Being female poses a greater risk for developing osteoporosis than male; however, the risk increases in each gender with age. Low bone mass, family history, amenorrhea, estrogen deficiency, cigarette smoking, certain medications, and Caucasian or Asian ethnicity are all risk factors (Figure 9).
Weight loss and low body weight can be associated with an increased risk of fractures due to a greater loss of bone mass.53 The prolonged use of corticosteroids is a common cause witnessed in osteoporosis. It has been estimated that 30-50% of long-term users of corticosteroids will experience an incidence of fracture.54 Smoking, a modifiable factor, has been identified in leading to lower bone density.55 Chronic alcohol abuse has been found to be detrimental to the quality of bone health from contributing direct toxic effects to bone forming cells.56 A sedentary lifestyle and/or physical inactivity contribute to reduced muscle strength and impaired balance and gait, each impairing neuromuscular function contributing to fragility and fractures.57
While there is no cure for osteoporosis, prevention and treatment is available. Before age 20 is when most skeletal mass forms; therefore, preventive measures are important to implement at even young ages. Eating a diet rich in calcium, vitamins D and K, avoiding smoking or excessive use of alcohol, and exercising regularly (including weight-bearing exercises) are important preventive steps. In fact, the positive effect of physical activity during children’s growth stages has been maximized by adequate levels of daily calcium intake.58 Daily calcium enriched foods, milk, and supplementations with calcium have shown enhanced rates of bone mineral acquisition in children and adolescent studies.59 It has been further noted the positive effects on bone mineral density in postmenopausal women taking calcium supplementations.60 Good nutrition is an essential component for any successful rehabilitative program; however, it is critically important in the frail, elderly, and osteoporotic risk patients where poor nutritional levels can impair healing and increase further susceptibility to future fractures.61
Physical activity and fitness exercise programs have been shown to reduce the risk of osteoporosis,62 and epidemiological evidence has suggested that physical activity can assist in reductions of hip fractures in both women and men in so much as strengthening back muscles and improving strength and function.63 With therapeutic exercise assisting in maintaining or increasing bone mineral density in postmenopausal women64 studies have shown those early postmenopausal women practicing Tai Chi Chun to have a 47% decrease in falls.65 In the 2004 Nurses Health Study, it was reported that women who walked at least four hours weekly experienced a 40% reduction in the risk of hip fractures.66 It is important to value daily exercise with any age group, especially during the childhood and adolescent years where bone mass, strength, and balance develop into essential elements necessary for maintaining bone density in the aging years.
Early screening with a DEXA scan measuring bone density in critical areas of the body such as the hip and spine is recommended. It is a painless, non-invasive test that takes about 20 minutes. Follow-up DEXA scans should be performed in women who develop bone mass loss. Changes in height or complaints of back pain can require consulting with a physician and healthcare professionals about x-ray and bone density measurements to determine if a fracture is present. Monitoring bone health is essential and a baseline DEXA scan can be performed for women who experience premature menopause.
Once diagnosed, treatments for osteoporosis may include oral bisphosphonates (Actonel®, Actonel® with Calcium, Fosamax® or Fosamax Plus D, Boniva®). Intravenous bisphosphonates (Zometa®, Aredia®) are used for patients with metastatic cancer and Paget’s disease and in some cases are used by physicians for osteoporosis. Calcitonin or Fortical®, an injectable or nasal spray, Reclast, an intravenous infusion once yearly, Foreto, a daily subcutaneous injection, Prolia, an intra-muscular injection administered every 6 months, Selective Estrogen Receptor Modulators (Evista®) and Hormone Therapies (HT) have also been used. Controversial theories exist around the use of HT’s resulting in physicians prescribing treatment based on individual needs, whereas communication and patient advocacy are essential.