Q&A: Osteoporosis Symptoms and Testing

Dear Doc:

When should I be tested for osteoporosis?  I am 55-years-old and when I spoke with my doctor he said that I did not need testing now and could wait until I am 65.  Several of my friends who are of similar age have been tested so I am concerned that I have not.  I am in good health overall, I am normal weight and do not smoke.  I do take a low dose of medication to treat high blood pressure and that has been well controlled.  Do you think I need a bone density test?

Answer:

Dear Reader:

Over 10 million Americans are affected by osteoporosis and 43 million have low bone mineral density.  Unfortunately, many women at risk of osteoporosis do not recognize their risk.  In fact, even women with a diagnosis of osteoporosis fail to recognize their significant risk of debilitating facture.  Osteoporotic related fractures in the hip and spine can result in life long disability, permanent deformity and even increase mortality.  Forty percent of people suffering a hip fracture will never regain full function and they have 36 percent increased mortality in the first year after the fracture. 

According to the National Osteoporosis Foundation, regular risk women should start screening for osteoporosis at age 65 with a bone density scan (DEXA).  That being said there are multiple factors that may make a women higher risk for osteoporosis.  Women over age 50 who are underweight, Caucasian, or have had a parent suffer from a hip fracture are all at higher risk and should consider early bone density screening.  Medical conditions that contribute to poor absorption of vital nutrients such as Chron’s, celiac, or a history of gastric bypass surgery can increase the risk.  The long term use of steroids to treat a variety of illnesses from asthma to rheumatoid arthritis also increase the risk of bone loss.  Lastly, there are a variety of common medications including proton pump inhibitors (used to treat gastroesophageal reflex) and serotonin reuptake inhibitors (used to treat anxiety and depression) that can increase the risk of thinning bones.

It is important that your medical provider review your personal and family history in detail to determine if you have risk factors that warrant bone density screening earlier than the age of 65.  Based on the limited information you have given me today it sounds appropriate to wait until the age of 65 for screening.

Although you may not be a candidate for early screening there are things women can be do now to prevent the development of osteoporosis.  Daily intake of 1,100 mg of calcium and 800 IU of Vitamin D along with 46 g of protein will gives the body what it needs to continue to make new strong bone.  We strongly encourage smoking cessation for all women.  Smokers tend to go through menopause at an earlier age.  The early loss of estrogen has a significant impact on bone density.  Additionally, women that smoke one pack per day have a five to ten percent increase in bone loss.  Finally, exercise is vitally important.  Exercise decreases the risk of falls by up to 57 percent.  Fall prevention is extremely important to reduce the impact of osteoporotic fractures.        

Tara Gellasch, MD, is the Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice.  Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider.