The degenerative bone disease osteoporosis is underdiagnosed and undertreated — even though it affects almost 20 percent of women older than 50 in the United States (and 5 percent of men that age). Experts say this is partly because many people misunderstand or underestimate the debilitating effects of this serious condition.
A recent survey of 240 post-menopausal women — a time of especially high risk — published in the July 2023 issue of Menopause, underscores the widespread misinformation and the need for physicians and patients to work together to take action to help prevent, diagnose, and treat osteoporosis.
Don’t Wait for a Bone to Break
Osteoporosis occurs when our bones lose too much mineral density and mass. The resulting brittle bones are vulnerable to fracture, which can seriously impact a person’s health and well-being, according to the North American Menopause Society (NAMS), which publishes Menopause. Women are more prone than men because hormone changes during menopause speed up bone loss.
Waiting for a fracture to occur before you get serious about the disease is dangerous, notes Ira Khanna, MD, an assistant professor of rheumatology at Mount Sinai West in New York City. “You want to catch low bone mass even before it becomes osteoporosis and certainly before there’s a bone break,” Dr. Khanna says.
Yet many people who have the disease don’t realize they do until they break a bone, and some don’t connect their fracture to osteoporosis even after that happens.
In the Menopause survey, more than half the respondents said they previously had a bone fracture.
Yet 65 percent of respondents have not been tested for the disease, and most were not undergoing treatment to improve bone health. Some 10 percent stated they had never heard of osteoporosis, while 51 percent admitted they knew the term but little about the condition.
Although the survey respondents live in China, “it is likely that women in the United States are uninformed about their risks for osteoporosis and the substantial morbidity and mortality associated with the disease, says Stephanie Faubion, MD, the director of the Mayo Clinic’s Center for Women’s Health and the medical director of NAMS, pointing to the large number of people in the United States who break a bone before getting diagnosed.
Osteoporosis Is Serious — and Sometimes Deadly
Osteoporosis makes it more likely that a wrist, forearm, spine, or hip bone will fracture. Especially in older people whose bones heal more slowly, these breaks can have lasting effects, Khanna explains. They may experience lingering pain, the inability to stand up straight, or difficulty living on their own.
In its most severe form, osteoporosis can be deadly. A study published in the journal Nature in December 2019 concluded that 17 percent of people with osteoporosis who broke their hip died within one year.
Yet a majority of the Menopause survey respondents thought osteoporosis was less dangerous than heart disease, and more than a third incorrectly ranked it behind high blood pressure and diabetes. In fact, all four together are considered the most perilous health threats, the researchers noted.
Respondents also did not recognize the silent nature of the condition. Some 41 percent said they would seek treatment only after experiencing pain or another adverse event. Again, that is well after effective treatment should begin, Khanna says.
Changing Up Your Lifestyle Can Reduce Osteoporosis Risk
To keep your bones as strong as possible in midlife and after, it’s important to adopt a healthy lifestyle, the Centers for Disease Control and Prevention (CDC) advises.
This includes regularly doing weight-bearing exercises such as walking, running, or strength training; limiting alcohol use; quitting smoking; and eating a healthy diet with adequate amounts of calcium and vitamin D.
Most people get sufficient calcium in their diet and don’t need to supplement, Khanna says, pointing to milk, soy foods, leafy greens, oats, and beans as especially good sources.
But many women are deficient in vitamin D, which is why she recommends asking your doctor to test your level along with your regular blood work and supplementing as necessary.
People with osteoporosis should also take care to prevent falls, the CDC emphasizes, by removing floor rugs, installing grab bars in the bathtub and shower, and having regular eye exams so they don’t accidentally trip on obstacles they don’t see.
Get a Bone Density Test When Appropriate
The strength of your bones can be evaluated with an imaging scan known as dual-energy X-ray absorptiometry (DXA).
The U.S. Preventive Services Task Force currently recommends that women at average risk for osteoporosis have their first screening at age 65. Post-menopausal women who are not yet that age but are at risk should also be screened, the task force states. This includes a family history of osteoporosis, inflammatory bowel or thyroid disease, certain medications, including steroids or breast cancer hormones, and many other factors, Khanna says.
You can check your risks with an online calculator known as a FRAX Risk Assessment tool. Then speak with your physician about the right time to have a DXA screen.
Tests should be repeated every two years after the first, Khanna notes.
In the United States, screening rates currently fall well below the recommendations. Just 27 percent of women 65 to 79 were screened in the prior two years, according to results published in the American Journal of Medicine in 2017.
Medicines That Can Help
Post-menopausal women with osteoporosis or osteopenia — low bone mass levels that precede osteoporosis—should be treated with medication, Khanna says. Medicines include biphosphonates such as Fosomax, Reclast, and Boniva, which slow the rate at which bones break down. People with more severe disease may also need medicines that increase bone formation, such as Forteo, she advises.
Medications are a crucial component of treatment, NAMS emphasizes. Without effective and early therapies, the number of osteoporotic fractures and the associated costs are projected to double by 2035, the organization notes.
Hormone therapy is another option for reducing fracture risk, Dr. Faubion says. “Estrogen is an appropriate therapy for prevention of bone loss,” especially for younger, healthy post-menopausal women who also have hot flashes, which estrogen also helps with.