Osteoporosis is sneaky. It can progress so gradually that bone density diminishes and bones weaken before people realize they have it.
Just ask Sarah Williams.
Sarah was unaware she was experiencing bone loss. With no symptoms of her bone structure changing, she went about her day-to-day activities. She worked full time, attended graduate classes at night, and spent time with family.
It wasn’t until Sarah received results from a bone density test she took as part of her annual well-woman exam that her doctor discovered she has osteoporosis.
“They told me I had lost 2 percent of bone density within the last year,” Sarah said of her results from a dual energy X-ray absorptiometry test, or DXA scan, which measures bone density to diagnose osteoporosis.
The National Institutes of Health describes osteoporosis as a condition that causes bone loss, makes bones thin and weak, and increases the risk of fractures.
And Sarah is far from alone. Millions of people in the U.S. are either at risk or suffer from osteoporosis, according to the NIH.
Sarah, a City of Houston employee who asked that her real name be withheld for privacy (Sarah is a pseudonym), said a couple years before her diagnosis, her doctor recommended that she get a bone density test every two years. Her family history of osteoporosis and other risk factors prompted the recommendation.
Treatment is evolving
Dr. Tom Thomas, an endocrinologist and medical director of the Kelsey-Seybold Osteoporosis clinic in Houston, says ways to approach osteoporosis have changed over the years and also depend on individual patients’ medical histories.
Thomas helped found the clinic in 2007. He is not Sarah’s personal physician and was commenting generally about osteoporosis, not her specific case or condition.
Thomas said recommendations for DXA scans and bone density testing are not necessarily for everyone over 50. Instead, DXA testing is generally recommended for post-menopausal women and men between 50 and 70 years of age with risk factors.
“Risk factors include anyone with a strong family history of either a hip fracture, an individual with a prior non traumatic fracture of the hip, back, the wrist or the ribs, history of rheumatoid arthritis or chronic steroid treatment,” Thomas said. “And all smokers along with very thin people with body mass indexes below 19.”
Sarah said learning that she has osteoporosis did not come as a complete surprise.
“I was not surprised. My older sisters both have a history of it,” said Sarah, whose sisters were diagnosed with osteoporosis 10 years ago.
After her test results, Sarah was referred to an endocrinologist.
“With osteoporosis, we want to make sure certain organ functions are actually good, particularly kidney function,” Thomas said. “We do workups regularly to ensure there are no secondary causes of osteoporosis that need to be treated first.
“We also want to make sure they can tolerate some of the usual medicines, meaning they have no major gut problems like severe reflux disease, ulcer history, or colitis,” he said.
Although Sarah wasn’t surprised by her diagnosis, she was concerned about possible medication interactions with Fosamax, the medication her doctor prescribed to treat her decreased bone density.
“All medications have side effects,” said Sarah, who takes Amlodipine to treat her high blood pressure and Atorvastatin to treat her high cholesterol.
Among patients with 10 to 12 years of continuous use of Fosamax, side effects are more common, according to Thomas.
“But it’s still the first line of treatment for those that have never been on treatment before,” Thomas said. “Typically it’s used for osteoporotic individuals or in individuals with fairly advanced osteopenia that’s getting worse over time.”
Now, Sarah has added Fosamax to her weekly medication regimen.
“I take one pill per week first thing in the morning with a full glass of water,” Sarah said.
“I still don’t have any aches or pains,” Sarah said.
“Typically in regard to symptoms, you’re not going have much unless the osteoporosis has progressed so far that they’re actually fracturing,” Thomas said. “Then you’re going to notice pain and discomfort or symptoms associated with fractures from the osteoporosis.”
Sarah’s doctor called her prescription into Cigna Home Delivery Pharmacy,
“I use it for everything, “ said Sarah of how she receives medications to treat her high blood pressure and high cholesterol.
Cigna Home Delivery Pharmacy is available to city employees enrolled in a city health plan who take prescription medications on a regular basis for diabetes, asthma, heart conditions, high blood pressure and more, according to Cigna.
Ahead with exercise and diet
Along with medication, Thomas recommends lifestyle modifications to help manage osteoporosis.
“If an individual is a smoker, I strongly recommend stopping cigarettes. If there’s a lot of alcohol in the day-to-day, other than social drinking, it would help to minimize it,” Thomas said. “Those kind of things deter the effects and benefits of treatment.”
“The other part of it is weight-bearing exercises, muscle-strengthening exercises, and balance and coordination exercises,” Thomas said. “These kinds of things are really useful to help strengthen bones and some of these exercises have proven to reduce fracture risk as well. With cardiovascular and aerobic exercise you can refer to the American heart society of 150 minutes a week.”
Also, a diet rich in calcium and Vitamin D can help to slow bone loss, Thomas said.
Sarah said she includes provolone cheese, kale and spinach in her diet and takes a Vitamin D supplement.
“The recommendation these days for calcium intake for women should be 1,200 mg a day recommended mostly with dietary supplementation — if not by diet, through calcium supplements,” Thomas said. “It’s 1,000 mg of calcium a day for men 50 to 70 years of age.
Thomas said research shows healthy Vitamin D levels of 35 or higher reduce fracture risks.
“The general recommendation is 800 to 1,000 units of Vitamin D a day for patients 50 years and older,” he said. “But most individuals require a whole lot more than that and we base that on a Vitamin D level.”
Getting health screenings
“I didn’t think it would progress into this,” Sarah said of her osteoporosis. “There is no way I would arbitrarily just go to the doctor and ask for a bone density test and act upon it this quickly.”
For Sarah, the cost of seeing a specialist weighed heavily on her.
“Ultimately I decided to go,” Sarah said. “Your health is your wealth.”
And Thomas agrees.
“I think they’re critical,” said Thomas of recommended health screenings.
“A lot of folks who feel well overall and have been healthy all their lives may not feel unusual or abnormal,” he said. “These types of evaluations are really important to get done because some of these things are not symptomatic.”
“I go back to see the specialist in one year,” Sarah said. “He’ll see if there is no bone loss and if the medication is effective.”