Rheumatology: Osteoporosis Clinic

Personalized Care Plans for Patients with Osteoporosis

The mission of our Osteoporosis Clinic is to identify and treat patients with osteoporosis through individualized therapy and treatment tailored to their specific needs.

What is osteoporosis?

“Osteo” means bone and “porosis” means porous (full of holes or sponge-like). Osteoporosis is defined as decreased bone mass (i.e. bone amount or density) as well as decreased bone strength. This results in fragility and weakness of the bone and increased risk of fractures.

As a result of the bone weakness and fragility, patients can have major fractures at the hip, spine, wrist, ribs, etc. These fractures can occur with minor falls from standing height, bending and even coughing.

Our bones are constantly renewed. Old bone is removed by certain cells (called osteoclasts) and then replaced by new bone that is made by other cells (called osteoblasts). Osteoporosis results when the new bone production is less than the amount of bone that is removed.

Who gets osteoporosis?

In 2010 there were an estimated 12 million people with osteoporosis and another 40.5 million with osteopenia (that means significant bone loss, but not enough to be called osteoporosis).

Both men and women can have osteoporosis. Although osteoporosis occurs more commonly in post-menopausal women, about 20% of all patients with osteoporosis are men. One in two women and one in six men over age 50 will suffer an osteoporosis-related fracture at some point in their lives.

In the U.S. alone, there are 1.5 million osteoporosis-related fractures each year, out of which 250,000 occur at the hip (high risk of morbidity and even mortality) and 750,000 in the spine (leading to pain, hunched back spine deformity, height loss, difficulty breathing, etc.)

Who needs to be checked for osteoporosis?

• Post-menopausal women with osteoporosis risk factors, in particular women who are 65 years or older and men after age 70
• Patients with risk factors for osteoporosis, which includes, but is not limited to, the following:
  • Older age
  • Non-Hispanic white or Asian ethnic background
  • Low weight (less than 125 lbs.)
  • Family history of osteoporosis, particularly hip fracture in either parents
  • Early menopause or low levels of sex hormones (such as estrogen, testosterone).
  • Malabsorption (like celiac disease) and eating disorders (anorexia nervosa and bulimia).
  • Cigarette smoking
  • Three or more daily alcoholic beverages
  • Sedentary lifestyle and immobility
  • Visual impairment
  • Frequent falls due to neurologic or musculoskeletal disorders
  • Certain medications, such as prednisone (and related corticosteroids), excess thyroid hormone replacement, heparin (form of blood thinner), stomach acid blockers (such as omeprazole, pantoprazole and related medications), some hormone blocking medications used in treatment of breast and prostate cancer (such as anastrozole, letrozole, or leuprorelin)
  • Endocrine disorders, such as hyperthyroidism, hyperparathyroidism, Cushing's disease, etc.
  • Inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, etc.)
• Patients with compression spinal fractures or thinning of the bone noted in X-rays
• Anyone with a history of low impact fracture as an adult, which significantly increases the risk of future fractures

What are the symptoms of osteoporosis?

Most patients with osteoporosis do not have any symptoms until they have a bone fracture. Interestingly, even some patients with spine (vertebral) fractures may not even have any pain or realize that they have developed a fracture. Sometimes loss of height can be a symptom.

What is a DEXA scan (bone density test) and what does it show?

A DXA or DEXA scan (Dual Energy X-ray Absorptiometry), is currently the best test to measure the bone density (referred to as BMD or bone mineral density).

The test is similar to an X-ray with less radiation. The report includes a T score that compares your bone mass to a normal bone mass of a young healthy adult. Depending on the T-score values, you can have osteoporosis or osteopenia (which means low bone mass, but not low enough to be called osteoporosis).

The report also includes how you compare with people your age (Z-score), but this is only used to compare young adults and children. T-score values guide your doctor in determining your risk of fracture and whether you need medicine to treat osteoporosis.

If your T-score is -2.5, it means your bone density is less than 98.5% of young women at their peak bone density (between ages 25 to 30).

Who should be treated with prescription medications for osteoporosis?

If you have either a T-score equal or less than -2.5, or prior history of “low stress” (like a fall from standing height) fracture as an adult, your doctor may recommend treatment for osteoporosis. Medications used to treat osteoporosis include bisphosphonates (alendronate, risedronate, ibandronate, zoledronate), Teriparatide, Denosumab, Calcitonin or Raloxifene.

All patients should receive calcium and vitamin D supplementation (please see the calcium and vitamin D supplements handout) and are recommended to start weight-bearing exercise. For helpful fall prevention tips, please see the fall prevention handout.

What is a FRAX score?

If your T-score is between -1.0 and -2.5 (in the osteopenic/borderline range), your doctor may use the FRAX score to determine whether you need treatment.

The FRAX score is calculated using a formula to determine your fracture risk over the next 10 years. The FRAX score takes into account your age, race, gender, as well as other osteoporotic fracture risk factors, including prior history of fractures, use of prednisone, smoking, alcohol use, family history of hip fractures, endocrine and inflammatory conditions associated with increased risk of bone loss.

Additional Reading on osteoporosis and its treatments can be found at:

• American College of Rheumatology
• National Osteoporosis Foundation
• National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center