Osteoporosis: Skeletal Disorder With Silent Symptoms

November 5, 2020

Osteoporosis is a systemic skeletal disorder where the body loses too much bone, makes too little bone – or both, said Dr. Jennifer Clem, associate professor of family, internal, and rural medicine at The University of Alabama College of Community Health Sciences.

“Osteoporosis literally means porous bone,” said Clem, who also cares for patients at University Medical Center’s Family Medicine Clinic. The College operates UMC.

Clem, who said the spine, hips and wrists are risky spots, provided a presentation about osteoporosis October 6 as part of this semester’s Mini Medical School program. Mini Medical School is a joint program of UA’s OLLI program and CCHS and provides an opportunity for OLLI and community members to receive updates and learn about trends in medicine and health.

There are a number of risk factors for osteoporosis, but age tops the list, Clem said. The risk increases for women particularly during menopause because of the loss of estrogen during that time. Other risk factors include low intake of vitamin D, potassium and protein, inactivity, smoking, excessive alcohol use and the long-term use of certain medications, including steroids and seizure medications.

“There doesn’t seem to be a strong genetic component,” she said. Clem added that estrogen is not used to treat osteoporosis because of the adverse side effects it can cause.

Osteoporosis takes a toll on people, Clem said. Statistics show that 10 million Americans aged 50 and older have osteoporosis of the hip and experience disability and pain; 1.5 million Americans sustain an osteoporosis fracture, and while 40% regain their pre-fracture independence, between 10% and 20% have increased mortality one year after the fracture; and 20% of people with osteoporosis fractures require long-term nursing care.

Clem said it’s important that people be tested for osteoporosis. Current guidelines recommend that all women over the age of 65 be tested, and women younger than 65 and with risk factors should also be tested. “The guidelines are a more ambivalent for men,” she said. But with two million American men having osteoporosis, and 1 in 4 men over the age of 50 having an osteoporosis fracture of some sort, “Certainly, men with risk factors should think about it (testing).”

Testing for osteoporosis is done with a DEXA scan, which compares the patient’s bones to that of a healthy 30-year-old, Clem said. A normal DEXA scan means the patient does not need another scan for five years. A DEXA scan showing low bone density signals osteopenia, which can be a precursor to osteoporosis and can increase the risk of developing osteoporosis because “the fracture risk increases as bone mineral density declines,” Clem said.

She said to prevent osteoporosis, eat a healthy diet and consume adequate amounts of calcium and vitamin D, engage in weight-bearing exercise that include strength and balance training, limit alcohol consumption and stop smoking. In addition, decrease caffeine intake – no more than 2.5 cups of coffee per day, and no more than five cups of tea per day, Clem said.