Did you know that there’s a disease that affects over half of all Americans but often shows no symptoms? Around 54 million US citizens aged over 65 have reduced bone density, and this is expected to increase in the future. At its most extreme, this causes osteoporosis. Out of the 43.4 million people in the US with osteopenia (low bone mass), 10.2 million people in the US have osteoporosis. Experts believe this is a health time bomb that could ruin millions of lives and is already putting a strain on health services.
What is osteoporosis?
Strong bones are essential for maintaining fit and healthy bodies, and we lay down the foundations of strong bones throughout childhood and early adulthood. We reach our peak density at around age 30. After that, our bodies must keep two aspects in balance to maintain healthy bones: the loss of old bone material and the production of new bone. Healthy bone looks like a very dense sponge with tiny holes in it, encased in a hard layer of outer bone. If we lose bone density, this sponge contains more holes and less bone, making it weaker.
We lose bone density naturally as we get older, but in some cases, we’ve either not built sufficiently strong bones in our early life, or we lose bone density more quickly than we can build new bone material. Bone density is measured using a T-score, which compares bone density to the ideal density in a healthy young adult. A T-score of 0 to -0.1 indicates normal bone strength, between -0.1 and -2.4 indicates osteopenia, and -2.5 or below shows osteoporosis.
What are the symptoms of reduced bone density?
In the early stages, there are no symptoms at all. In fact, most patients remain unaware they have reduced bone density until they suffer a fragility fracture—a fracture that would not normally occur in someone with strong bones (for example, after tripping from standing height). This is why osteoporosis is often considered to be a hidden disease. If the reduced bone density is undetected until it becomes serious, you are at greater risk of a wrist fracture, a hip fracture, or fractures in the spine. In severe cases, even a sneeze or bending forwards can cause a fracture.
Osteoporosis can also cause miniature fractures in your vertebrae, which gradually lead to a stooped posture. The consequences of a hip fracture can also be devastating. There are two million hip fractures in the US annually, and treatment is in the top 5% of Medicare costs. 20% of patients die within a year of a hip fracture, and the implications of surgery and rehabilitation are serious. Around one-third of patients are still hospitalized a year later.
What causes loss of bone density?
Risk factors that can lead to reduced bone density include a genetic predisposition, delayed onset of periods or irregular periods, having a limited diet or an eating disorder such as anorexia, and lack of weight-bearing exercise. Caucasian women are more at risk than Afro-Caribbean women. Women are especially vulnerable in general, because the loss of bone density increases dramatically around menopause—fragility fractures are the leading type of bone fracture in postmenopausal women.
How is osteoporosis diagnosed?
The only way to positively diagnose osteoporosis is through a high-density X-ray known as a DEXA scan. This will show a high-resolution image of your spine and hips, and calculate your T-score for each area. Your family doctor can then use an online FRAX tool to calculate your risk of suffering a fragility fracture in the future, recommend the most appropriate treatment, and identify when a follow-up scan should be done. Many physicians automatically refer anyone with a possible fragility fracture for a DEXA scan.
Can I prevent or cure low bone density?
There is no definitive cure for osteoporosis, but a combination of medication (including calcium and vitamin D supplements), a high calcium diet, and a program of weight-bearing exercise can help to rebuild bone density. A diet rich in calcium, together with regular weight-bearing exercise, is also recommended for younger people who are building their bone strength and can help to slow bone loss as they get older. If you are affected by any of the aforementioned risk factors or simply want to be sure about the condition of your bones, ask your physician for a bone scan for your own peace of mind.
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