by Jon Thatcher, MD

It is an unpopular reality that our bodies begin a slow decline after our mid 30s as we slide into those “golden years.” Differences in hair color, muscle mass, and eyesight are obvious changes, but what goes unnoticed is the gradual loss of bone mass. Often it is not until a fracture occurs due to a simple fall from a low height, such as standing, that fragile bones become apparent. These “fragility fractures” are most common about the shoulder, wrist, hip, and spine, often require surgery and can have life changing consequences.

Jon Thatcher, MD
Jon Thatcher, MD

Osteoporosis has become a well-recognized bone condition. As life expectancy has increased, so have fragility fractures causing a huge health and financial burden on this country. About 20 years ago bone density scans became widely available as a means of estimating the amount of bone mass present and age-adjusted, normal bone mass standards were established. If the results of a bone density study fall below the average expected bone mass, it is labeled osteopenia, mild bone loss, or osteoporosis. These measures serve as a predictor of fragility fractures and offer guidelines for treatment.

Bone mass loss is difficult to regain. The amount of bone developed until age 35 represents the storage of bone available through subsequent “golden years.” Building strong, thick bones the first half of your life and minimizing the inevitable loss of bone the second half is the best way to avoid osteoporosis.

Bones love loads. Strength training, walking, or simply jumping up and down several times a day stimulates bone formation. Our sedentary lifestyles, particularly among our youth, have become a concern for medical providers, portending an increase in fragility fractures. Bones also need calcium found in leafy greens and dairy, as well as, vitamin D3, which is necessary to absorb calcium across the intestinal wall. The primary source of vitamin D3 is direct sunlight hitting the skin. Fish oil is the only natural food source of vitamin D3 and has been artificially added to milk to combat rickets in children. It can be a challenge to maintain what is thought to be the necessary level of vitamin D3. The FDA suggested daily requirements of vitamin D3 have been creeping up the past several years from 400 IU to 800 IU. For the elderly, 2000 IU are recommended, particularly after fragility fractures. In northern climates, such as New England sunlight is only intense enough to optimally absorb Vitamin D3 for 6 months of the year at best. We are spending less time outside; justifiably avoiding sun for fear of skin cancer, thus, vitamin D3 deficiency is common. The easiest way to maintain healthy levels of calcium and vitamin D3 is with supplements. 1000 mg calcium and 1000 IU of vitamin D3 daily are currently recommended.

The treatment of established osteoporosis is more complicated. Bone is continually being dissolved by osteoclast cells to allow new strong bone to be made by osteoblast cells. After age 35, osteoclasts outpace osteoblasts. There are medications that alter bone metabolism directly through hormonal stimulation, or by slowing osteoclast function to favor bone formation. This is the only way to reverse and rebuild osteopenic or osteoporotic bone. However, there is controversy around these medications; which to choose, who should be using them, and for how long.

If you want to learn more about this topic, attend my evening presentation, Osteoporosis: Prevention, Associated Fractures and Treatment where I will be discussing prevention and treatment options associated with osteoporosis. We will also discuss fractures that can occur as a result of osteoporosis and treatment of those fragility fractures. The program is on October 20, 2014 from 6:00 – 8:00 PM in the BMH Brew Barry Conference Center.

Jon Thatcher, MD is a board-certified orthopaedic surgeon at BMH Orthopaedics & Sports Medicine, a department of Brattleboro Memorial Hospital. He can be reached at 802-251-8611.