Careful review of your patient’s medications and medical conditions can help evaluate their risk for osteoporosis. An estimated 10 million people have osteoporosis, 80% of them women, and 22 million more are at an increased risk. Almost 1.5 million fractures each year are the result of osteoporosis, and almost half of these are hip fractures, which require hospitalization and result in permanent disability or long-term nursing care. For both men and women, medications such as glucocorticoids, aromatase inhibitors, immunosuppressive drugs, chemotherapy drugs, and anticonvulsants can lead to bone loss. In addition, Celiac disease and Crohn’s disease reduce the ability of the body to absorb calcium, while rheumatoid arthritis, osteogenesis imperfecta, anorexia nervosa, and chronic kidney or liver disease are associated with osteoporosis as well. Vital nutrients such as calcium (1,000 to 1,200 mg/day) and vitamin D (800 to 1,000 mg/day) are needed to preserve bone strength. Weight-bearing exercise stimulates bone cells, and resistance exercise of the upper body stimulates bone growth through muscle activity. Smoking causes faster bone loss and in postmenopausal patients causes higher fracture rates. Patients at risk due to age, having had fractures past age 50, who are white, or are thin, should be evaluated with bone mineral density (BMD) testing, generally recommended for all women at age 65. There are drugs that preserve bone density by slowing the break-down of bone turnover, and there is one drug (Forteo) that stimulates new bone formation. Osteonecrosis of the jaw is a possible side effect of many drugs, though most agree that cancer patients on IV bisphosphonates are more likely to be affected. Also, there is evidence that patients being treated for depression are at higher risk for osteoporosis and may benefit from BMD testing. Loss of weight after menopause indicates loss of bone, and vitamin supplements for calcium and vitamin D with daily exercise are essential. Finally, falling causes most fractures in people with low bone density. Evaluation of the home for areas that may cause trips and falls is essential. Look for unsecured rugs and unlighted stairwells. The addition of grab bars in tubs, showers, and near toilets can reduce the chances of fractures in susceptible patients.
These Web sites can provide additional information:
niams.nih.gov/Health_Info/Bone/Bone_Health/Nutrition/Other_nutrients.asp, as well as courses.washington.edu/bonephys/FxRisk-Calculator.htm. (Source: Harvard Women’s Health Watch, January 2008)
