Farrah Anwar, MD, on preventing and managing osteoporosis

Often called the “silent disease,” osteoporosis is a bone-thinning condition that is a threat to millions of Americans. The Bone Health and Osteoporosis Foundation reports that due to osteoporosis, one in two women and up to one in four men will break a bone in their lifetime. It is responsible for an estimated two million broken bones each year, yet nearly 80% of older Americans who suffer bone breaks are not tested or treated for osteoporosis. These breaks 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.

In her BCH lecture “Preventing and Treating Osteoporosis,” board-certified internal medicine and endocrinology specialist Farrah Anwar, MD, of Endocrinology Associates of BCH--Superior described how osteoporosis is diagnosed, the causes of osteoporosis and preventative treatments that can help maintain and increase our bone density. 

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Watch “Preventing and Treating Osteoporosis"

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What is osteoporosis?

Osteoporosis is a bone disease that makes our bones weak and more likely to break. "As we age, our bone mass is lost faster than it’s created. Approximately 10 million Americans, mostly women, who are 50 years and older have osteoporosis; another 43 million have low bone density, also known as osteopenia. Those with osteopenia have an increased risk of getting osteoporosis,” said Dr. Anwar. 

Additionally, she added, “Osteoporosis breaks occur when bones that would not normally break do so. While most broken bones are caused by falls, osteoporosis can weaken bones to the point that a break can occur more easily for example by coughing, bumping into something or falling from standing height. These are considered fragility fractures.” 

Fragility factures can result in significant pain, decreased mobility and function, a fear of falling, decreased quality of life, increased mortality rates, increased health care costs and more fractures. Those who have had fractures are at a higher risk of suffering subsequent fractures.

What are the risk factors associated with osteoporosis?

A number of factors can increase the likelihood that we’ll develop osteoporosis, including age, race, lifestyle choices and medical conditions and treatments.

Unchangeable Risk Factors

• Your sex. Women are more likely to develop osteoporosis than men.
• Age. The older we get the greater our risk of osteoporosis.
• Race. If you’re white or of Asian descent you’re at greater risk of osteoporosis.
• Family history. Having a parent or sibling with osteoporosis puts you at a greater risk, especially if your mother or father fractured a hip.
• Body frame size. Men and women who have small body frames tend to have a higher risk of osteoporosis.
• Low BMI
• Low peak bone mass

Modifiable Risk Factors

• Smoking
• Excess alcohol consumption
• Inadequate calcium and vitamin D intake
• Chronic steroid use
• Chronic opioid use
• Hypogonadism—decreased functional activity of the gonads (ovaries or testes)

Medical Risk Factors

• Kidney failure
• Liver disease
• Rheumatoid arthritis
• Inflammatory bowel disease

How is osteoporosis diagnosed?

Your bone density can be measured by one of the following:

• Bone Density Scan (DEXA), which uses low levels of X-rays to determine the proportion of mineral in your bones. A DEXA scan reports two numbers: T-score and Z-score. The T-score compares your bone density to what is normally expected. The Z-score is the number of deviations above or below what’s normally expected for someone of your age, sex, weight and ethnic or racial origin. If your Z-score is significantly higher or lower than the average, additionally testing may be recommended.

• A FRAX (Fracture Risk Assessment Tool) score is used to determine a person’s 10-year risk of fracturing their spine, hip, forearm or shoulder over the next 10 years. Dr. Anwar explained, “We recommend treating patients with FRAX 10-year risk scores of greater than or equal to 3% for hip fracture and greater than or equal to 20% for major osteoporotic fracture to reduce their fracture risk.”

“Regardless of your scores, if there is a presence of a fragility fracture you do have osteoporosis,” said Dr. Anwar. “With the proper management of osteoporosis, we can significantly reduce the risk or fractures and improve the quality of life of our patients.”

Anwar emphasized, “Anyone with an established diagnosis of osteoporosis based on their DEXA or FRAX scores, or if they have a fragility fracture, should be treated for osteoporosis.” She added, "There are also some risk factors for those with osteopenia that would suggest they should be treated as well, for example those who have taken steroids for a long time.”

How can we prevent and manage osteoporosis?

Osteoporosis can be prevented and managed with a balanced diet that includes adequate calcium and vitamin D intake and exercise. Dr. Anwar provided the following guidelines. 

• Calcium intake—1200 mg per day is recommended. This can be obtained by consuming healthy foods such as low-fat dairy, dark green leafy vegetables, canned salmon or sardines with bones, soy products and calcium-fortified cereals or orange juice. Calcium supplements may also be necessary.
• Vitamin D intake—800 units per day is recommended to increase your ability to absorb calcium and improve bone health. Supplements may be needed if you’re not reaching the optimal units per day.
• A diet rich in fruits and vegetables along with adequate caloric intake are important to support healthy bones.
• Exercise is essential for keeping your bones healthy throughout your life. Thirty minutes each day is recommended; strength, weight-bearing and balance exercises are ideal. The benefits of exercise are lost once you stop.
• Maintain healthy body weight.
• Avoid smoking.
• Limit alcohol consumption.
• Fall prevention—Be aware of loose rugs, be sure you have adequate lighting, avoid slippery surfaces and unfamiliar areas. Also, some medications do cause us to be unsteady. 

"Additionally, pharmacological treatment may be necessary along with lifestyle changes for management," said Dr. Anwar.  

Schedule an Appointment

Call 303-415-4344 if you have any questions or to schedule an appointment with Farrah Anwar, MD, of Endocrinology Associates of BCH--Superior.

Click here to view/download a PDF of slides shown during the lecture.

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