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  Short Answers to Basic Questions about Osteoporosis

  1. What is osteoporosis?

  2. Who gets osteoporosis?

  3. What causes osteoporosis?

  4. How is osteoporosis diagnosed?

  5. How is osteoporosis treated?

  6. How much calcium is recommended?

  7. How can a person determine the amount of calcium in their food?

  8. Why not just take calcium pills instead of trying to get calcium from food?

  9. When should I have a bone density test?

10. What kind of test should I get?

11. Does a DXA bone density test involve a lot of radiation?

12. What is osteopenia?

13. What is a T-score?

14. Do all countries have the same definition of osteoporosis?

15. Some osteoporosis drugs (bisphosphonates) have been linked to osteonecrosis of the jaw. What is osteonecrosis, who gets it, and how can it be prevented?

 

  1. What is osteoporosis?

      Osteoporosis is a disorder of the skeleton in which bones become more porous and fragile and therefore susceptible to fractures. This can occur when the body breaks down old bone faster than it forms new bone.  If osteoporosis is not prevented or treated, it can progress painlessly until a bone breaks.

  2. Who gets osteoporosis?

      Anybody can get osteoporosis, whether they're young or old. However, women are more likely to develop osteoporosis than men. Women often have smaller skeletal frames than men, and their estrogen and progesterone levels decrease around menopause, which often results in significant bone loss. Nevertheless, men also get osteoporosis, especially after the age of  70. People with a family history of osteoporosis or fragility fractures are more susceptible to getting osteoporosis.

  3. What causes osteoporosis?

      The most common causes of osteoporosis are an inadequate diet, smoking, heavy drinking, insufficient weight-bearing activity, decreasing levels of sex hormones, celiac disease, inflammatory bowel disease and drugs such as prednisone, cortisone, anti-seizure drugs and excessive thyroid medication. Certain diseases can also lead to osteoporosis.

  4. How is osteoporosis diagnosed?

      Ultrasound and various types of x-rays are used to detect osteoporosis. The most common test for diagnosing osteoporosis is called a DXA test (dual energy x-ray absorptiometry).

  5.  How is osteoporosis treated?

       Osteoporosis is treated with the above preventive measures and with drugs such as Actonel®, Boniva®, Didronel PMO®, Fosamax®, Evista®, calcitonin, Forteo®, Protelos® (strontium ranelate), Reclast® , Prolea®, (denosumab) and hormone replacement therapy. Braces are occasionally used to help support the spine, hip pads may be recommended to help prevent hip fractures, and surgical procedures may be used to treat vertebral fractures. Referrals to physical therapists may be provided; these specialists can recommend safe exercises and help patients improve their posture.

   6. How much calcium is recommended?

      The recommended amount can vary from one country to another. In the US, the Institute of Medicine of the National Academy of Sciences recommends 1000 mg/day for adults 19 to 50 years, 1200 per day for adults over 50, and 1300 mg/day for children 9 to 18 years of age. This includes dietary calcium.

      In Great Britain, the Scientific Advisory Commission on Nutrition recommends an intake above 700 mg/day in the normal population. It states that there is inconclusive evidence that more calcium may be needed, but further research is necessary. They recommend 1200 mg/day for adults diagnosed with osteoporosis (www.nos.org.uk).. 

  7. How can a person determine the amount of calcium in their food?

      In the US, you can just look for the Percent Daily Value on the food label under "Nutrition Facts." Since this value for calcium has been set at 1000 mg per day, you only need to drop the % sign from the Percent Daily Value for calcium and add a zero.

      For example, on an American carton of milk, it typically states that in one cup of milk you get 30% of your Daily Value. This means one cup of the milk provides 300 mg of calcium. A cup of fortified orange juice or a slice of Swiss cheese can supply a similar amount. Chapter 8 in Osteoporosis Prevention lists the calcium content of a variety of foods, and Chapter 9 lists the content of other bone nutrients in various foods.

  8.  Why not just take a calcium supplement instead of trying to get it from food?

       It’s best to try and get your calcium from food because you’ll also get other important bone nutrients along with it. In addition, calcium from food is more natural and may be better absorbed than calcium from pills. One notable exception is spinach, which has a high amount of oxalates, substances that bind with calcium and prevent it from being absorbed. You are less likely to have negative side effects from dietary calcium than supplemental calcium.

  9.  When should I have a bone density test?

       If you’re a woman, it can be helpful for you to establish a baseline for your bone density either at the age of 50 or around the time of perimenopause, whichever comes earlier, provided you get a detailed, written report. Even if the results are normal, you can use the information to design an appropriate exercise program for yourself in order to prevent osteoporosis. Establishing a baseline can also help you determine your rate and amount of loss. No matter what the results may be, examining your test results can increase your awareness of osteoporosis and encourage you to take preventive measures against it. However, if you want a test at the age of 50, you may have to pay for it.

