Guidelines for osteoporosis screening updated. Should one be made?

How strong are your bones?

At least one in five women over age 50 in the United States has osteoporosis, but many don’t know it.

Women age 65 and older should undergo bone densitometry to screen for osteoporosis, recommend updated guidelines from the U.S. Preventive Services Task Force (US Preventive Services Task Force).

Osteoporosis is often described as a “silent disease” because it has few, if any, symptoms until someone breaks a bone, usually in the hip, wrist or spine. Women who have gone through menopause are the most exposed to bone loss, although it can also affect men.

For postmenopausal women under age 65, the task force, an influential government-appointed panel of medical experts, reiterated the existing recommendation that if one or more risk factors exist, such as low body weight, family history of fracture of the hip, smoking and excessive alcohol consumption, a risk assessment questionnaire can determine whether a scan is necessary.

Dr. Esa Davis, a member of the task force and professor of family and community medicine at the University of Maryland in Baltimore, stressed the importance of the test because osteoporosis weakens bones and makes them easier to fracture, causing disability, pain chronic, loss of independence and even death.

According to studies, between 21% and 30% of people Those who suffer a hip fracture die within a year.

Although there are few obvious symptoms, there may be signs that the disease is developing, such as a stooped posture, loss of height, and bone discomfort. However, bone pain can also be a symptom of various diseases, such as arthritis.

“Osteoporosis is a serious bone disease that occurs when the body loses too much bone, makes too little bone, or both,” said Dr. Andrea Singer, medical director of the Bone Health and Osteoporosis Foundation.

What is osteoporosis testing?

“The term osteoporosis screening refers to the use of bone density, X-ray studies or other tools to identify people at increased risk for bone fractures or breaks,” Dr. Thomas Weber explained in an email. endocrinologist at Duke University Medical Center who studies and treats patients with osteoporosis and metabolic bone disorders.

Doctors may not appreciate the devastating consequences of bone fractures, including chronic pain, disability or premature death, Weber explained. As a result, doctors may consider a bone density test a low priority, according to a national survey of doctors published in 2023. Patients’ concerns about the cost of the tests may contribute to women not undergoing them.

A large study that analyzed insurance claims data from more than 1.5 million women between 2008 and 2014 found that less than 25% of women aged 65 or older with private insurance who did not have a diagnosis of osteoporosis underwent screening.

A 2021 report from the National Osteoporosis Foundation found that only 9% of women and 5% of men with Medicare received a bone density test within six months of a new fracture.

“While very few women are screened for osteoporosis, even fewer men undergo the necessary testing,” Singer said.

The task force did not have enough evidence to recommend or advise against testing in men.

Rapid weight loss is risky

Rapid, significant weight loss can pose a risk to bone health, according to Dr. Christopher McGowan, a gastroenterologist and obesity specialist who runs True You Weight Loss in Cary, North Carolina.

In fact, the updated recommendations come at a time when a growing number of women and men are using prescription weight-loss medications, such as semaglutide, the active ingredient in weight-loss drugs like Novo Nordisk’s Ozempic and Wegovy, and tirzepatide, the active ingredient in Zepbound, from Eli Lilly.

A recent study found that participants using GLP-1 medications without exercise experienced a significant decrease in bone density in the hip and spine. The combination of exercise and weight loss medications protected bone mass density.

“People at risk for decreased bone density, especially women over 65, should have a bone density test before starting anti-obesity medications, if they have not recently had one,” McGowan said. .

According to previous research, between 25% and 40% of the weight lost corresponds to lean muscle masswhich has important implications for strength, mobility, bone health, and fracture risk.

A Novo Nordisk spokesperson indicated that osteoporosis is not listed as an adverse reaction in the information provided by Ozempic.

A Lilly spokesperson said: “There is no information or data available on the effect of tirzepatide on bone density or osteoporosis.”

Is osteoporosis preventable or reversible?

Osteoporosis is preventable and treatable, but experts emphasize that it is a chronic disease, like diabetes and hypertension, so it is not curable. That is why it is important to detect it early.

According to experts, most people with osteoporosis will need medication to prevent fractures.

“Stabilization or improvement of bone density can be achieved with medications, so the risk of bone fractures can be reduced by half to two-thirds, depending on the drug used and the location of the fracture,” Weber said.

Dr. Felicia Cosman, an osteoporosis expert and professor of Medicine at Columbia University, recommends that everyone follow universal prevention measuresincluding:

  • A healthy diet with lots of fruits and vegetables.
  • Avoid excessive consumption of tobacco and alcohol.
  • An active lifestyle, including strength training, weight-bearing aerobic exercise, and balance training, as needed, to reduce the risk of falls.

Most studies indicate that strength training is safe for elderly patients with bone diseases, but people at risk for spinal fractures should avoid exercises that cause forward movements of the spine or rapid twisting movements of the spine. the column, Cosman said.

To have healthy bones it is important to have an adequate amount of calcium, vitamin D and protein.

Cosman recommended getting calcium through food whenever possible, with the goal of eating about three calcium-rich foods a day, such as milk (fortified plant-based milk is fine), yogurt, and cheese.

“For people on a low-calcium diet, calcium supplements should be given at the lowest doses necessary,” he said.

It is difficult to get enough vitamin D through food and, although exposure to sunlight allows the skin to produce it, this process is reduced with sun protection, he added.

Many people need a vitamin D supplement, but the dosage varies depending on the individual.

“In general, for people 50 years of age and older, vitamin D doses of 800-1,000 international units daily are adequate,” Cosman explained.

A large clinical trial conducted in 2022 concluded that vitamin D supplements do not prevent fractures in healthy men aged 50 or older and in women aged 55 years or older.

Experts believe it is best to talk to your doctor about the risks and benefits if you have any questions about taking vitamin D supplements.