Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both, the National Osteoporosis Foundation said on its website. “As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.”
While bones should be strong and dense, a person with osteoporosis has bones that are porous. In short, they look like Swiss cheese or a honeycomb. These holes and spaces equal the lost density or mass, and as this occurs, they weaken and are more likely to break.
Osteoporosis is a “silent disease,” explained Lisa Brandt, ACNP-BC, with Trinity Health’s Rheumatology department. “You can’t feel osteoporosis. You don’t know it’s going on until you either get screened and the test tells you, or you fall and have a hip fracture.”
Appropriate screening is important because a fracture can be life-changing, Brandt said, noting that time for recovery, possibly with inpatient rehabilitation, as well as the pain and the process of recovering, can be “a pretty significant deal.”
It is recommended for women over the age of 65 – and men over the age of 70 – to be screened for osteoporosis, unless there is another known disease process or something else that makes the bones thinner, Brandt said. “We know that about one in three women and about one in five men over the age of 50 will have an osteoporosis-related fracture in their lifetime.”
The DEXA scan, which measures bone density, can let the provider and the patient know if the latter has a normal bone density level; osteopenia, where the bone density is thinner than normal; or osteoporosis, “the thinnest category,” Brandt said. When looking at a patient with osteopenia, she noted that if the patient’s bones leaned toward being unhealthy, rather than healthy, “we would treat you as if you have osteoporosis.”
With osteopenia, which Brandt described as being “a gray zone,” there are other risks that can push the bone density level to osteoporosis levels, including smoking, heavy alcohol use, steroid use, a parent with a history of osteoporosis, or an inflammatory condition like rheumatoid arthritis.
“All of those different factors go into a calculation, the FRAX score,” she said. That will tell if a person is leaning toward the healthy side or the thin side, bone-wise.
Treatment options for osteoporosis vary, from shots to pills to IVs. Reclast, a once-a-year IV treatment, is unique to Trinity’s Rheumatology department. There are also Fosamax®, a once-a-week pill, and Prolia®, an anti-absorptive shot. These stop the osteoclasts, the cells that tear at bone and make it weaker.
While it cannot repair damage that has already been done, it can prevent further damage, Brandt noted. “It works on stopping the bones from losing it faster than they normally would,” she said. “And in turn, it gives the cells that build up the bones a bit of a head start. You can see an increase in your bone density.”
Once a patient is diagnosed with osteoporosis and treatment starts, a further DEXA scan will be ordered two years after diagnosis, Brandt said. “That will give us an opportunity to compare the two to see how they improve. If they hold steady or improve, they’ll stay on that therapy. If it doesn’t, then we’d change.”
Trinity’s Rheumatology department, which also includes Erdal Diri, MD, is located in Health Center-Medical Arts, 400 Burdick Expy E, Minot. For more information or to make an appointment, call 701-857-7495.
Depending on insurance, a patient may need a referral from their general healthcare provider.