who we evaluate will be considered for evaluation by an absolute fracture risk score. We use the World Health FRAX® calculation model to better estimate fracture risk which also helps us determine who may benefit from pharmacologic treatments.

At AOC we take a relatively aggressive approach to treatment of Osteoporosis. Our providers fully understand the consequence Osteoporosis fractures can have on a patient’s life.   We certainly emphasize non-pharmacologic treatments for all patients which include regular weight bearing and muscle strengthening exercises, avoiding falls, taking in adequate amounts of calcium and vitamin D (and supplementing as needed), avoidance of smoking and excessive alcohol consumption.

However, the vast majority of elderly patients with Osteoporosis will benefit from consideration of pharmacologic treatments. The effectiveness of all FDA approved treatments for Osteoporosis has been demonstrated in clinical trials of Osteoporosis patients since 1995. The medications which have been FDA approved for the treatment of Osteoporosis have consistently shown a significant reduction in the risk of hip and spine fractures along with also increasing bone density scores after serial measurements recorded by DXA Scans. These outcomes have not been consistently demonstrated with non-pharmacologic treatments including exercise, calcium/vitamin D supplementation, etc.

While most patients will benefit from nearly any FDA approved Osteoporosis therapy, our providers understand the nuances of these treatment choices. There are advantages that some treatments have over others, particularly with respect to more modern treatments that have shown a better bone building effect compared to older options. While our providers still consider all treatments for Osteoporosis, we offer some of the latest and most effective treatments as noted below.