Bone Health & Osteoporosis

The Bone Health and Osteoporosis Clinic at Shoreline Orthopaedics

People who suffer a bone fracture due to osteoporosis are more likely to experience another, often within the first year.

According to the National Osteoporosis Foundation, approximately 10 million Americans have osteoporosis and another 44 million have low bone density, which places them at increased risk for the disease. One in two women and up to one in four men will break a bone in their lifetime due to osteoporosis. For women, the incidence is greater than that of heart attack, stroke and breast cancer combined.

Shoreline Orthopaedics has opened the Bone Health and Osteoporosis Clinic to help patients prevent fractures and breaking of that second bone.

The American Orthopedic Association recommends that orthopedic surgeons provide extra care to patients who’ve experienced a recent bone fracture. If your simple fall resulted in a fracture and you’re a woman aged 50 or older or a man aged 59 or older, it’s crucial that you have your bone health evaluated and be screened for osteoporosis.

Shoreline Orthopaedics Bone Optimization Program

The American Orthopaedic Association and National Institutes of Health have recommended that orthopaedic surgeons evaluate the bone health of patients aged 50 and older before initiating elective joint replacement or spinal surgery.

Based on these recommendations, Shoreline Orthopaedics offers bone optimization to improve surgical outcomes in patients who have poor bone density.

Our multifaceted approach to bone optimization includes:

Identifying patients over 50 who may be at increased risk for osteoporosis
Bone mineral density testing (DXA scan) for high-risk patients
If testing reveals osteoporosis, the patient is started on medications to improve bone mineral density prior to surgery
Patients also receive counseling on nutrition and lifestyle factors to improve bone health

Bone Function and Anatomy

The skeletal system is the framework that supports the body’s soft tissues and anchors the muscles, making coordinated movement possible. Our bones are living, growing tissue with many important functions, such as protecting internal organs, producing blood cells, and serving as storage for minerals. The human body contains 270 bones at birth. Some of these fuse together as a child grows, reducing the number to 206 by the time a person reaches adulthood.

Bone Remodeling

Every year, approximately 10 percent of an adult human skeleton is rebuilt through bone remodeling. During this process, the body absorbs old bone tissue and regenerates new bone to replace it. By the time we reach 50, the body’s ability to form fresh bone has slowed and can no longer keep up with what is lost.

Osteoporosis and Related Bone Fractures

Osteoporosis is a disease that occurs when the body’s creation of new bone no longer keeps pace with the loss of old bone, causing bones to lose density and strength. As bones become thinner, weaker, and more brittle, fracture injuries become more likely. Although osteoporosis-related fractures can occur in any bone, they are most common in the hip, wrist, spine, or arm.

What are the Symptoms of Osteoporosis?

You could have osteoporosis and not even know it. Osteoporosis has been called “the silent disease” because it causes weakening of the bones that easily goes unnoticed—until a minor fall or bump results in a broken bone. If you’ve fractured an arm or leg due to low bone mass and continue to lose bone density, it may be leading to osteoporosis. If you’ve fallen and fractured your hip, pelvis, or spine, you may already have the disease.

What Are the Causes and Risk Factors for Osteoporosis?

While gender, age, race and other genetic risk factors can’t be changed, those related to behavior and lifestyle are within our control. The Bone Health and Osteoporosis Clinic at Shoreline Orthopaedics is here to help.

Age

Osteoporosis is most common in people over 50. After age 70, bone loss and fracture risks increase significantly. Although osteoporosis typically occurs in older adults, younger men and women with certain risk factors are more likely to develop the disease.

Gender

Although osteoporosis occurs in both men and women, it’s much more common in women. Men have a higher peak bone mass than women, greater bone size and width, and they accumulate more skeletal mass than women during growth, making them less vulnerable to the disease.

Hormonal Changes

The body’s process of building and remodeling bones involves hormones—estrogen in both sexes and testosterone in men. This decline in hormone levels is among several aging factors that lead to progressive bone loss.

Women – At menopause, quickly dropping estrogen levels can produce rapid bone loss, especially in the typically smaller, thinner bones of a woman.
Men – Testosterone loss occurs slowly with age, so a man may experience bone weakness later in life. However, some younger men do experience testosterone deficiency, or hypogonadism.

Ethnicity

While osteoporosis affects people of all races, white and Asian women are at a higher risk for the disease.

Body Size and Frame

Men and women who have a small body frame or weigh under 125 pounds are at higher risk for osteoporosis. Petite adults may have less bone mass to draw from as they age, which may result in lower-than-normal bone mineral density.

Family History

A family history of osteoporosis can mean an increased risk of developing the disease. Factors to look for include: a parent or sibling with osteoporosis, or a parent who has suffered a hip fracture.

