Osteoporosis on the Rise as Population Ages

As we age, most of us tend to focus on a short list of potential health concerns — heart disease, cancer and associated risk factors like diabetes and hypertension. Osteoporosis, which can result in serious and potentially fatal injuries, is often an afterthought.

However, the prevalence of the disease, which causes bones to weaken, become brittle and fracture, is expected to dramatically increase in the coming years. An aging population, together with other risk factors including poor dietary and exercise habits, are causing the numbers to rise.

With three million baby boomers reaching retirement age every year starting in 2014, a sharp increase in the occurrence of osteoporosis can be expected, according to a report by the U.S. Surgeon General. By 2020, the report says, half of all Americans over 50 are expected to have, or be at risk of developing, osteoporosis of the hip, while more people will be at risk of the disease at any area in the skeleton.

Osteoporosis is already the most common cause of fractures. According to the National Institutes of Health, about 53 million people in the United States already have osteoporosis, or are at high risk, because of low bone mass.

Most often, the culprit is hormonal changes, said Cindy Shaffer, M.D., a primary care physician with Baptist Health Medical Group, part of Baptist Health South Florida.

“The most common cause of osteoporosis that we see is postmenopausal osteoporosis,” Dr. Shaffer said. The female hormone estrogen, she said, helps to maintain bone mass. “When you start losing estrogen, you may lose strength in your bones.”

While the condition is most often diagnosed in post-menopausal women, it can also affect men. Men’s bones also become weaker with the loss of hormones.

“Long-term testosterone deficiency can lead to osteoporosis,” said Dr. Shaffer, whose focus includes wellness and prevention.

Most guidelines suggest that women should begin screenings at age 65, and some also recommend screenings for men at age 70. However, both women and men should start screenings earlier if clinically indicated by other risk factors.

Who’s at Risk?
If an immediate family member has experienced an unusual fracture, it may be time for you to get a bone density screening.

“Family history is very important,” Dr. Shaffer said.  “If someone has a little fall — not a huge trauma — and break a hip, that’s not normal.”

Taking certain medications is also a risk factor. Steroids and other drugs used to treat asthma, thyroid problems, seizures and lupus can cause bones to weaken, causing osteoporosis.

Another risk factor is celiac disease, an inherited intestinal condition in which the body cannot tolerate gluten, a protein found in grains including wheat and rye. Adults with celiac disease can become malnourished, which results in loss of boss mass. People with the disease have a 3.5 percent chance of being diagnosed with osteoporosis, compared with .05 percent of the general population. Their risk of fractures double.

Lifestyle is also a risk factor, Dr. Shaffer said, and therefore preventable.

• Poor dietary habits, which result in calcium and Vitamin D deficiencies
• Lack of exercise, particularly weight bearing exercise, which strengthens muscles and supports the bones
• Smoking
• Excessive use of alcohol
• Not enough Vitamin D from sunlight

The Importance of Vitamin D
Spending all day in the office or at home is depriving people of a critical source of Vitamin D, the nutrient most important in the absorption of calcium. While too much sun places us at risk for skin cancer, too little is not a healthy choice either.

“We stay inside most of the time, and when we go out we put sun screen on,” Dr. Shaffer said. “We’re not absorbing the UV light, and we’re not producing Vitamin D. All we have is dietary Vitamin D,  which may be harder to obtain as there are only very few foods that naturally contain vitamin D. We have to make sure we’re getting enough to compensate for the lack of sun exposure.”

Treatments for osteoporosis include medications that can help reduce bone loss and increase bone mass, or even hormone replacement if indicated. To prevent osteoporosis, eat dairy products, leafy green vegetables including spinach, kale and broccoli. Supplements of Vitamin D and calcium may also be recommended.

The average person with osteoporosis is thin, and therefore may appear healthy. If you have risk factors, Dr. Shaffer recommends adding the disease to your health check list the next time you visit your primary care physician.

“It is important,” she said, “but a lot people don’t know they’re at risk.”