      Men aged 70 or older should be tested. And whether you’re a man or a woman, bone density tests are usually advisable if you:

—  have had a fracture resulting from minor impact

—  have a chronic disease that causes bone loss

—  take anti-seizure drugs or drugs such as prednisone and cortisone

—  take high doses of thyroid medication

—  have had a loss of sex hormones at an early age

10. What type of bone density test should I get?

      Get a DXA or QCT test that measures the bone density of the spine and hip. Bone loss typically occurs first in these areas. My book and the web pages sample reports, QCT, Hologic, and GE Healthcare give more information on these tests. 

11. Does a DXA bone density test involve a lot of radiation?

      No. The radiation dose of a DXA bone density test is about 1/10 that of a chest x-ray and 1/500th of a CT scan (data from GE Healthcare brochure). You’ll get about as much radiation from a DXA test as you would during a transcontinental flight. One big advantage of a DXA test is that it can provide images of the skeleton using very low radiation. If a problem is noted, these can be followed up with regular x-rays, which are sharper and provide greater detail. The figures below are examples of DXA images.

Figures 1 & 2   DXA images of a lumbar spine and femoral hip. Images like these show visually the areas of highest density (the whiter the area the higher the density). They also give doctors clues about potential alignment or disc problems and in some cases indicate where fractures have occurred. Photos from GE Healthcare.

12. What is osteopenia?

       It’s pre-osteoporosis; in other words it’s the precursor of osteoporosis. Penia means "lack" or "deficiency." The term originated from the Greek goddess of poverty, Penia. A diagnosis of osteopenia means your bone density is lower than normal but not yet full osteoporosis, and it can encourage you to take steps to prevent further bone loss.

13. What is a T-score?

      On a bone density report, a T-score is a statistical number that compares the bone density of an area of your skeleton to that of a normal, young adult. T-scores can vary from one skeletal area to another.

      According to the guidelines of the World Health Organization, the worst score of the important skeletal areas should be used to establish a diagnosis of osteoporosis or osteopenia. Like the weakest link on a chain, the site with the lowest bone density is at highest risk of fracture.

14. Do all countries have the same definition of osteoporosis?

      According to the World Health Organization (WHO), a T-score of -2.5 or lower indicates the presence of osteoporosis. Countries throughout the world have adopted this standard. However, densitometers can vary in the way they measure bone density and assign T-scores. This means it’s important to be retested on the same densitometer to accurately compare your test results. Chapters 14 and 17 of Osteoporosis Prevention discuss issues regarding the accuracy and reproducibility of bone density tests, and they compare the results of two pairs of my tests done on different densitometers at about the same time.

15. Some osteoporosis drugs (bisphosphonates) have been linked to osteonecrosis of the jaw. What is osteonecrosis, who gets it, and how can it be prevented?

     Osteonecrosis of the jaw (ONJ) is a condition in which the bone tissue in the jaw fails to heal after minor trauma such as a tooth extraction. Surgery may be required to remove the dying bone tissue. Symptoms include pain, swelling, loosening of teeth and poor gum healing. News releases on the link between ONJ and osteoporosis drugs began to appear in the general press in 2005.

     Osteonecrosis is rare and occurs primarily after tooth extraction in cancer patients who have received high doses of the intravenous bisphosphonates (pamidronate or zoledronate). A few cases have been reported in patients who have taken Fosamax (alendronate) or Actonel (risedronate). Most of these cases occurred after dental procedures in patients who had taken the drug for more than five years.

     Good dental hygiene, avoidance of overdoses of bisphosphonates, and doing dental surgery before initiating bisphosphonate therapy are ways to prevent bisphosphonate-related osteonecrosis. Any drug taken in excess can cause serious problems. Since bisphosphonates can remain in your bone as long as ten years after they are taken, the longer you take the drugs, the less you may need for the prevention of fractures and osteoporosis. It’s desirable for bone to renew itself with the process of breaking down old bone and forming new bone. Therefore the goal with osteoporosis drugs should be to just slow bone breakdown, not to stop it by taking too much of an osteoporosis drug. Dentists and oral surgeons often have specialized knowledge about osteonecrosis. Ask them for further information.

 

For more information on questions 1–14, consult Osteoporosis Prevention: A Proactive Approach to Strong Bones & Good Health by Renée Newman. 

GE DXA Bone Density Report

GE DXA Body Composition Report

Hologic DXA Bone Density Report

Hologic DXA Body Composition Report

Spine TBS Report

Mindways QTC Bone Density Report

General Sample Reports Web Page

Conversion Tables

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