Most of us who are 50 years old or older are acutely aware of the many changes we see in our bodies. The mirror shows us everyday that we ain’t what we used to be. But there are some things we can’t see that may need your attention. One of those is a condition called osteoporosis. You’ve probably already heard about it but may not think it applies to you.
Osteoporosis is a decrease in bone mass. The bone is less dense, a concept referred to as a decrease in bone mineral density (BMD) — a thinning of the bone, so-to-speak. Left untreated, bones can become brittle and break causing bone fractures and other problems.
You may not think this applies to you, but half of all adults over the age of 50 are affected. How can you tell if you have osteoporosis? Your primary care physician is the best person to evaluate and advise you. But educating yourself about this skeletal disease, recognizing your risk factors, and practicing some prevention is a very good idea.
First, who is at risk? Are you? According to the National Osteoporosis Foundation (NOF), there are two categories of risk factors: lifestyle factors and medical risk factors. Lifestyle factors include things like too much alcohol, tobacco, caffeine, and antacids (aluminum). Not enough calcium, vitamin D, and physical activity add to your risk. These are all considered modifiable risk factors, meaning you can do something about them to reduce your risk.
Some of the medical risk factors are nonmodifiable. For example, there’s not much you can do about your age or sex (women are at greater risk than men). A previous fracture, poor vision (contributing to falls), poor balance, and some medications also increase your medical risk of decreased bone mass. Some of these are modifiable, while others are not. Your physician will help you sort out which are your risk factors and how to reduce your risk as much as possible.
Although older Caucasian (white) women (especially after menopause) are the group affected most often, anyone of either sex (male or female) and of any color (racial or ethnic background) can develop osteoporosis. In fact, there is evidence now that not enough calcium and having diabetes mellitus has bumped up the number of Hispanic women affected by osteoporosis.
Men can also develop osteoporosis. This is especially true if they are over 70 years old or have low levels of testosterone hormone and any of the other risk factors already mentioned. Caucasian men are affected most often (seven per cent), followed by African American men (five per cent), and Hispanic men (three per cent). Those figures compare with 20 per cent for both Caucasian and Asian women.
If you have any of these risk factors, you should be evaluated. The next question is what kind of testing is available to see if you do have osteoporosis? The gold standard (number one tool used) is still dual-energy X-ay absorptiometry (DXA, pronounced Dex-uh) scanning. It’s painless, noninvasive, and easy to do. Not only that but it is precise (accurate). In some cases, ultrasound or MRI may be used instead of DXA scans, but the DXA test measure is the most reliable and the most widely used.
The National Osteoporosis Foundation along with the World Health Organization (WHO) recommends the use of another assessment tool. This one is called the fracture risk assessment tool or FRAX. The FRAX measures your risk of fragility fractures and gives the probability of a major osteoporosis fracture (spine, wrist, shoulder, hip) over the next 10 years. You can access the FRAX questionnaire yourself at www.sheffield.ac.uk but you will need your DXA scan results in order to complete the formula.
Many older adults who need osteoporosis testing may be concerned about how to pay for it. Medicare coverage is available for women who have low estrogen and qualify for Medicare and anyone on Medicare who is taking corticosteroids (usually used for chronic inflammatory conditions). Patients on Medicare who are already on medication for osteoporosis are covered for repeat testing to monitor response to therapy.
The important thing is to recognize your risk factors, take precautions when necessary, and see your physician for testing and treatment if you are 50 years old or older. This is one condition for which a small amount of prevention can go a long way. And these days, anything that keeps us healthy, active, free of fractures, and out of the hospital or nursing home is worth paying attention to!