FOUR. Living with Osteoporosis
Bone mineral density together with the quality of the bone determine how strong your bones are and how easily they can break.
Will the treatments help me make new bone, or will there always be holes? Will I be more likely to break a bone? Does a fracture look differently on a bone with osteoporosis?
Though many people think that we're done making new bone after we reach young adulthood, bone is an active and dynamic tissue throughout our lives. The process of bone breakdown and new bone formation is always going on. Of course, it does slow down as we approach the end of life. Osteoporosis treatment and prevention strategies are intended to slow down bone breakdown and speed up bone formation. If you are on Actonel (risedronate), Fosamax (alendronate), Boniva (ibandronate), Reclast (zoledronic acid), Miacalcin NS (calcitonin), Fortical (calcitonin), Evista (raloxifene), or MHT (estrogen, progestin), your treatments are targeting the osteoclasts, the cells that break down bone. If you are taking Forteo (teriparatide), your treatment helps your body build new bone, rather than just slowing down the process of bone breakdown. Don't forget that there are two characteristics about bone that put you at greater risk for fracture. Bone mineral density together with the quality of the bone determine how strong your bones are and how easily they can break. So, you can increase your bone density, but you may still be at considerable risk for breaking a bone.
Depending on the balance in the bone breakdown-formation cycle, you have the potential to reduce those holes left by the osteoclasts. If your treatments help the osteoblasts form more bone than the osteoclasts break down, you will make new bone. The new bone will improve your bone density T-score when you are retested after treatments. In order for the increased bone mass to be clinically significant on the DXA testing, your bone mass will need to have increased by more than 2% to 4% at the spine and 3% to 6% at the hip. If you stop your treatment, the cycle of remodeling bone will likely once again favor bone breakdown, and holes will reappear. The positive effects of some of the medications remain even after the medication has been stopped. This is another important consideration in the medication you select with your clinician.
If you are being treated for bone loss, you are still more likely to break a bone even though you are on medication, because for each standard deviation that your score is below zero, your fracture risk increases. But numbers are not what matter most here. Being aware that you can break a bone more easily if you fall should prompt you to make changes in your environment to prevent falling. Question 79 has some tips about preventing falls. It should also help you to remember your medication. Taking your medication exactly as it is prescribed is very important to improving your bone health.
In order for osteoporosis to become apparent on a conventional x-ray, you would have lost 30% to 40% of your bone mass. But even though lower bone mass can be seen on x-rays, osteoporosis is not diagnosed by those x-rays, and DXA testing is still needed (see Question 23). Conversely, fractures can be read on conventional x-rays and do not require DXA imaging for diagnosis. Some fractures, like vertebral compression fractures, can be difficult to diagnose even by conventional x-rays, so additional testing may be needed. Fractures that occur with very little force or trauma are most likely related to osteoporosis. Conventional x-rays show the entire bone rather than focusing on density, and osteoporosis does not interfere with identifying a fracture. It's the fracture itself and
Being aware that you can break a bone more easily if you fall should prompt you to make changes in your environment to prevent falling.
There are more fractures related to osteoporosis than the combined number of heart attacks, strokes, and new diagnoses of breast cancer among women each year.
especially the way the fracture occurred that might make your clinician suspicious of osteoporosis, if you have not already been diagnosed with it (see Question 74).