Osteoporosis is a condition characterized by low bone density. Bones are living structures in our bodies, and up until around age 35 they are actively growing and getting stronger. Although bones continue to grow for nearly our entire lives, after age 35, bones begin to deteriorate. Once deterioration occurs at a faster rate than bone growth, osteoporosis can develop. Bones develop pockets that cause weakness and can eventually lead to fracture from just a little pressure. The key to managing osteoporosis is focusing on early prevention, correct diagnosis, and proper treatment.
Preventing osteoporosis is an important first step.
An estimated 55% of adults over the age of 60 have some level of osteoporosis, but this does not have to be an inevitable part of aging. Focusing on building strong bones during prime bone-building years is crucial. This means eating plenty of calcium-rich foods, participating in weight-bearing exercise, and avoiding calcium-depleting foods, drinks, and other substances. Avoiding smoking, excessive alcohol consumption, and prolonged steroid use can go a long way to ensure strong bones from the start.
The second key to managing osteoporosis is proper diagnosis. This may seem straightforward (go to the doctor, get screened, get a diagnosis), but research from the University of California Davis Health System has found that osteoporosis screenings aren’t targeting the highest risk populations. The screening records of 51,000 women who were between the ages of 40 and 85 and received health care in the Sacramento region were examined over a seven-year period. Physician and study lead Anna Lee Amarnath found that 42% of eligible women between the ages of 65 and 74 and 57% of women over 75 were not screened. This was true even when these women were at risk and screening was warranted.
Conversely, 46% of low-risk women between 50 and 59 and 59% of those between 60 and 64 were screened for osteoporosis without cause. Amarnath and her team believe this lopsided screening was caused by one primary factor: the timing of menopause. Most doctors begin to think of osteoporosis risk for their patients when they enter menopause, typically around 50 years of age. Thus, screenings tend to occur at that time. The U.S. Preventive Services Task Force recommends that osteoporosis screenings occur after age 65 unless risk factors are present, but the behavior of doctors in this large study suggests that recommendation is not being followed.
Although two million men in the U.S. have osteoporosis, with an estimated eight to 13 million more with low bone density, the majority of men avoid osteoporosis screenings. What is most troubling about these findings is that although men are typically less affected by osteoporosis, when they do have it and suffer a hip fracture because of it, they are twice as likely to die as women. Men are also more likely to lose their independence after a fracture than women and require more post-fracture care.
A survey of 146 older adults in New York and Florida found that most adult men (75%) would refuse osteoporosis screenings if offered. Men were also four times less likely to take preventative measures than women.
Dr. Wolf-Klein, program director for the geriatric fellowship at North Shore-Long Island Jewish Health System, believes that much of the gender difference rests squarely on the shoulders of physicians, saying:
“Our survey clearly establishes that physicians are just not thinking of screening men. It’s only when older men fall and break their hip that someone thinks maybe we should do something to prevent them breaking the other hip. Not only is society in general unaware of the problem of osteoporosis in men, men are not seeking screening and diagnosis.”
Another population that does not receive the care they should is patients in long-term care facilities who sustain a hip fracture. Researchers in Ontario, Canada found that high-risk patients in long-term care facilities were not receiving proper drug therapy for osteoporosis. This drug therapy could include increased levels of vitamin D and calcium supplementation. Although the effectiveness of excess calcium supplementation has been recently called into question, it is still recommended for high-risk patients. Patients in the high-risk category include those who have already suffered a fracture.
The study found undertreatment in each high-risk category, with treatment levels in these amounts:
- 47% of those with prior spine fracture
- 34% of those with prior hip fracture
- 38% of those with two or more non-hip or non-spine fractures
- 43% who were taking glucocorticoids
- 41% who had a diagnosis of osteoporosis
Dr. George Ioannidis, researcher at the GERAS Centre and McMaster University and lead author of the study was shocked at the care gap and reiterated the need for more intense care for high-risk patients, saying:
“The study shows that there is a significant treatment gap in all categories of high risk patients, all of whom have suffered a previous fracture or are at high-risk due to glucocorticoids or a diagnosis of osteoporosis. It is interesting that those with prior hip fracture are those least likely to receive treatment. Given the potentially serious consequence of secondary fractures it is critical that all high-risk patients are considered for appropriate treatment.”
Osteoporosis fracture increase the risk of premature death. It is important to follow screening guidelines and treatment protocols, regardless of gender. Determine if you may be at risk for osteoporosis, then talk to your doctor about screening and treatment options.
Image by NASA Goddard Space Flight Center via Flickr