Lifestyle and Other Risk Factors

One or more of the following lifestyle choices or behaviors increases your risk for osteoporosis.

Poor nutrition – Low intake of dietary calcium or dietary protein, vitamin D deficiency, and significant weight loss.
Sedentary lifestyle – Lack of physical activity, both in childhood and adulthood.
Excessive alcohol use – Alcoholic beverage consumption that exceeds one per day for women and two per day for men.
Smoking and tobacco use – In addition to acting directly on bone-forming cells to decrease the amount of bone formed, nicotine also affects hormone metabolism, causing the body to lose bone more quickly than normal.

Medications

Some drugs can increase the risk of developing osteoporosis, such as: daily use of prednisone or other oral corticosteroids, diuretics, antacids containing aluminum, anti-seizure drugs, Heparin (long-term use), Warfarin, Lithium, Depo-Provera (progesterone used for birth control), Methotrexate (for inflammatory arthritis), certain cancer medications, immunosuppressants, and more.

Health Conditions and Procedures

Autoimmune disorders, including lupus, rheumatoid arthritis, multiple sclerosis, and ankylosing spondylitis
Certain surgical procedures, such as gastrointestinal bypass, gastrectomy, and organ transplantation
Chronic kidney disease or liver disease (including biliary cirrhosis)
Eating disorders
Endocrine disorders, such as diabetes, hyperparathyroidism or hyperthyroidism, Cushing’s syndrome, and premature menopause
Gastrointestinal and digestive disorders, including inflammatory bowel disease and celiac disease
Hematologic disorders, including leukemia, lymphoma, multiple myeloma, and sickle cell disease
Neurological disorders, such as stroke, spinal cord injury, and Parkinson’s disease
Prostate or breast cancer

What to Expect During Your Visit to the Bone Health and Osteoporosis Clinic at Shoreline Orthopaedics

Our staff may request certain tests before your appointment. These will help us determine if you have low bone mass or osteoporosis, and if so, how severe the problem is. Laboratory tests are also useful in ruling out secondary causes and detecting treatable conditions that can cause bone loss. In addition to blood and urine tests, specialized X-rays called bone densitometry testing, or DXA, may be needed.

The Nurse Practitioner (NP) at our clinic is an expert in bone health.

During your visit, our NP will check your strength and balance, review test results with you, and talk to you about your family and medical histories and risk for osteoporosis. Together, you’ll come up with a plan that may include nutrition, physical activity, ways to prevent falls, and possibly medication to keep your bones healthy. The Bone Health and Osteoporosis Clinic at Shoreline Orthopaedics will work with your regular doctor to make sure everyone is on the same page regarding your plan and care.

Prevention and Treatment

Your plan for fracture prevention, bone health, and treatment for osteoporosis may include one or more of the following:

Nutrition – Updating diet and supplements to ensure proper levels of vitamin D, calcium, and healthy protein
Exercise – Regular physical activity, such as weight-bearing exercise (walking), resistance exercise (weights), and measures to improve balance and strength and slow mineral loss
Lifestyle modification – Limit or eliminate alcohol use; quit smoking
Medications – Drugs that reduce fracture risks by increasing bone density, preventing bone loss, or building new bone
Recommendation to follow up with primary care physician – Optimize management and treatment of chronic diseases, such as diabetes or kidney disease

Preventing a Fall

Falling is especially dangerous for someone with osteoporosis because they’re more likely to break a bone and a break will take longer to heal. People fall for many reasons, including tripping over obstacles, slipping due to loss of traction or footing, slow reflexes, balance problems, poor vision, reduced muscle strength, alcohol use, illness, and some medications. Taking the proper precautions can help you avoid a fall.

Adapt your home, inside and outside – Eliminate hazards like poor lighting, wet or slippery surfaces, missing handrails, loose rugs or other clutter in pathways, and more.
Vision and hearing – If you need glasses and/or hearing aids, be sure to wear them.
Properly fitting footwear – Wear appropriate, low-heeled shoes, both indoors and out.
Don’t rush – Accidents are more likely to occur when we act in haste. Slow down.
Stay alert in public places – Unfamiliar ground makes it easier to overlook an obstacle and trip. Pay close attention to where you walk.

Avoid Fracturing a Bone if You Fall

It’s not always possible to prevent falling, but you can try to prevent breaking a bone if you do. As you feel yourself going down, grab onto something nearby to break your fall, or try to fall forwards or backwards (on your buttocks) instead of landing your side, which can result in a broken hip. Some people choose to lessen the risk of injury by wearing special hip pads or extra clothing to cushion their hips.