Bone fractures can be a particularly painful and debilitating injury for individuals to have to endure. For people over the age of 50 with a fracture, there is a relatively high chance that the fracture is related to osteoporosis. A fracture may also be the first indication that osteoporosis is present since the process of bone loss that characterizes osteoporosis is often asymptomatic.1Still, many people are unaware of this close relationship between broken bones and osteoporosis in older adults. In today’s blog post the importance of screening and referring patients for osteoporosis evaluations will be highlighted, and prevention strategies to reduce the risk for future fractures will be discussed.
Evaluating for Osteoporosis
General practitioners are able to conduct an osteoporosis evaluation and may then refer to a specialist, such as an endocrinologist or rheumatologist, if treatment or further evaluation is indicated. The evaluation will typically begin with the doctor or nurse asking questions regarding medical history and lifestyle to determine whether risk factors for osteoporosis are present. Some of these risk factors include a personal or family history of fractures, low levels of estrogen or testosterone hormone, and use of certain medications such as glucocorticoids.1
The most accurate evaluation tool to determine if a person has osteoporosis is through a bone mineral density (BMD) test. The most common BMD test is called a dual-energy x-ray absorptiometry (DXA) scan, which can identify osteoporosis, determine fracture risk, and monitor an individual’s response to osteoporosis treatment. For the DXA scan a person lies on a table while a machine above measures bone density at either the hip or spine. The scan only takes about 15 minutes to complete, is painless, and exposes the individual to less radiation than a typical x-ray.1,2
Some private insurance carriers will cover BMD tests ordered by a doctor. Medicare may or may not pay for a BMD test for individuals age 65 or older depending on if certain circumstances are present. If a person is unsure whether a BMD would be covered by their insurance, the doctor or their office staff should be able to help determine if the test would be covered.1
Fracture Prevention Strategies
Individuals who have osteoporosis are at a greater risk for fracture compared to individuals who do not have this condition. A multifaceted approach combining medication, diet, exercise, and lifestyle modifications is recommended to reduce the risk for future fractures.1,3
Medication—A number of different classes of medications for prevention and treatment of osteoporosis. Biphosphonates, estrogen agonists/antagonists, parathyroid hormone, estrogen therapy, and hormone therapy are options that may be used.4Doctors and nurses should be familiar with these medication classes in order to help patients understand the benefits and risks associated with each.
Diet—A dietrich in calcium and vitamin D should be encouraged.1,3 Calcium is needed to maintain healthy, strong bones throughout the lifespan. Vitamin D helps the body to absorb and utilize the Calcium.1The Institute of Medicine suggests a daily Calcium intake of 1,000 mg for men and women up to age 50, increasing to 1,200 mg for women over age 50 and men over the age of 70.5The suggested daily intake for Vitamin D is 600 IU up to age 70, and 800 IU daily for individuals over the age of 70.6
Maintaining adequate protein intake and monitoring sodium intake are also important components in maintaining a diet that promotes bone health.1
Exercise—Individuals who have suffered a fracture and receive a diagnosis of osteoporosis may have the misconception that it is best to decrease their activity level to prevent another injury. Health professionals should be advocates for promoting safe ways to exercise and increase physical activity. Exercise has not only been proven to be one of the most effective ways to maintain bone density through the aging process, but also reduces the risk for an assortment of other health problems.1,7Building muscle, improving balance, and increasing flexibility through exercise can also serve to reduce the risk for falls that can result in fracture.1The two types of exercise most important for preserving bone density are weight-bearing activities and resistance training.7
Exercise activities should be carefully selected for individuals with osteoporosis to reduce injury risk. Doctors and nurses who are prescribing exercise need to consider the individual who is being prescribed exercise to determine an exercise method that is enjoyable, sustainable, and safe. In general, high-impact exercise, activities with a high risk for falling, and those requiring repetitive bending and twisting at the back should be advised against.1,7
Since bone loss and osteoporosis usually occur without noticeable symptoms, it is unfortunately often not until after a fracture occurs that an individual is diagnosed with this condition.1-3In order to lessen the incidence of fractures in adults over 50 it is essential for general physicians and nurses to be able to determine the appropriate time and methods to screen individuals who may be at risk. Current research advises physicians to evaluate all postmenopausal women who present with fractures, as well as younger women who present with risk factors.
References:
- Once is enough: A guide to preventing future fractures.Bones.nih.gov. https://www.bones.nih.gov/health-info/bone/osteoporosis/fracture. Reviewed April 2015. Accessed March 26, 2019.
- How osteoporosis is diagnosed. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis/art-20304599. Published March 10, 2017. Accessed March 26, 2019.
- NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785-795.
- Medication and treatment adherence: The how’s and why’s of Osteoporosis medications. Nof.org. https://www.nof.org/patients/treatment/medicationadherence/. Reviewed September 7, 2018. Accessed March 26, 2019.
- Osteoporosis and musculoskeletal disorders: Calcium. Iofbonehealth.org. https://www.iofbonehealth.org/osteoporosis-musculoskeletal-disorders/osteoporosis/prevention/calcium. Accessed March 26, 2019.
- Osteoporosis and musculoskeletal disorders: Vitamin D. Iofbonehealth.org. https://www.iofbonehealth.org/osteoporosis-musculoskeletal-disorders/osteoporosis/prevention/vitamin-d. Accessed March 26, 2019.
- Exercise for your bone health. Bones.nih.gov. https://www.bones.nih.gov/health-info/bone/bone-health/exercise/exercise-your-bone-health. Reviewed October 2018. Accessed March 28, 2019.