July 25, 2014

Outwitting Osteoporosis

"Osteoporosis is a disease that has no symptoms whatsoever. It's the silent disease," warns Susan Branco, a professional fitness instructor who has taught a variety of senior exercise programs for the NCH Healthcare System and the Parkinson Association of Southwest Florida. Her summation of osteoporosis reflects the current thought of many health care professionals-that the disease is underdetected and underdiagnosed.

"The general population does not appreciate how common it is," agrees rheumatologist Eric Hochman of Naples' Anchor Health Center. "The numbers [of diagnoses] are astoundingly low," even though he estimates that more than half of women over 50 will suffer an osteoporotic fracture during their lifetimes.

Part of the problem, Hochman and many other physicians believe, is the way the health care system works today. Doctors often have so many patients and so little time that more pressing issues-chest pain, high blood pressure and the like-take priority. "Doctors treat the acute issues, and I think it just gets swept under the table," Hochman says.

Still, more attention has been paid in recent years to osteoporosis, a decrease in bone mass that creates porosity and fragility in the bones, making them more vulnerable to fractures. Most people know about the risk factors-family history, lack of exercise, insufficient calcium or smoking.-but they may not think to request a bone-density test during a doctor visit.

"More patients are having these tests done, but it tends not to be the first thing n your mind," says Dr. Geoffrey A. Negin, a neuroradiologist with Florida Radiology Consultants in Fort Myers.

The good news is, with more accessible equipment to test bone density, advances in medications, and an increased understanding of the effects of diet and exercise on bone mass, osteoporosis is more manageable than ever before.

"It's preventable and it's treatable," says Dr. Negin. "It's not something you have to resign yourself to."

get tested

Because no symptoms of osteoporosis usually appear until a fracture occurs, patients need to educate themselves about the disease and request the proper tests from their doctor. Most people regard osteoporosis as a woman's disease, because the abrupt drop in estrogen levels postmenopause can lead to a more sudden onset of the disease. But men are also at risk-and by the time patients are in their 70s, the risk for both sexes is equal.

Women should start getting annual bone-density tests around age 50, or postmenopausally, depending on their health history. Men might wait another five or 10 years, says Dr. Negin, but should be tested regularly after that.

Traditionally, tests are done by CAT scan, but Medicare only pays for these scans every two years; and some patients have concerns about the radiation levels.

A machine called the DEXA (dual-energy X-ray absorptiometry) is a simple, inexpensive piece of equipment that tests bone density in the spine and hip, as does the CAT scan-only radiation levels are lower. The machines are now found in the offices of many general practitioners, and the cost is usually reimbursed by insurance.

Male or female, be aware of your personal risk factors. If you have a family history of osteoporosis, lead a sedentary lifestyle, smoke, have dietary deficiencies or take certain medications that can affect bone density, it's important to begin monitoring your bone mass. Differing races have differing risks, as do various body types-tall, thin, small-boned physiques are more susceptible to decreased bone mass, for example.

Get Moving

Peak bone mass is achieved early in life-generally by age 30, after which time we tend to lose more bone than we build. But we do continue to build bone mass throughout our lives, so it's still important to get adequate calcium in our diets (most doctors recommend between 1,000 and 1,500 mg) and to stay active.

"When you have toned, conditioned muscles, it stimulates bone density growth," says Susan Branco, Her one-hour classes at NCH's Wellness Center in Naples feature low-intensity, low-impact weight-bearing exercises, performed with the skeleton in an upright position, supporting the body weight (walking, dancing, stepping, etc.). "Regular weight-bearing exercise can counteract and even reverse the effects of osteoporosis," Branco says.

In addition, her classes include resistance training with light handheld weights, stretches for flexibility, and exercises to improve balance and joint mobility. Branco teaches five days a week in season to accommodate the demand for the popular program: "We have an enormous room, and it just gets filled up," she says. The majority of her students are 65 and over, and participants regularly report bone density increases of between 5 and 12 percent after joining her class.

"Exercise is key," agrees Dr. Negin, and he thinks it may be one area in which Floridians have an advantage. Dr. Hochman moved to Florida in July from St. Louis, and he sees a marked difference in the activity level of most of his older patients. "The older population of Naples is much healthier than the older population of the Midwest," he says.

Floridians also benefit from the sunshine, which helps our bodies convert vitamin D, an essential element for calcium absorption, into a usable form. But patients still need to be aware of their own health history, and insist upon being tested regularly. Hochman has seen some patients resist medication for their osteoporosis. Those already taking a number of different medications may not want to add one that doesn't seem to have an obvious, immediate effect-especially if they don't have secondary drug coverage through Medicare and have to pay for it out-of-pocket. And the truth is, "it's not going to make them feel better, or any different," he says.

So while the outlook for osteoporosis sufferers is brighter than ever before, patients need to be aware and active in seeking diagnosis and treatment.

"You can prevent the effects of osteoporosis," says Negin. "It's never too late to detect it."

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