Bones are living tissue and are continuously remodeling, a process that involves old bone cells dissolving while new bone cells form. Unless there is major trauma, healthy bones in adults should not break. In people with osteoporosis, or bone disease, breaks and fractures are more common because bone loss occurs at a quicker pace than new cells can form, leaving bones porous and brittle. Osteoporosis is called a “silent disease” because people do not show any signs or symptoms until a fracture occurs.
“Aging and a decrease in hormones cause an imbalance in the bone remodeling process,” said Sara Arndt, APNP, an advanced practice nurse in the Froedtert & the Medical College of Wisconsin Orthopaedic Bone Health Program. “Bone is broken down faster than new bone is formed, but osteoporosis is not a normal part of aging. There are many treatment options, and the disease doesn’t have to impact a person’s quality of life.”
According to the National Osteoporosis Foundation, low bone mass and osteoporosis affect more than 54 million Americans. One in two women and up to one in four men over the age of 50 will break a bone due to osteoporosis. This type of break is known as a fragility fracture, a fracture that occurs because of a fall from standing height or less and commonly affects the wrist, shoulder, knee, ankle, spine or hip.
“Fragility fractures are often the result of slips and falls,” Arndt said. “They can also be caused by something as simple as bending down to tie a shoelace or bumping into a door.”
Osteoporosis can be diagnosed in several ways. One way would be following a bone mineral density scan. Another less commonly known way of making the diagnosis is after a person sustains a fragility fracture. Just by nature of having a fall that results in a major fracture, a person can be diagnosed with osteoporosis.
The bone density scan uses X-ray technology to measure a person’s bone mass (measuring the calcium in grams per centimeter squared in the bone). The result is called a T-score, and that value is compared with the average bone mass of a 30-year-old adult (when bone mass is optimal). The lower the T-score, the higher the risk of fracture. A T-score of -1.0 or above is considered normal bone density. A T-score of -2.5 or below is a diagnosis of osteoporosis.
“In some cases, the patient’s T-score will show a person has low bone mass (osteopenia),” said Erin Zepezauer, APNP, an advanced practice nurse in the Froedtert & MCW Orthopaedic Bone Health Program. “However, in the presence of a fragility fracture, this would still be considered osteoporosis. The presence of a fragility fracture trumps the patient’s T-score reading. We are finding that many of our patients are fracturing while in the low bone mass range, just before falling into the osteoporosis category. In order to prevent future fractures, it is important for individuals with fragility fractures to begin treatment.”
According to the National Osteoporosis Foundation, “a recent fracture at any major skeletal site in an adult older than 50 years of age should be considered a significant event for the diagnosis of osteoporosis and provides a sense of urgency for further assessment and treatment.” Hip fractures are one of the most common types of fragility fractures, yet studies suggest adults with minimal-trauma hip fractures rarely receive treatment to prevent further fractures.
The Froedtert & MCW Orthopaedic Bone Health team is involved in a national effort to improve the bone health of patients who suffer from a fragility fracture and reduce the incidence of future fragility fractures.
“We’re part of the American Orthopaedic Association’s Own the Bone® initiative,” Arndt said. “This gives us access to many tools and resources, which allow us to run a successful fracture prevention program. We have access to a network of experts who provide us with the latest information and research about the management of osteoporosis after a fragility fracture.”
Treatment for osteoporosis is guided by a patient’s medical history and lab work. The patient’s T-score is used to monitor the effectiveness of treatment over time. It is important to remember that with appropriate medical treatment, exercise and a diet with adequate amounts of calcium and vitamin D, future fractures can be prevented. If you are concerned about the health of your bones, talk with your provider about undergoing osteoporosis screening and evaluation.