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The Osteoporosis Crisis is Worse Than We Thought

Article at-a-glance:

  • A newly released study shows that this healthcare crisis is much worse than we thought, and this silent killer is affecting people at a much younger age.
  • A 50-year-old woman has a similar lifetime risk of dying from hip fracture as from breast cancer. 
  • In a new study, both men and women 35-50 years old showed osteopenia (bone loss termed “pre-osteoporosis”) at equal rates and at a younger age than researchers ever imagined.
  • If you’re not already being proactive about your bones, it’s time.

by Dr. John Neustadt

Osteoporosis is a dangerous and scary medical condition. It’s second only to cardiovascular disease as a global healthcare problem. Every 3 seconds someone suffers an osteoporotic fracture.

Fractures among the elderly are so common that 50% of women and up to 25% of men 50 years old and older will break a bone due to osteoporosis.

Osteoporosis is diagnosed by a bone mineral density (BMD) test. This test is an x-ray that evaluates the mineral content of bones. The results are reported as a T-score. A T-score between -1.0 and -2.5 means you have osteopenia (pre-osteoporosis). A T-score of -2.5 of lower means you have osteoporosis.

In 2018, the US Preventative Services Task Force (USPSTF) released its updated recommendations for osteoporosis screening in women and men. They recommend that postmenopausal women 65 years and older, or those younger than 65 with at an increased risk for osteoporosis get screened for with a bone density scan.

Certain medications cause osteoporosis, such as prednisone, acid blocking drugs (eg, Protonix, Prilosec, Zantac) and pre-menopausal Tamoxifen all increase osteoporosis risk. Some medical conditions also increase your risk, such as irritable bowel disease (IBD; Crohn’s disease, Ulcerative Colitis), autoimmune diseases (Lupus, Rheumatoid Arthritis) and Celiac Disease.

But for men, the recommendation is different. The USPSTF recommends men not get screened for osteoporosis. They concluded that there’s insufficient evidence of benefit when men are screened.

A Wake-Up Call for Women and Men

But a newly released study should be a wake-up call for the general public and the medical community. This healthcare crisis is much worse than we thought, and this silent killer is affecting people at a much younger age.

The study published in June 2019 in the Journal of the American Osteopathic Association evaluated bone density in women and men 35-50 years old. This is the first study of its kind, because most other research has been conducted on older patients.

Shockingly, in their sample of 173 volunteers, 23 men (28%) and 24 women (26%) had osteopenia at the hip (femoral neck). This means clinically significant bone loss is occurring much younger than previously believed.

Equally as surprising, more men than women had osteoporosis—5 men (6%) and 2 women (2%) had osteoporosis at the lumbar spine. This goes counter to the overall osteoporosis statistics that show that 80% of osteoporosis is in women and 20% in men.

The population from which it’s concluded that women’s risk for osteoporosis four times more than the risk for men is taken from studies in the elderly. Elderly is defined in medical research as anyone 65 years old and older. Therefore, what we may be discovering is that men are actually at equal or higher risk for osteoporosis when they’re in middle age, but after menopause, women are at greater risk for osteoporosis and end up getting it at much higher rates than men.

The ten years after menopause is the time when women have the greatest rate of bone loss, so this may be a plausible explanation. This was a small group of volunteers in the present study, but clearly this groundbreaking research raises more questions that deserve attention.

What We Do Know

What we do know is that osteoporosis is a killer. A 50-year-old woman has a similar lifetime risk of dying from hip fracture as from breast cancer. Let that sink in a moment. If you’re a woman who is 50 years old, osteoporosis is as dangerous as breast cancer. And yet, for far too many women, they’re much more focused on changing their breast cancer risk than changing their osteoporosis risk.

It’s startling to note that up to 40% of patients with osteoporosis who suffer a hip fracture die within 6 months. And if you’re one of the lucky ones to survive, your chances of dying are 30% higher for the next 10 years.

While death is the more serious effect of osteoporosis, chronic pain caused by osteoporosis fractures can make the remaining time on this planet pretty miserable. Debilitating short- and long-term pain in the elderly is often attributed to fractures from osteoporosis and can lead to further disability and dying early.

Osteopenia May be an Even Bigger Danger

While most treatments don’t begin until someone has osteoporosis, and most people don’t seem to take their bone health seriously enough until they receive the dreaded osteoporosis diagnosis, osteopenia may be an even bigger danger. While most attention is on fractures in people with osteoporosis, people with pre-osteoporosis (osteopenia) are the ones at greater risk.

In a National Osteoporosis Risk Assessment study published in the Journal of the American Medical Association, in the first year after being diagnosed, more than two-thirds of hip fractures occurred in patients with osteopenia, not osteoporosis. And in a separate study published in Osteoporosis International, researchers concluded that half of all hip fractures occur in women who were not classified as having osteoporosis (they had osteopenia).

While it’s unclear why exactly someone may be at higher fracture risk when they have osteopenia, it may be that they simply aren’t taking their bone health seriously enough. 

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References

Bass MA, Sharma A, Nahar VK, et al. Bone Mineral Density Among Men and Women Aged 35 to 50 Years. J Am Osteopath Assoc. 2019;119(6):357-363. [Article]

Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ, 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137(9):1001-1005. [Article]

Curry SJ, Krist AH, et al. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(24):2521-2531. [Article]

Facts and Statistics. International Osteoporosis Foundation. Accessed June 3, 2019. [Report]

Gregg EW, Cauley JA, Seeley DG, Ensrud KE, Bauer DC. Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med. 1998;129(2):81-88. [Article]

Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-1733. [Article]

Old JL, Calvert M. Vertebral compression fractures in the elderly. Am Fam Physician. 2004;69(1):111-116. [Article]

Robbins JA, Schott AM, Garnero P, Delmas PD, Hans D, Meunier PJ. Risk factors for hip fracture in women with high BMD: EPIDOS study. Osteoporos Int. 2005;16(2):149-154. [Article]

Sasaki N, Fujiwara S, Yamashita H, Ozono R, Teramen K, Kihara Y. Impact of sleep on osteoporosis: sleep quality is associated with bone stiffness index. Sleep Med. 2016;25:73-77. [Article]

Sunyer T, Lewis J, Collin-Osdoby P, Osdoby P. Estrogen’s bone-protective effects may involve differential IL-1 receptor regulation in human osteoclast-like cells. J Clin Invest. 1999;103(10):1409-1418. [Article]

The Global Burden of Osteoporosis: A Fact Sheet. Accessed August 9, 2017. [Report]

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