Meryl S. LeBoff, MD
Osteoporosis is a weakening of the bones that results in fractures. There are two million fractures each year in the United States. And there are, overall, 54 million Americans that have an increased risk of fracture or actually have osteoporosis.
A spine fracture, a hip fracture, some wrist fractures and humerus or arm fractures are considered osteoporotic fractures. There are many risk factors for osteoporosis. And these include increasing age, female sex, and also many endocrinologic causes of osteoporosis, gastrointestinal causes of osteoporosis, patients who have rheumatoid arthritis, and many medications are associated with osteoporosis.
The development of bone density testing has helped us identify patients who have low bone mass, as well as osteoporosis. There are new tools that we are using now to identify those patients who may have the presence of a spine fracture. And we’re using clinical risk factors integrated with our bone density testing, using the FRAX Score to identify patients, men and women, from all over the world, who are at increased risk of fracture.
The fracture risk assessment tool, the FRAX Score, includes a number of risk factors that have been associated with the risk of fractures. We also include in the FRAX Score the femoral neck bone density that we obtain using a bone density test. And these risk factors are integrated with our bone density test to identify which patients who might have low bone mass are at increased risk for a hip fracture, or for another major osteoporotic fracture.
Bone fracture prevention is extremely important because only approximately 25 to 20 percent of patients who have a fracture will be evaluated and treated for their underlying osteoporosis. So there is a very large fracture gap in the care of patients who have osteoporotic fractures. And we have extremely effective therapies to treat patients with osteoporosis now that can not only prevent fractures and reduce the vicious cycle of fractures that occur in individuals who’ve already had a fracture.
We have universal recommendations to improve bone health at all ages. And we advocate regular weight-bearing exercises. We counsel on fall prevention and balance trainings, which is extremely important as we get older. We advocate smoking cessation and limited alcohol intake. We recommend calcium that should include the dietary calcium and, if necessary, a supplemental calcium. The total calcium intake for adults is usually 1,000 to 1,200 milligrams a day. In addition, we recommend Vitamin D, which is extremely important in all climates.
Exercises produce important strains on the bone. But in individuals who already have osteoporosis, it’s important to avoid exercises that result in forward-bending of the spine. In addition, we would recommend exercises that avoid twisting or jerking of the spine. And individuals who have physical limitations or have concerns about the risk for fracture, work with a physical therapist to develop a safe and appropriate exercise program
Skeletal Health and Osteoporosis Center in the Endocrinology Diabetes and Hypertension Division at Brigham and Women's Hospital, provides a comprehensive program to evaluate the presence of osteoporosis or low bone mass. And endocrinologists and clinicians who are trained in identifying patients who can have secondary causes of osteoporosis, and who can benefit from treatment to prevent further fractures or the occurrence of a fracture.
At Brigham and Women's Hospital, we have a program called the Brigham Fracture Intervention Team Initiative or BFIT. This is a program that endocrinologists, in conjunction with orthopedic surgeons, have worked together, so that we evaluate patients who come in with hip fractures, to look for secondary causes of osteoporosis, so that we can treat the underlying Vitamin D deficiency and the osteoporosis, to reduce the risk of a subsequent fracture over time.
There are a number of emerging therapies for osteoporosis. And these therapies include new approaches to decrease the risk of fractures and to address the mechanisms that lead to osteoporosis. This group of future therapies include more potential anabolic therapies that could build bone.
We’re carrying out research with the National Institutes of Heath on the effects of Vitamin D, with or without omega 3 fatty acids or fish oil, on fractures and a number of bone health outcomes. We have also been carrying out research in secondary causes of osteoporosis to really kind of best understand the many factors that contribute to osteoporosis, so that we can prevent osteoporosis as well as treating it. Our goal is to optimize bone health across the lifespan, from young adulthood to older age.
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