Dr. Christopher Fox on Preventing Osteoporosis and Future Fractures

Osteoporosis — a bone-thinning disease — is a major health threat for millions of Americans. In fact, about half of all women and a quarter of men will suffer a bone fracture because of osteoporosis. These fractures can be devastating and lead to chronic pain, loss of independence and, in some cases, death.

“Fortunately, treatments are available to prevent and manage osteoporosis,” endocrinologist Christopher Fox, MD, said during a free online health lecture.

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VIDEO: Watch Dr. Fox's online lecture on preventing and treating osteoporosis.
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Fragility Fractures: A Sign of Osteoporosis

According to Dr. Fox, osteoporosis is a disease that makes bones thin and weak. “This predisposes our bones to fragility fractures,” he explained. “These type of fractures result from an event that would not ordinarily result in a fracture, such as a fall from standing height or less. They are a sign of underlying osteoporosis.”

Fragility fractures can be painful and cause disability and loss of function. Dr. Fox said, “The most feared is the hip fracture. Fifty percent of those who experience a hip fracture will not be able to return to their previous level of function and living the way they were before the fracture.”

Osteoporosis Explained

Understanding osteoporosis begins with understanding how bones are made.

Dr. Fox stated, “Bone is living. It’s alive and continually being remodeled.” He explained that during a process called bone resorption, special bone cells called osteoclasts break down and resorb old bone, digging out a cavity. Once this occurs, other bone cells called osteoblasts lay down new bone until the resorbed bone is completely replaced.

“After about age 30,” said Dr. Fox, “we start to build less bone than we break down.” For perimenopausal and post-menopausal women, the bone-breaking osteoclasts become more active and break down bones more quickly. “The osteoblasts work to keep up, but the osteoclasts begin to remove more bone than the osteoblasts can create. Accelerated bone loss ends up occurring, increasing the risk of fragility fractures.”

Preventing Fragility Fractures

There are four things we can do to prevent fragility fractures.

1. Calcium + Vitamin D—Because vitamin D helps our intestines absorb calcium from the food we eat, getting enough of both is important in helping to maintain our bone density. “We know for postmenopausal women you should have at least 1,200 milligrams of calcium and 2,000 units of vitamin D each day,” said Dr. Fox. It’s best if your calcium comes from food versus supplements.
   
   He said you can find calcium in dairy, leafy greens and small fish such as sardines. Exposure to sunlight is one way to obtain vitamin D. Additionally, fatty fish like salmon, tuna and mackerel, and beef liver, cheese and egg yolks have vitamin D. Milk and orange juice have vitamin D added. All of these are good to consider adding to your diet.
   
   Magnesium, vitamin K, zinc and boron are also important. “The best thing to do,” said Dr. Fox, “is simply eat a healthy diet.”
2. Weight-bearing exercise—“Bones love when stress or force is applied. This means biking and swimming aren’t as beneficial for maintaining bone strength as weight-bearing excercise such as walking, hiking, dancing and aerobics,” said Dr. Fox. He added however, “It’s also important to be able to maintain our balance and muscle mass, so that the muscles around our bones are also strong. This makes us strong enough to avoid falling. Resistance training is important to build and maintain this muscle mass.”
3. Avoid tobacco—Smoking is never good for your overall health. It’s also affects bone health.
4. Avoid excess alcohol—Regularly consuming more than two drinks each day raises a person’s risk of developing osteoporosis.

Assessing Osteoporosis Risk

“Most people receive their osteoporosis diagnosis through a bone density analysis,” said Dr. Fox. “A T-score of -2.5 or less results in an osteoporosis diagnosis.”

Dr. Fox recommends that the following groups have a bone density scan to understand their risk for osteoporosis:

• Women age 65 and older
• Men and younger women with increased risk of fracture including those:
  • With family history of osteoporosis/hip fracture.
  • Undergoing steroid therapy.
  • Who are using estrogen blocking medication.
  • With low body weight.
  • With a condition associated with increased risk (early menopause, low testosterone, diabetes, celiac disease, rheumatoid arthritis, etc.).

It’s important to understand your risk for experiencing a fracture. “If you have already have had an osteoporosis-related fracture, a hip, pelvic or humerus fracture, or you have a parent who has had a hip fracture, you have a substantially increased risk of having a fracture in the future,” Dr. Fox stated.

Treatment for Osteoporosis

Treatment recommendations are typically based on an estimate of your risk of fracturing a bone in the next 10 years using information such as the bone density test.

Patients may want to consider medications if they have:

• Had a prior fragility fracture
• A T-score lower than -2.5
• A high fracture risk.
• Low bone mass and receiving steroid therapy.

Medications can help maintain or increase your bone density. Some medications can slow further bone loss if you’ve already been diagnosed with osteoporosis.

If your risk isn't high, treatment might not include medication and focus instead on modifying risk factors for bone loss and falls.

Click here to view/download a PDF of slides shown during Dr. Christopher Fox's online lecture on “Preventing and Treating Osteoporosis.”

To schedule an appointment with Christopher Fox, MD, call (720) 923-7209.