Osteoporosis is the pathological thinning of our bones, related to age and loss of calcium and bone substructure (in women typically after menopause) and sometimes to other biological conditions, that may result in a much greater likelihood of broken bones from minimal trauma. Let me quickly summarize key points on this issue.
1. We will continue to screen all women with a bone density measurement around the time of menopause. I also will assess overall fracture risk by using the FRAX score calculator, which factors in the bone density and many other biological issues (including prior fractures or family history) that affect your individual risk. The radiation exposure from this test is trivial.
2. Men may be screened after about age 70, but are inherently at much lower risk of osteoporosis.
3. Everyone should continue with some physical exercise, have meaningful intake of dietary calcium or use a supplement, and have vitamin D levels of 28-30 or more or take a supplement.
Treatment possibilities and safety
If treatment is indicated, I will recommend a bisphosphonate drug such as alendronate (Fosamax) or Reclast.
- Treatment duration is initially 3-5 years. It is safe. We then will monitor the stability of your bone density to determine if additional treatment is indicated.
- Persons whose bone density then regresses substantially will require longer treatment (total of 10 years or more), and some may require indefinite but perhaps intermittent treatment. We are still gaining experience on best practices for more severe or recalcitrant cases.
- Treatment is pretty effective and safe and substantially reduces spine and hip fractures.
- The much-talked-about risks of bisphosphonate drugs, such as osteonecrosis of the jaw or thigh-bone fractures, are respectively extremely rare (1:100,000 patient-years) or just rare (1:10,000 patient-years). The alternative is devastating spine and hip fractures that are definitely life-altering and life-shortening.
This is the current synopsis, validated after my most recent continuing education conference today. We will of course talk about each of you individually at an appropriate visit.