Osteoporosis

Jul 12, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

You are not panicking enough. Let's review how far the enemy has come. Can they beat humans at a very complicated strategy game like chess where a player has about 35 valid choices every move? Yes. Can they beat humans at a game that involves bluffing like poker? Yes. Can they beat humans in a game like Go where a player has about 250 valid choices per move? Yes. Now they know how to cooperate. In the video game DOTA 2, not only is the enemy able to decide between over a 1000 valid moves every 1/8 of a second, now one enemy has learned to cooperate with other enemies to kill all humans. Or at least beat them in video games. Our new robot overlords have taken our measure and found us lacking!

Before SkyNet sends a terminator to take out your family, I need you to panic about something else. About 1 in 3 women will have an osteoporotic fracture during their lifetime. Over 80% of all fractures in patients over 50 are due to osteoporosis. In severe cases, it causes hunching over or kyphosis of the spine. Kyphosis can cause shortness of breath and problems with your stomach. Even in less severe cases, osteoporosis makes you more likely to break a bone.

Osteoporosis is when your bones get thinner and more brittle. If you look at a bone under a microscope, it looks like a honey comb. It isn't solid. When a person has osteoporosis, the microscopic structure changes, and the holes in the honey comb get bigger. The bone also gets weaker. Osteoporosis is called a silent disease. Sometimes the first sign of the disease is when a person breaks a bone unexpectedly. For example, someone with osteoporosis can break a rib by coughing. Other bones that can break in osteoporosis are the vertebrae in the spine, the upper thigh bone, the wrist, and the hip. Hip fractures are the most serious osteoporotic fracture. People with osteoporosis begin to break their hips at about age 60 and the average age of a hip fracture patient is 80. In older osteoporotic hip fractures, up to 28% of women and 37% of men die within a year of breaking their hip.

What causes osteoporosis? Bones are a living tissue. Bones are built up by a type of cell called osteoblasts. Bones are broken down by cells called osteoclasts. Up until the age of 30 the osteoblasts are more active. They build a scaffolding of protein and then fill up the spaces with calcium, phosphorous and other minerals. The osteoclasts are still breaking down old bone, but up to the age of 30 you are building more bone than you are breaking down. The osteoclasts and osteoblasts are pretty much in balance between the ages of 30 and 50. Then after the age of 50, the amount of estrogen drops in women and the amount of testosterone drops in men. We think that is the trigger that causes less bone to be built than is broken down. After the age of 50 our bones start to get less dense. For many people, this gradual decline in bone mass is no big deal. For some people, the bone density decreases rapidly and the bones get so fragile and porous they break easily. This is osteoporosis.

What factors put someone at risk of developing osteoporosis? The one of the biggest risk factors is being female. Women are 4 times more likely to get osteoporosis than men. Besides being female, other risk factors include being Caucasian or Asian, being over 65, having a small frame, having relatives with osteoporosis, being inactive, low calcium intake, smoking and high alcohol intake.

What can you do to help reduce the risk of breaking a bone? Depending on your age, you should be getting 1000 to 1500 mg of calcium per day either from your diet or supplements. You should be getting 800-2000 IU of Vitamin D per day. Calcium helps build and maintain bone. Vitamin D helps your body absorb calcium from the gut. Regular weight-bearing exercise will also help build bone. For example, regular walks with the dog 4-5 times a week for about 20 minutes each will help strengthen your bones. Also, quit smoking and reduce your alcohol intake.

If your doctor has determined your bones are already thinning and you are at risk for breaking them, they may put you on a prescription medication. There are a lot of choices but the most common class of medications are called the bisphosphonates. The have names like alendronate, fosamax, risedronate and actonel. They are a little complicated to take. You have to take them first thing in the morning at least 30 minutes before food and you can't go lie back down during that 30 minutes. On the plus side, there are bisphosphonates that you can just take once a week, which reduces their inconvenience.

There are some newer, but more expensive osteoporosis treatments available. Zoledronic acid is an injectable bisphosphonate that only has to be injected once a year. It will cost about $400, and is only for people who are unable to take oral bisphosphonates. Parathyroid hormone analogs are now available for those who fail on bisphosphonates. These often are people whose bones are thinned by long term treatment with steroids. Teriparatide is a parathyroid hormone analog that requires daily injections and will probably cost more than $13,000 per year.

You probably think I'm being alarmist by saying Cyberdyne Systems is in the process of producing SkyNet. Yet the US military has flying drones with weapons, right now. Nearly everyone has a phone in their pocket with which Google has been tracking your location for years, right now. Facebook and other social media have collected and synthesized every opinion you`ve every had, right now. So, don`t tell me I`m alarmist. And for goodness sake, drink a glass of milk! Our new robot overlords will need workers with strong bones.

As always if you have any questions or concerns about these or other products, ask your pharmacist

For more information on Osteoporosis please see: www.osteoporosis.ca

FRAX algorithm for 10 year fracture risk: www.shef.ac.uk/FRAX/tool.jsp

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 


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