Osteoporosis Clinic

The Osteoporosis Clinic at Orthopaedic Associates of Central Texas will provide the medical advice to assist in the management of your osteoporosis including:

• Dietary recommendations
• Exercise education
• Medication management, if needed
• Referrals to medical subspecialists, if needed

If you have experienced a recent fracture and/or have one or more of the risk factors for osteoporosis, we recommend that you follow up with your orthopaedic surgeon and with our osteoporosis professionals for an accurate diagnosis, education, and treatment to aid in the reduction of future fractures.

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What is Osteoporosis?

Osteoporosis means “porous bone.” If you look at healthy bone under a microscope, you will see that parts of it look like a honeycomb. If you have osteoporosis, the holes and spaces in the honeycomb are much bigger than they are in healthy bone. This means your bones have lost density or mass. It also means that the structure of your bone tissues has become abnormal. As your bones become less dense, they become weaker.

For some people affected by the disease, simple activities such as lifting a child, bending down to pick up a newspaper, bumping into furniture or even sneezing can cause a bone to break. A person with osteoporosis is most likely to break a bone in the hip, spine or wrist. However, other bones may also be affected by the disease.

Certain people are more likely to develop osteoporosis than others. Factors that increase your chances of having osteoporosis are called “risk factors.” While you have no control over some risk factors, there are others you can change. By making healthier choices you can help reduce your risk of osteoporosis as well as the painful broken bones it can cause.

It’s also important to discuss your risk factors with your healthcare provider. Together, you can develop a plan to protect your bones.

Risk Factors That Are Difficult to Change

• Age. Osteoporosis can affect people of all ages, but it is far more common in older people than younger people. All of us lose some bone density as we age, but some of us lose more bone or lose it faster. It is not true that every older person gets osteoporosis, but it does become more common with age.
• Sex. About one in two women over the age of 50 will break a bone because of osteoporosis. A woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined. Women have lighter, thinner bones than men. Many women also lose bone quickly after menopause.

However, osteoporosis isn’t just a woman’s disease. Up to one in four men over the age of 50 will break a bone because of osteoporosis.
A man older than age 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer.

• Menopause. In women, the sex hormone estrogen protects bones. For many women, bone loss increases after menopause when estrogen levels drop sharply. If you go through menopause early, your risk of osteoporosis increases. The same is true if you have your ovaries removed. That’s because your ovaries produce most of your body’s estrogen. In either of these cases, it’s important to speak with your healthcare provider about steps to improve bone health.
• Family History. Research suggests that heredity and genetics play a major role in osteoporosis and broken bones. If either of your parents had osteoporosis or a history of broken bones, you are more likely to break a bone. Also, if one of your parents had a noticeable amount of height loss or a spine that curved forward, they may have had broken bones in the spine.
• Low Body Weight/Being Small and Thin. Women and men with small bones are more likely than larger people to have osteoporosis. But that doesn’t mean heavier or larger people can’t get it.
• Broken Bones or Height Loss. People who have broken one or more bones during their adult years may already have osteoporosis and not know it. Broken bones in the spine can occur with no noticeable pain. These breaks can cause height loss. They can also cause the spine to curve forward. This curvature of the spine is sometimes called a dowager’s hump or kyphosis. Breaks in the spine often go unnoticed until a person becomes aware that a significant loss of height of an inch or more has occurred.

Lifestyle Factors That Affect Bone Health

• Not Getting Enough Calcium and Vitamin D. Calcium is a mineral that is important for healthy bones. It is a building block of bone. Vitamin D is important because it helps your body use calcium. If you don’t get enough vitamin D or if your body does not absorb it well, you are at much greater risk for bone loss and osteoporosis.
• Not Eating Enough Fruits and Vegetables. Eating a well-balanced diet, rich in fruits and vegetables, is important for healthy bones. In addition to calcium and vitamin D, magnesium, potassium and vitamin K are a few of the many minerals and vitamins that are important for bone health.

If you eat a well-balanced diet, experts believe that you should be able to get enough of the nutrients needed for healthy bones. Most experts recommend multivitamins or supplements for people who do not get enough minerals and vitamins from foods. This includes people who have gastrointestinal disorders that can interfere with the absorption of vitamins and minerals.

