Osteoporosis: Five Fast Facts

Catherine Johnston, BSN, RN

Do you think Osteoporosis won't happen to you? Think again. Osteoporosis is a common disease which causes bones to become weak and brittle and can lead to bone fractures. It is often considered a disease of older women, but this is not entirely true. While postmenopausal women have a higher risk of developing osteoporosis, it also affects men and younger women.

Despite the devastating effects osteoporosis can have, it is rarely screened for. As Nurses, we need to be concerned about developing this disease ourselves, and educating our patients about it. This article will discuss 5 reasons for Nurses to have themselves screened for osteoporosis, and to encourage their patients to do the same.

1. Osteoporosis is Common.

Osteoporosis is considered a major non-communicable disease worldwide and is much more common than many diseases which receive public attention.

In the United States:

The percentage of women 50 years or older with osteoporosis is 18.8 %, and for men 50 years or older, the percentage is 4.2 %.
This means approximately 1 in 5 women, and 1 in 20 men in this age group have osteoporosis.
This number represents approximately 10.2 million Americans.

Studies of osteoporosis usually concentrate on older men and women, but it affects adults of all ages. White and Asian women, especially postmenopausal women, are at the highest risk. There are other factors that increase the risk of developing osteoporosis

Risk Factors

Gender. Women are much more likely to develop osteoporosis.
Age. The risk factor for osteoporosis increases with age.
Race. Asian and Caucasian people are at greater risk.
Family History. Having a parent or sibling with osteoporosis puts a person at greater risk, especially if the parent sustained a hip fracture.
Body frame size. Women who have a small body frame have less bone mass to draw upon as they age which puts them at risk of developing osteoporosis.

2. Osteoporosis Has No Symptoms.

Osteoporosis is often referred to as the "Silent Thief" because there are no symptoms in the early stages. Slowly, over a number of years, bone tissue deteriorates. There is no pain associated with bone loss, and from the outside bones appear a normal size and to have normal strength. Often the first symptom of osteoporosis is a fractured bone, usually of the spine, wrist, shoulder or hip.

As osteoporosis develops and bones become weaker, some warning symptoms may appear

Later Symptoms of Osteoporosis

Loss of height over time
A stooped posture
Back Pain, caused by a fracture or collapses vertebrae
A bone that breaks more easily than expected

3. Osteoporotic Fractures can have a High Mortality Rate.

Osteoporotic Fractures, especially of the hip, are a major negative life event. They are painful, result in hospitalization, and have a long recovery period. The financial burden of a long hospitalization on the health care system is great.

There is also a huge financial burden on the patient and family, such as the cost of medical care and the loss of income while recovering. Many people who have had a hip fracture are unable to regain the ability to live independently, which means they must live with family or pay for some form of assisted living accommodation.

As Nurses, we can all recall patients who were fairly well, or barely managing, but still living independently, and who declined rapidly after falling and fracturing a hip.

The 1-year mortality rate following a hip fracture is 23.9%.
This means that almost 25% of people who fracture a hip will be dead within a year.

4. Testing for Osteoporosis is Fairly Simple.

The test for osteoporosis is called a Bone Mineral Density (BMD) Test, or sometimes just a Bone Density Test. Bone density is measured by a machine which uses low-level x-rays to determine the proportion of minerals in bones. The patient lies on a table as the scanner passes over the top of the patient's body. Usually, bone density is measured in the hip (the neck of the femur) and the lumbar spine. The test is painless and does not require being admitted to the hospital. It is similar to having an x-ray and takes the same amount of time.

5. Osteoporosis is Preventable and Treatable.

Prevention

There are many things an adult can do to maintain healthy bones.

Obtain enough calcium and protein in your diet.
Absorb enough vitamin D from the sun, or boost it through fortified foods and supplements.
Maintain a healthy body weight, as being too thin is damaging to bone health.
Exercise regularly. Activity will build bone mass as well as improve balance and muscle strength, which in turn, helps prevent falls.
Avoid smoking and heavy consumption of alcohol.
Be cautious about preventing falls.

Treatment

Treatment for osteoporosis of takes a multi-faceted approach by prescribing medications, and encouraging the patient to modify risk factors that can be controlled, such as diet, exercise, and fall prevention,

Medications:

Biphosphonates, such as Alendronate or Risedronate. Usually, these drugs are prescribed orally and taken once weekly.
Denosumab, such as Prolia. This drug is administered subcutaneously every 6 months.

Conclusion

In conclusion, osteoporosis is a common disease, which does not garner much attention, nor is it normally screened for. It develops silently over many years, and does not have symptoms until later. Later symptoms, such as loss of height, and vertebral fractures indicate bone mass has already decreased. If detected early, further bone mass loss may be prevented by modifying diet and exercise and taking measures to reduce fall risk. Medications, such as the bisphosphonates and Denosumab may also prevent further bone loss. Are you at risk?

References

CDC Osteoporosis

Mayo Clinic - Osteoporosis

International Osteoporosis Foundation - Take Action for Prevention, Diagnosis & Treatment
International Osteoporosis Foundation

What is Osteoporosis? The "Silent Thief"