Osteoporosis Part II

Last week we talked about osteoporosis, including risk factors and complications.  This week, I wanted to talk about things that you can do to try to prevent osteoporosis.  We will also talk about ways that it can be treated, if it does develop, in order to decrease the risk of complications.

As I mentioned last week, bones are living tissue, and they are continually being remodeled with old bone being removed and new bone being created.  Bones continue to grow and reach a maximum size and strength (peak bone mass or bone bank deposit) on average sometime between ages 25 and 30.  There are two processes that increase your risk for osteoporosis.  The first is a decrease in bone bank deposits, and the second is an increase in bone bank withdrawals.

Preventing osteoporosis starts with optimal bone growth and development from a very young age.  It is never too early to start depositing into your bone bank!  It is estimated that a 10% increase in peak bone mass reduces the risk of an osteoporotic fracture during adult life by 50%.

People of all ages should eat a nutritious diet with adequate calcium intake.  We have learned that getting calcium through foods is much more beneficial and causes fewer long term complications than taking calcium supplements.  I would not recommend taking a calcium supplement without you discussing it with your doctor first.  The amount of recommended daily calcium varies depending on age and other factors. 

Here is the recommended dietary calcium intake for children and adults.
 

• Less than 4 years old	consult your pediatrician
• 4-8 years old	1000 mg per day
• 9-18 years old	1300 mg per day
• 19-50 years old	1000 mg per day
• Men 51-70 years old	1000 mg per day
• Women 51-70 years old	1200 mg per day
• 71 years and older	1200 mg per day

What else can you do to decrease your risk of osteoporosis? 

• Avoid under-nutrition or malnutrition, especially during childhood and adolescence.  Be aware of possible eating disorders and the effects they have on nutritional status.
• Maintain an adequate supply of vitamin D, which is often found alongside calcium in fortified foods.  Vitamin D is made in your body when your skin is exposed to sunlight.
• Participate in regular physical activity, particularly weight bearing exercises, or activities that provide resistance, such as walking, jogging, running, weight training, dancing, aerobics, hiking, stair climbing, and push-ups.  Daily activities like gardening, vacuuming, mowing the lawn, or shoveling snow are also beneficial.  Remember that weight bearing exercises are the only exercises that enhance bone growth or stop bone loss.
• Avoid smoking and second-hand smoke exposure.  We learned decades ago that there is a direct relationship between tobacco use and lower bone density.  
• Avoid excessive alcohol intake.  Too much alcohol intake interferes with the body's calcium balance.  It can also cause hormone abnormalities that can affect our bone bank balance, as well as vitamin deficiencies that can affect our bones.
• If you have thyroid problems, be sure to have this monitored regularly by your doctor.  Excessive thyroid hormone, either from an overactive thyroid, or thyroid replacement at a dose that is too high, can lower your bone mass.
• Talk with your doctor about a bone density test.  This is a painless test which can detect osteoporosis before a fracture occurs.  The age at which you should have this test depends on your risk factors, so discuss it with your family doctor at your next annual exam.

How is osteoporosis treated?

There is no cure for osteoporosis, but there are a number of treatment options.  The treatment option recommended as the first line treatment for most women is use of a medication in the bisphosphonate class.  This class includes several different medications which may be taken by mouth daily, weekly, or monthly, as well as given by injection on a less frequent basis. There are also several other classes of medications that can be used to treat osteoporosis.  Which medication is best for you depends on many things including other medical problems or your risk for other medical problems, other medications that you take, and other factors as well.  If you have osteoporosis, you should talk with your doctor about which of treatment option is best for you.

If you have any questions about your risk for osteoporosis or prevention, send a question to one of our doctors.  For a list of calcium-rich foods from the National Osteoporosis Foundation, follow this link:
https://www.nof.org/patients/treatment/calciumvitamin-d/a-guide-to-calcium-rich-foods/

If you have any questions about osteoporosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Osteoporosis

Osteoporosis is a medical condition in which the bones become brittle and fragile as a result of loss of tissue.  This is typically a result of hormonal changes, or deficiency of calcium or vitamin D.  The complications of osteoporosis, including hip fractures and spinal fractures, can cause significant disability.  We'll talk today about this condition, and whether you might be at risk.  Next week we'll talk about how you can help prevent it from happening to you.

What causes osteoporosis?

Your bones are living tissues that are constantly being broken down and rebuilt by specialized cells.  Osteoporosis is the result of the rebuilding process not being able to keep up with the breakdown of bone.  The rebuilding process relies heavily on calcium and vitamin D.  When you are very young, your body makes new bone faster than it breaks it down.  As you get older, this gradually shifts to a steady state, then shifts to the breakdown outpacing the rebuilding. 

  

Most people reach their peak bone mass by age 30.  Think of this as a "bone bank account."  You can only deposit into it until you are about 30 years old, but you have to rely on that bank account for the rest of your life.  It is important to try to get to the highest peak bone bank balance that you can, so you can withdraw from your bone bank account as you age, without that balance dropping too low.   

What are the risk factors for osteoporosis?

