By Carmella Fernandez MD, MBA
As an orthopedic surgeon the topic of bone health and osteoporosis typically arises after my patients have sustained a traumatic fracture of their bones. As a woman and a orthopedic surgeon, bone health and fracture prevention are near and dear to my heart. I hope this article can shed some light on the importance of bone health, and ways that you can prevent a fracture. The following are a few common questions I en-counter frequently by my patients:
1. Why does bone health become so important as we age?
Our bones are living and dynamic structures. They are continuously remodeling, which means that new bone replaces old bone. When we are younger, we actively build new bone so that there is net positive bone growth. The opposite phenomenum occurs with aging, where we favor more bone resorption than formation. The end re-sult is that with aging our bones become more porous and the strength decreases, thereby predisposing individuals to hip, spine, and wrist fractures.
2. How can I maximize the strength of my bones?
Peak bone mass is achieved by the late teenage years, and it occurs slightly earlier in women than men. There is slow decline in bone mineral density after the age of forty in both women and men which is inevitable. Considering that our bodies are not able to produce calcium, and 99% of our calcium stores are in our bones, we will mobilize calcium from our bones when we are calcium deficient. Therefore daily consumption of calcium via supplements and our diet are the most effective way to maintain our balance of calcium and prevent resorption from bone. In addition to calcium, vitamin D is integral to maintaining our calcium homeostasis as it promotes the resorption of cal-cium from our intestines. Therefore without vitamin D we cannot absorb the calcium we take in.
In addition to maintaining a healthy diet and weight, incorporating weight bearing ex-ercises such as walking, running, and tennis to your daily routine will help to maintain your bone strength.
Avoiding tobacco use and excessive alcohol consumption with help reduce bone loss.
The American Academy of Orthopedic Surgeons website is a great source for infor-mation on recommended daily values of calcium and vitamin D intake.
3. What is the difference between osteopenia and osteoporosis?
Both osteopenia and osteoporosis are defined by a decrease in bone density. How-ever osteoporosis is more severe, and has been coined as the “silent disease” as it often is not recognized until a fracture, or break in the bone occurs following a low en-ergy fall. Falls are the leading cause of injury among persons aged 65 and older in the United States. Fractures are the primary cause of hospitalization or death following a fall, and the mortality rate is approximately 30% following a hip fracture. One in two women and one in four men older than age 50 will have an osteoporosis-related frac-ture in her or his lifetime.
4. How do I know if I have osteopenia or osteoporosis?
Bone density exams, also known as a DEXA, are screening tools to monitor an indi-viduals bone density. In general, it is recommended that all women over the age of 65 and men over the age of 70 obtain a DEXA scan. Based on the test results your prima-ry care physician can help guide you regarding treatment options if necessary.
Carmella Fernandez MD, MBA
Dr. Fernandez is a dual fellowship trained orthopedic surgeon specializing in surgery of the hand, wrist, and elbow. Her clinical interests focus on developing personalized treatment plans to restore pain-free function to her patients through a variety of non-surgical and surgical solutions.