The Latest on Osteoporosis

Your bones have supported you from the day you took your first step. So what have you done for them lately? Keeping your bones healthy now may help you avoid bone weakness and fractures caused by osteoporosis later on. So learn how to protect your bones by getting answers to these important questions about osteoporosis.

Q. Does a bone density scan tell me all I need to know about my risk for fractures?

A.

Yes and no. Bone mineral density (BMD) is the most important indicator of fracture risk, but it’s only one.

Doctors most often measure BMD using a DEXA scan. This stands for dual-energy X-ray absorptiometry. The scan provides a measurement called a T-score. Your T-score compares your BMD to the peak bone mass of an average, healthy young adult. A T-score of -1.0 to -2.5 means you have low BMD. A T-score of -2.5 or lower means you have osteoporosis. The lower your BMD, the greater your risk for fracture.

However, other factors also play into your fracture risk. For example, each of these appears to increase risk: older age, a lower body mass index or low body weight, having a parent who fractured a hip, tobacco use, long-term use of medicines such as corticosteroids or thyroid replacement, and having more than two alcoholic drinks a day.

When you discuss bone health with your doctor, ask about your fracture risk and how to lower it.

Q. When should I get a bone density test?

A.

The United States Preventive Services Task Force recommends that women over age 65 be screened routinely for osteoporosis. For women between the ages of 60 and 64, routine screening should occur for those with an increased risk for osteoporosis. For women younger than 60, there is no recommendation. Be sure to talk to your doctor as to when screening should begin, based on your age and risk factors.

Q. Is it too late for someone my age to prevent osteoporosis?

A.

Maybe. But even if you already have the condition, you can use many of the same steps to prevent fractures that you would use to prevent osteoporosis. These include getting enough calcium and vitamin D, exercising regularly and taking medicines that protect or build bone, if needed.

The amount of calcium you need depends on your age. Kids ages 9 to 18 need the most: 1,300 milligrams (mg) daily. Adults need 1,000 mg daily from ages 19 to 50 and 1,200 mg thereafter. Your body probably makes enough vitamin D if some skin is exposed to the sun for 15 minutes every day. Ask your doctor whether you should take calcium and/or vitamin D supplements.

Weight-bearing exercises, such as walking, are the best type to maintain or increase bone. But other types of exercise also build muscle and improve balance, which can help prevent falls.

If these steps aren’t enough, your doctor may recommend that you take a medicine that slows bone loss, boosts bone growth or increases bone density.

Q. What about hormone replacement therapy? Is it still used to help prevent osteoporosis?

A.

Sometimes, but this requires carefully weighing the potential benefits and risks with your doctor. Because of the risks, doctors use hormone replacement therapy (HRT) for this purpose less and less.

Bone loss increases in the years right after menopause, when a woman’s estrogen level drops steeply. HRT during this time can increase bone density and reduce the risk for osteoporosis and fractures. But so can other treatments, such as osteoporosis medicines.

In most women, the risks of longterm HRT use are likely to outweigh the benefits. Specifically, research shows that HRT can increase the risk for breast cancer, heart attack, stroke, blood clots and ovarian cancer. So you may decide to use HRT over the short term for bone health and to relieve menopausal symptoms, such as hot flashes. But once these symptoms subside, you may prefer to stop using it. Ask your doctor to help you evaluate your options based on your other health risks.

Q. Should men be thinking about osteoporosis, too?

A.

Definitely. About 2 million men in America have osteoporosis. Another 14 million are at risk because they have low BMD. After age 50, one-quarter of men get an osteoporosis-related fracture. These figures are lower than those of women, but they’re still significant. And men do outpace women in some areas:

• Men tend to fracture bones at a higher BMD than women do. Bone density scans are used in both sexes. But it’s not clear whether the same threshold (a T-score of -2.5 or less) should be used to diagnose osteoporosis in both men and women.
• Men aren’t likely to be given a bone density scan even if they’ve had a fracture unless the doctor suspects secondary osteoporosis. That means it’s caused by another condition, such as an overactive thyroid, or from another condition’s treatment (glucocorticoids, for example). So primary osteoporosis may be under-diagnosed and undertreated in men.
• Men are more likely than women to die after a fracture. While hospitalized for hip fracture, 8 percent of men and 3 percent of women older than age 50 die. One year after the fracture, it’s 36 percent of men and 21 percent of women.

Men, talk with your doctor to see whether you’re at risk for low bone density or fracture. Ask whether you should have a scan, make lifestyle changes or get treatment to protect your bones.

Back to Top