Risk factors include things that decrease your bone bank deposits, or increase your bone bank withdrawals.  Some risk factors are out of your control, but some you can control.  Risk factors include: 

• Age - Risk increases as you get older.
• Sex - Women are at much higher risk for osteoporosis than men.
• Race - The risk is highest in people who are white or of Asian descent.
• Bone frame size - Smaller body frame size increases your risk.
• Family history - Having a close relative with osteoporosis increases your risk.
• Hormone levels, including
  1. Reduced estrogen levels at menopause is one of the greatest risk factors for developing osteoporosis.  
  2. Reduced testosterone levels as men age also increases the risk.   
  3. Too much thyroid hormone can cause bone loss, either due to your thyroid being overactive, or taking too much thyroid hormone to treat an underactive thyroid.
  4. Abnormal function of the parathyroid or adrenal glands.

• Dietary factors
  1. Low calcium intake - If you don't get enough calcium when you're young, you end up with a lower peak bone bank account.  As you age, lower calcium intake doesn't allow you to keep up your balance.
  2. Eating disorders - Severely restricting your intake of food, or being significantly underweight contributes to lower bone mass.
  3. Soft drinks - We are not sure why, but people who drink a lot of carbonated soft drinks do have a higher risk of osteoporosis, especially if this intake starts at a young age.

• Lifestyle factors
  1. Sedentary lifestyle - Weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, including walking, running, dancing, weightlifting, and many others.
  2. Smoking - Tobacco use has been shown to contribute to weak bones.
  3. Alcohol - Regular consumption of more than 2 alcoholic drinks a day increases your risk.

What are the complications of osteoporosis?

• Hip fractures - These are often caused by a fall.  Hip fractures can result in significant disability and even increase the risk of death within the first year after injury.
• Spinal fractures – These fractures can occur from an injury, such as a fall. Sometimes the bones in your spine become weak enough that they just crumple without any injury (like crushing an aluminum can).  This can cause significant pain, and can cause you to lose height or become unable to stand fully upright. 
• Other fractures - Any bone in your body will be more likely to break from an injury.

Osteoporosis is a serious health concern in the United States.  Over 1.5 million fractures per year are attributed to osteoporosis.  Estimates indicate that U.S. medical costs for osteoporosis range from $10 to $22 billion yearly, which does not include the indirect costs of reductions in survival, quality of life, and productivity.
   

Next week we will talk about how you can help to prevent osteoporosis as well as available treatments.

If you have any questions about Osteoporosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Diagnosis and Treatment of Migraine Headaches

Last week, we talked about migraine headache symptoms and possible triggers.  This week we'll talk about how the diagnosis is made, and what treatment options are available.

How does your doctor make the diagnosis of migraine?

The first thing your doctor will do is get a good description of your headaches.  The doctor will use the description to determine if your headaches fit the migraine diagnosis.  We talked about these qualities last week.

Your doctor should then do a thorough neurologic exam, which will help to rule out other serious causes of headache.  This also helps determine if additional tests are necessary.  If you have headaches that fit the description of migraine, have no symptoms of other serious causes of headache, and have a totally normal neurologic examination, then a diagnosis can be made without additional tests.  An MRI of the brain is not required, unless there are concerning features in the description, or abnormal exam findings.

How are migraine headaches treated?

Several medications from different classes are available to treat migraine.  The treatment approach depends on the severity and frequency of headaches.  

Treatment of the acute headache

For patients who have headache symptoms less than an average of 2 days each week, we treat with medications taken only when a headache occurs.  Here is an idea of the medications we recommend.

For mild to moderate intensity headaches - Over-the-counter (OTC) medications, including acetaminophen, ibuprofen, naproxen, or caffeine containing medications such as Excedrin Migraine.  Many migraines respond well to over the counter treatment options.

For mild to moderate intensity headaches that do not respond to OTC treatments, or for moderate to severe migraines - Prescription drugs in the triptan class, such as sumatriptan, eletriptan, rizatriptan, and others, or prescription medications in the ergotamine class, such as Migranal.

Evidence shows that acute treatment works best if taken as soon as possible after the onset of migraine, or during the aura (if you have one), before the pain progresses.  OTC drugs have been shown to have comparable effectiveness to prescription medications for most patients, if they are taken early enough.

Medications containing opiates or barbiturates should NOT be taken for acute migraine, for multiple reasons, including the increased risk of developing chronic daily headaches.

Treatment to prevent headaches

Preventive (or prophylactic) therapy is recommended for migraine patients in the following situations:

• Headaches occurring more than 2 days a week
• Headaches that severely limit the quality of life despite acute headache treatment
• Inability to take acute headache treatments (due to side effects or other medical problems)
• Presence of severe symptoms associated with headaches, such as loss of speech or stroke-like symptoms.

What are the goals of preventive therapy?

• Reduce the frequency, severity, and duration of headaches
• Improve responsiveness to acute treatment
• Reduce the level of disability/improve quality of life
• Reduce the excessive or overuse of acute medications (which can lead to rebound headaches)
• Reduce the cost of treatment

Which preventive treatment is right for you?

There are a number of different classes of medication which can be used for prevention of headaches.  Different medications have different safety and cost factors which may play a role in deciding which medication is best for you.  Some patients respond better to certain medications than others.  It is a very individualized treatment. 

Preventive medications are usually started at low doses, and gradually increased based on your response.  It may take 2-3 months for you to notice a decrease in frequency or severity of headaches, so remember to be patient and work with your doctor to get the medication and the dose that is right for you.

If you have any questions about migraine headaches, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor