Bone is made up of a combination of collagen, bone cells and calcium. The calcium in bones gives it hardness and strength. Despite its hardness, bone is not a static tissue, but is constantly being absorbed and remade by a process called remodeling. The bones in our bodies are at their strongest in our late 20s, and after that point, although bone continues to remodel, the rate of this process slows down and bone gradually loses its strength. The quality of bone — that is, its strength — is determined by its density.
A bone density study or dual-energy x-ray absorptiometry is used to measure the strength of bone. Bone with low density is said to have osteoporosis and is at increased risk for fractures. Osteoporosis is caused by loss of the bone structure/substance in both the amount of calcium and the amount of bone tissue. Therefore the bone tissue quality is the same, but there is simply less tissue.
Although there are many conditions which can cause osteoporosis, certain people, such as post-menopausal white women, are at increased risk for osteoporosis as they grow older. It is recommended that post-menopausal women over the age of 65, regardless of risk factors for osteoporosis, should be routinely screened for osteoporosis. Women between 60 and 65 with increased risk of osteoporosis should also be screened routinely.
However, there is no recommendation for testing women less than 60 or in women 60 to 65 who have no increased risk. Despite these recommendations, some feel that all postmenopausal women should be screened with a bone density study to at least establish a baseline bone density.
Although there is no firm recommendation for how often a woman should have a bone density screening, it is felt that once treatment has started the test can be repeated once every two years. However, there is no recommendation on when to stop testing. For those patients who have not been diagnosed with osteoporosis, a bone density in 1-2 years is recommended.
If the bone density study shows that a patient has osteoporosis, then treatment should begin. There are various treatments available, and each patient’s situation will determine which treatment would work best. The most common treatment includes medications including Fosamax, estrogen or calcitonin. These treatments are usually combined with increased calcium intake to help make the bones stronger.
These treatments are focused on keeping the bone density stable, or slowing down the osteoporotic process, but these treatments cannot reverse the osteoporosis process. For this reason it is important that osteoporosis is diagnosed as soon as possible and treatment started.
The goal of treatment for osteoporosis is to keep the bones strong enough to prevent fractures. The common fractures in osteoporotic patients include compression fractures in the spine, wrist fractures and hip fractures after minor falls. These type of fractures, especially hip fractures, pose significant health issues and can make it very difficult for patients to function.
Prevention of osteoporosis is focused on adequate nutrition, calcium, vitamin D, exercise, weight gain and smoking cessation.
Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at DrSpine.com. His column, which appears every other week, covers a wide range of health and medical issues.