Photo by Vina Cristobal – Dr. Chien-Wen Tseng talks with a patient at the UHP Family Medicine clinic at the Pali Momi Outpatient Center

Originally Posted On: Subduing the Silent Killer: Osteoporosis and Low Bone Density Prevention – University Health Partners of Hawaii (uhphawaii.org)

People are inclined to chuckle when we tell them that May is National Osteoporosis Month.  It seems that there’s a month, week, or day for everything nowadays!  But these healthcare commemorative dates are useful in that they can get us thinking about an aspect of our health that might not otherwise cross our minds – like bone health.  How important is that?  Well, it turns out that maintaining healthy bones could save us from living out our lives with a severe loss of mobility. It can even save us from an untimely death.

Called the silent killer, osteoporosis is a condition whereby our bones lose density, become fragile, and break easily. The numbers of us affected are alarming. Nearly one in five women age 50 and older have osteoporosis, and though it primarily affects older women, it is possible, though far less common, for younger women and men to develop this debilitating condition as well.  In the US, 10 million people have osteoporosis, and another 44 million have low bone density and are at risk for osteoporosis. As many as 2 million older Americans have 2.3 million osteoporotic fractures a year.  30% of people with hip fractures die within 12 months.

Dr. Chien-Wen Tseng, of the University of Hawaii’s John A. Burns School of Medicine and University Health Partners of Hawaii Family Medicine Clinic, serves on the US Preventive Services Task Force (“the reason I know so much about osteoporosis,” she says).

The biggest concern regarding people dying from having osteoporosis, she said, “is when people with weak bones have a simple fall.  If you have healthy bones, you wouldn’t end up with a fracture.”  Also, for the more than 300,000 older people who are hospitalized with a hip fracture each year, “their ability to live independently goes down quite a bit.”  Along with hip fractures, she said, doctors who treat osteoporosis see a lot of patients with spine injuries, which can be very painful and “affect your ability to get up in the morning and do the things you enjoy doing.”

For osteoporosis, Dr. Tseng tells us, “The biggest risk factor is actually being a woman and going through menopause.”   One of the reasons for this is that a woman’s bone strength is very much connected to her supply of female hormones. “As we go through menopause, levels of these hormones drop and that’s when our bones can start to weaken significantly.”  But for younger women and men there are also certain risk factors, she tells us.

Some of those risk factors which can affect all of us are “being on certain medications such as chronic steroid medications. Those can weaken bones. Also, someone who drinks quite a bit – two to three alcoholic drinks per day on a pretty regular basis, what we consider heavy drinking, also can weaken the bones,” as can smoking, she says.

In fact, the first thing she said when asked about what you can do to keep your bones healthy was “Quit smoking!  We know that smoking accelerates the rate which bone loss occurs in all people.”  Also, she said, “having a good diet” will support the health of your bones. “Make sure you’re eating the right things for good levels of calcium and vitamin D.”

Dr. Tseng also advises us to “exercise for at least 30 minutes, 3 times a week. The reason we’re so interested in bone health is because when bones become weaker than they should be, a simple fall can result in a fracture of the spine or hip.  Exercise can help us build strength, coordination, and balance and it’s just good for us generally as well.”

There has been some question as to whether genetics is a factor in people getting osteoporosis. Dr. Tseng tells us that “genetics might have some role since individuals whose parent(s) have had a hip fracture are themselves at higher risk for osteoporosis.  However, the greatest risk factor for osteoporosis remains simply being female and post-menopausal, which is why all women age 65 and older should be screened regardless of family history.”

Although the National Institutes of Health (NIH) does indicate that genetics plays a role in osteoporosis, it does seem to agree with Dr. Tseng that the impact of genetics has not been found to be as significant as the risks mentioned above.  “Osteoporosis is a polygenic disorder, determined by the effects of several genes, each with relatively modest effects on bone mass and other determinants of fracture risk,” according to their National Library of Medicine site. “The individual contribution of these genes to the pathogenesis of osteoporosis is small however, reflected by the fact that the relationship between individual candidate genes and osteoporosis has beeninconsistent in different studies.”

Dr. Tseng emphasizes that anyone who has concerns about being at risk for osteoporosis “should definitely talk to their physician.  The clinicians actually have an equation that can be used to help patients assess their personal risk.  But the general message is, once a woman reaches age 65, she should be screened for osteoporosis.”

That last bit of wisdom, one that she comes back to often when talking about osteoporosis, is, she says, her most important message. The screening, highly recommended by the US Preventive Services Task Force, involves having your bone mineral density checked with DEXA scan, a dual x-ray that measures the porousness of your bones.

“Nobody can really tell what their bone strength is like unless they do the screening,” she says. “Screening for osteoporosis is strongly recommended for ALL woman 65 and older, and for younger post-menopausal women if they have significant risk factors.”

So what if you have been screened and learn that you indeed have a loss of bone density?  Can this be reversed?  No, Dr. Tseng tells us. “We never get back to where we were in our twenties. Having said that, we have seen evidence that even for people who already have osteoporosis, with exercise and medications, we can stabilize it. So we try to detect it early.  Part of the screening can show us that maybe we’re not at osteoporosis yet, but the bone density has gone down, and we can do a lot of preventative things. We definitely recommend exercise, a good diet, and quitting smoking. For people who have osteoporosis, there’s medications, which are simple to take and have been well-studied.  They work well to stabilize the bone health and reduce the risk of fractures.”

“There are lots of medication treatments available.  It might be as simple as taking a pill just once a week.”

One last bit of advice she gives is to get caught up on our preventative care in general.  In the last year, due to concerns about the pandemic, many people have gotten behind in what they should do to stay healthy.  “At the clinic, we are seeing patients we haven’t seen in a year and helping them catch up on immunizations; regular screenings for diabetes, hypertension or high cholesterol; and cancer screening. And those are just the people we have seen come back in yet. We’re even more concerned about the patients we still haven’t seen.”  But, she said, “We’ve got the vaccine. We’ve got the testing. This is the time to make sure everyone gets caught up on preventative care. It is important to keep ourselves healthy in every way.”