Our bones, the framework that holds us up, are constantly in a state called remodeling, which is the breakdown of bone followed by the formation of new bone. This process starts in childhood and is ongoing throughout our lives. When we are young and growing, more bone is made than is broken down and our bones grow. In our middle years, the processes work about equally. When we are older, especially in woman who are into the menopause, more bone breakdown occurs than does bone formation, which leads to weaker bones that are susceptible to fracture. Based on what was said above, the more bone made as a child and adolescent, the more bone you will have as an adult and senior citizen.
Other than age, there are also other conditions and some medications that may lead to osteoporosis. If your physician suspects that, some other cause may be responsible for the osteoporosis, additional testing may be necessary.
The diagnosis of osteoporosis can be made under the following circumstances:
- A T-score of less than -2.5 on DXA
- A T-score of greater than -2.5 on a DXA with a fragility fracture
A fragility fracture is fracture of a bone that occurs when a fall occurs from standing height.
A DXA is low dose X-Ray that assesses bone density. The lower the bone density, the greater is the fracture risk. Osteopenia is defined as a T-score of -1 to -2.4. Osteoporosis is defined as noted above.
There are many treatment options now available to treat osteoporosis. The majority of these are classified as antiresorptive, that is, they slow down the bone breakdown process and thus let new bone formation catch up. Medications in this group include Actonel, Atelvia, Boniva, Fosamax, Prolia and Reclast. All of these medications are taken orally except for Prolia, which is an injection under the skin every 6 months and Reclast, which is taken intravenously once a year. In addition, there is a bone formative agent, Forteo that is given as a daily injection under the skin for up to 2 years, that directly increases new bone formation. Which of these medications is best for any one patient is a decision between the physician and patient.
Many people are afraid of the side effects of these medications. Although side effects can occur, in general, the risks of not treating the osteoporosis are much greater than the risk of the medication. Bone fractures, especially those most commonly associated with osteoporosis, such as fractures of the hips, spine, wrist, ribs, and collarbone result in significant pain and suffering. Hip fractures, lead to surgery, disability, loss of independence and increased risk of death.