By MATTHEW A. SHLAPACK, MD
Osteoporosis is unfortunately an extremely common disease affecting 10.2 million Americans and resulting in 2 million fractures each year in the U.S. alone. Of further concern, 43.4 million Americans have low bone mass and are also at risk for fractures and progression to Osteoporosis. The great news is that our understanding of Osteoporosis is excellent and with the current treatment approaches available, the likelihood of fractures can be greatly reduced.
The catastrophic potential of an Osteoporotic fracture cannot be over emphasized. Research shows a mortality rate of 12-20% within the 2 years following an osteoporotic fracture. Further, more than half of survivors of hip fractures are unable to return to independent living. Vertebral fractures not only lead to permanent disfigurement but can lead to lifelong pain. This means that if a patient has an osteoporotic fracture, they may not survive it and even if they do, they are unlikely to return to their previously quality of life and independence.
The danger of Osteoporosis is that it is largely asymptomatic. The first warning sign can be a major fracture. For this reason, screening for Osteoporosis is essential. The analogy I often use for my patients is a porcelain vase on a high shelf. The vase may look secure, but only a small fall can cause it to shatter
The gold standard for screening is a DEXA scan. Both men and women require this screening. The age at which to complete a first DEXA scan depends on risk factors but, as a simple guide, all patients over the age of 65 should have a DEXA scan. Postmenopausal women under the age of 65 and men should be considered for a DEXA scan if they have risk factors for osteoporosis such as a history of smoking, need for treatment with glucocorticoids, or family history, to name a few.
The comprehensive management of Osteoporosis involves 3 crucial domains. The first of these is lifestyle measures designed to remove negative influences on bone health and promote measures that have been found to increase bone density and reduce fractures. The second is a group of interventions which help to reduce falls. Finally, pharmacologic agents are essential in patients with Osteoporosis.
We are fortunate in that we now have multiple medications which have robust date showing fracture prevention efficacy. Choosing among these different agents requires consideration of the patient’s baseline bone density and fracture history, as well as possible barriers such as tolerance, compliance, and cost. In that last several years, concerns have been raised about possible adverse effects associated with medications used to treat Osteoporosis. These adverse effects have received excessive social media attention to the detriment of the care of our patients. The reality is that while all medications have potential adverse effect, Osteoporotic medications are generally well tolerated and the rate of adverse effects is not only extremely low but is vastly outweighed by their known benefits.
Osteoporosis is an expected part of normal aging. The great news is that when this occurs, it can be addressed. Together with my fellow providers, I am here to ensure that our patients receive the best care. At Orlando Endocrinology, our mission is to ensure that patients benefit from all the latest advances in medicine, helping to preserve their health and maintain their independence.
Matthew Shlapack, MD, is a Board-Certified Endocrinologist practicing at Orlando Endocrinology. Shlapack completed both his Internal Medicine Residency and his Endocrinology Fellowship at The University of South Carolina, School of Medicine, and was awarded his Doctor of Medicine degree from Ross University Medical School. He graduated from The University of Maryland, College Park with bachelor’s degrees in both Neurobiology, Physiology, as well as Psychology. He attended Ross University Medical School. Visit http://orlandoendocrinology.com