Dr. Kevin Most: Bone health osteoporosis

Dr. Kevin Most

The body is pretty amazing, I am marveled every day by the cool things we find about our bodies. One thing we take for granted is our bones, rarely does anyone think about their bones and what can and should we do to protect them. Sure when playing sports we wear protective equipment, often to protect us from injury and pain. I am not sure we ever stop to consider how amazing our bone structure is. Tendons attach to bones allowing movement to occur with muscle contraction. Bones are placed in specific areas to protect vital organs like our lungs, heart, and brain. The importance of our bone structure although rarely thought of cannot be minimized.

First some fun facts about bones

1. We have 206 bones in the human body

2. The human hand contains 54 bones

3. At birth we have 270- 300 bones, but by adulthood some have fused together to form one

4. Our bones are the strongest somewhere between age 30-35 yrs. old

5. Bones make up about 15-20% of our body weight
6. The strongest and largest bone in our body is
the femur or thigh bone. It averages 18 inches in length and can support up to 30 times the weight of the body.

7. It is the most important bone when we think of mobility and aging with the femur being part of the hip as well as the knee.

8. The Stapes bone found in the inner ear is the smallest bone in the body, is important in the conduction of sound.

9. 1 in 4 men will break a bone due to weakened bones.

10. 1 in 2 women will break a bone due to weakened bones.

11. Bones are more important than just structure, our red and white blood cells are formed in bone and released into the blood stream.

So what are our concerns with bones, the obvious and most prevalent is Osteoporosis or weakening of the bones. It is extremely common and there is a very good chance you will suffer from this as you age. Estimates have over 54 million people living in the US currently have Osteoporosis and 3 – 4 million are added every year. Many think of this as a disease of women’s bones but in fact it will impact all of us, it does occur sooner and quicker in women as the loss of estrogen after menopause will accelerate bone loss. This is one illness that men actually have about a 10 year advantage, but if you live long enough you will become osteoporotic

This is thought of as a silent disease as you will not have symptoms until one of the bones is broken. Because it is a silent disease it is important for all of us to know what we can do to minimize the loss of bone mass. Again with all illnesses it comes down to, what can we do to prevent or delay the illness, what can we do to identify the illness and what can we do to treat the illness. Let’s take each one separately

Prevention- as I explained this comes on with aging, one way to prevent it is to not age. You may laugh but this one is actually true. We cannot stop the aging process but by staying active, on our feet, exercising, eating correctly and not smoking we can slow the aging process and certainly have better bone health. Like I said in the past the body knows when you are not exercising, you notice it with a higher heart rate, shortness of breath and pain, what you don’t notice is that the lack of exercise is a note to the body that you don’t need to keep your bones strong as they are not being used. We see this in patients who are hospitalized for a long time and we saw it in astronauts who are living in a weightless environment. In both of these cases the body is losing bone mass quickly. The body thinks, if the bone is not needed or being used why would I work to make it stronger and thus we get osteoporosis.

So exercising, with weight bearing activity is great. The best activity is Yoga as it works on bone strength, flexibility and balance.

From a diet view, making sure you get calcium in your diet along with Vitamin D.

Other ways to prevent is to use a can or walker if your balance is uncertain, this allows some weight bearing but also prevents or minimizes a fall.

Detection- we discussed that osteoporosis is a silent disease and no one will know how bad it is until you have some testing or have a fracture. Detection is currently recommended for those women over the age of 65 and for men the screening should start at age 70. The test is called a DexaScan and it is looking for bone density. When you have this test you will be given a T score, you want this score to be above -1.0. Scoring a -1.0 or higher shows you have normal bone density, scores below that show you have abnormal bone loss, a score below -2.5 is a sign of osteoporosis. Other simple x rays taken for routine testing or after a trauma can also give one an idea of weakened bones but not the actual scoring. The scoring is important as a tracking measure for the improvement of bone density or tracking the rate of loss.

Treatment- Treatment is actually based on your score and age which will give an estimate of your risk of breaking a bone. The simple treatment is walk or do yoga, not only does it prevent but it also helps treat osteoporosis. It slows the extension and tells the body to continue to place calcium in the bones. For some with more severe illness we have medications that help support and slow the loss of bone structure. You have probably seen ads or heard of Fosamax, Actonel or Reclast. These are a few of the most common drugs, they act by preventing the loss of bone which allows the bone forming cells to work thus strengthening the bones.

Women who are post menopause should discuss with their physician what medications they may need that would slow the accelerated loss due to the loss of estrogen. Estrogen treatment does have its risks, we know it is associated with blood clots, higher incidence for breast cancer and heart disease. There are medications that mimic estrogen benefits without the risks associated with estrogen. Evista is one of those drugs that helps but it also has some risks.