With Endocrinologist Angela Boldo, MD.
By the time they reach 80 years old, nearly 80% of women will have experienced significant loss in bone density. A third will have full-blown osteoporosis. It’s a condition that affects almost 10 million Americans, creating brittle bones and contributing to spinal fractures, hip breaks and more. But while loss of bone density is a natural part of aging, that doesn’t mean we can't do anything about it.
We spoke with First Physicians Group Endocrinologist Dr. Angela Boldo to learn about the latest screening guidelines and best practices for managing osteoporosis.
Why does osteoporosis affect women more than men?
Women develop osteoporosis more than men because they lose estrogen production with menopause and this increases bone resorption. So all women will start losing some bone strength. Depending on the genetics and how strong your bones were when you're young, you get at least osteopenia and about a third of the women will get osteoporosis in their lifetime.
Men have some testosterone for the rest of their lives, so they don't get osteoporosis as frequently as women, but they have it as well. Unfortunately, men don't get screening for osteoporosis and find out only after they have a fracture.
When does osteoporosis screening begin for women?
The official guidelines say women over 65, but sooner if you have any risk factors. I tell patients five to 10 years after menopause, or age 65, because sometimes we’re missing patients in their early 60s who already have osteoporosis. Some women have menopause in their 40s, so they should be screened in their 50s.
Are there symptoms people can be on the lookout for?
No symptoms. And that's the biggest problem with osteoporosis. You don't feel it until you experience a bone break.
But if you notice a decrease in height, that's a big warning.
What's the difference between osteopenia and osteoporosis?
You achieve peak bone mass when you're young, around age 20 to 30, and that's the strongest your bones will be. Then you start losing bone density. You get first to osteopenia, where there's no big increase in fracture risk. It's more like a warning. Your bone density is going down, your bones are not as strong anymore. When you get to osteoporosis, your fracture risk is high enough that it warrants treatment.
What are the risk factors for osteoporosis?
Family history is a big one. If you have family members who broke their hip or had compression fractures, I would start screening right at menopause.
And a lot of medications can damage bone, including long-term steroid use, some anti-estrogen medication used for breast cancer treatment, and medications that decrease testosterone in men. So if they need the medication, then we protect their bones.
Then there are other risk factors like hyperparathyroidism, where your parathyroid is overactive and it takes calcium out of your bones.
And smoking.
What does screening look like for osteoporosis?
A bone density scan is a simple test that takes maybe 15 minutes. And it’s a low radiation test. They measure the density of the hip area and the spine because those are the two areas where we are most concerned about fractures. Sometimes they also measure the density of the radius of the forearm.
How often does someone need to be screened?
If the results are completely normal, you repeat the scan in five years. Because it takes many years for the bone density to decline significantly. But if you have osteopenia, we’ll screen every two years to measure the rate of decline.
What diet changes can be made to help prevent or manage osteoporosis?
Get enough calcium and vitamin D. Those are the things that can make a difference. I recommend my patients have 1200 milligrams of calcium either in their diet or as a supplement. And I recommend 2000 units of vitamin D a day.
Sometimes I even recommend this to my patients before menopause because it's just healthy to have vitamin D so you can absorb the calcium that you're taking. And we want to make sure your bones are strong even before you go into menopause.
What exercises are most important in managing osteoporosis?
Weight-bearing exercises are good. And that can even be just fast-paced walking. If the patient wants to do something more than just walking, climbing stairs is a great exercise and so are squats. And I usually recommend at least 30 minutes a day. Exercises in the pool are great, but they are not weight bearing.
How else can we decrease fracture risk?
There are several medications approved for osteoporosis. And some of those medications can decrease your fracture risk by 50 to 70%. So discuss these options with your physician, if you have been diagnosed with osteoporosis.
If someone has concerns about osteoporosis, what should they do?
Call their primary care physician. If they have risk factors or if they’re the right age, they should get a bone density test and assess their baseline risk. Do some blood work and check their vitamin D, make sure they're getting enough calcium, that they exercise, and just try to maintain that bone health. If they don't have osteoporosis yet or they're not high risk for fractures, at least they're aware of their bone health and can work on keeping it.
More Resources
To schedule an appointment with Dr. Boldo or another endocrinologist at First Physicians Group, click here.
To learn more about the Bone Builders program at HealthFit, click here.
To find more osteoporosis resources near you through the National Osteoporosis Foundation, click here.
Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY, and is going to start taking calcium supplements.