In osteoporosis, the bone tissue deteriorates, leading to low bone mass. While a bone density test can detect a low bone mass, it cannot assess the quality of the bone. For anyone who has suffered a fracture from a standing height after age 40, it tells us that the bone quality has been impacted. It is not normal to fall from a standing height or fall off a chair, for example, and break a wrist.
In Canada, 1 in 4 women are at risk for fracture and have a diagnosis of osteoporosis. At least 80% of fractures in people over the age of 60 are related to osteoporosis. When it comes to hip fractures, 90% are due to an underlying diagnosis of osteoporosis. The most common sites of osteoporosis-related fractures include the hip, spine, and wrist.
Among the leading risk factors for fracture are:
a previous fragility fracture
a family history of osteoporosis and osteoporotic fractures.
treatment with glucocorticoid medications.
The impact of fracture affects both illness and even death. After a hip fracture, there is a 20% overall chance of dying. Women have an even higher risk of death: one in four women who suffer a hip fracture will die of complications due to that fracture. Of those who survive after a hip fracture, about 50% will suffer from some kind of disability. The lifetime risk of hip fracture for a woman is greater than the risk of developing breast cancer.
Although there are effective treatments for osteoporosis, one of the concerns is the ability to adhere to the medication given. Studies show that many patients fail to take their medication consistently.
Treatments available to women for osteoporosis include:
hormone therapy (primary indication for use is vasomotor instability),
selective estrogen modulators such as raloxifene
bisphosphonates such as zoledronic acid, alendronate, and risedronate
anabolic steroids such as parathyroid hormone and calcitonin.
These vary by their route of administration and side effects. While some medications are taken by mouth daily, others are taken once a week, once a month, by daily injection or by once a year infusion. Calcium and vitamin D are essential for all.
This week, a new class of medication has been released for treatment of postmenopausal women with osteoporosis who are at high risk for fracture. The medication, denosumab, is an entirely new class of medication called a RANK Ligand inhibitor. What that means is that the medication specifically targets the cells that break down bone, called osteoclasts, by binding to their receptor called RANK. As a result, by turning off the osteoclast, it allows bone mass, and therefore bone strength, to increase. Denosumab is an injectable medication given under the skin, subcutaneously, every six months. As a result, it is another opportunity to increase the ability of a patient to stay on the medications consistently and treat osteoporosis.
Know your risk for osteoporosis and be proactive about your bone health by attending to your diet, calcium and vitamin D intake as well as a bone-strengthening exercise.