• Getting Too Much Protein, Sodium and Caffeine. Diets that are extremely high in non-dairy sources of animal protein, sodium and caffeine may cause the body to lose calcium. Eating enough protein, however, is important for bone health. Bone loss may occur in people who eat special “high protein” diets. Having moderate amounts of caffeine each day from coffee and tea should not harm bone health. Studies, however, suggest that people who regularly drink cola drinks may be at greater risk of bone loss. Other non-cola carbonated soft drinks do not appear to have these same risks.

You can help make up for the potential loss of calcium from sodium, excessive protein, too much caffeine and cola drinks by making sure you get enough calcium every day.

• Having an Inactive Lifestyle. People who are bedridden, inactive or do not exercise are at high risk of osteoporosis. Certain types of regular exercise can help keep your bones strong. These include weight-bearing exercises such as fast walking and muscle-strengthening exercises such as lifting weights.
• Smoking. Smoking is harmful to your bones in many ways. The chemicals in cigarettes are bad for your bone cells. Smoking also might make it harder to absorb calcium. For women, smoking can prevent estrogen from protecting the bones.
• Drinking too much alcohol. Drinking heavily can reduce bone formation. Many people who drink too much do not get enough calcium. Drinking may also affect the body’s calcium supply.

In addition, drinking too much is bad for your overall health and can make you more likely to fall. This is how many people break bones. Alcohol in smaller amounts, however, does not harm bone health. This usually means no more than two - three drinks a day.

• Losing Weight. While losing weight can help prevent other health conditions like heart disease and diabetes, it can also cause bone loss. You can protect your bones while losing weight by exercising and eating a healthy diet that provides enough calcium and vitamin D.

Symptoms

• People cannot feel their bones getting weaker. They may not know that they have osteoporosis until they break a bone. A person with osteoporosis can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze or even spontaneously.
• Vertebral (spinal) fractures may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture. In many cases, a vertebral fracture can even occur with no pain.

Complications

• Compression fractures of the spine
• Disability caused by severely weakened bones
• Hip and wrist fractures
• Loss of ability to walk due to hip fractures

Treatment

After reviewing the results of your medical history, physical examination, bone density test and any other tests related to your bone health, you and your healthcare provider can develop a plan to protect your bones. If you have already broken a bone due to osteoporosis, you can take steps to slow or stop bone loss and prevent broken bones in the future.

Most people with osteoporosis need to take an osteoporosis medicine to prevent broken bones. If you have osteoporosis or have broken a bone, your healthcare provider may also refer you to a physical therapist (PT). A PT who works with osteoporosis patients can teach you safe exercises to improve your strength, balance and posture. A PT can also help you prevent falls and broken bones.

The goals of osteoporosis treatment are to:

• Slow down or stop bone loss
• Prevent bone fractures with medicines that strengthen bone
• Control pain from the disease
• Minimize the risk of falls that might cause fractures

There are several different treatments for osteoporosis, including lifestyle changes and a variety of medications.

MEDICATION

Medications are used to strengthen bones when:

• Osteoporosis has been diagnosed by a bone density study.
• Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred.

EXERCISE

Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:

• Weight-bearing exercises -- walking, jogging, playing tennis, dancing
• Resistance exercises -- free weights, weight machines, stretch bands
• Balance exercises -- tai chi, yoga
• Riding a stationary bicycle
• Using rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures.

DIET

Get at least 1,200 milligrams per day of calcium and 800 - 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium.Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include:

• Cheese
• Ice cream
• Leafy green vegetables, such as spinach and collard greens
• Low-fat milk
• Salmon
• Sardines (with the bones)
• Tofu
• Yogurt

STOP UNHEALTHY HABITS

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALLS

It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include:

• Avoiding walking alone on icy days
• Using bars in the bathtub, when needed
• Wearing well-fitting shoes

MONITORING

Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years.

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

RELATED SURGERIES

There are no surgeries for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebrae from becoming fractured by strengthening the bones in your spinal column.

The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)