Early signs of Osteoporosis In its early stages, osteoporosis is likely to be asymptomatic. That means many people will not know they have it without the benefit of testing. Osteoporosis often goes diagnosed until a fracture or injury occurs, because low bone mass does not cause pain. A hallmark sign of osteoporosis are fractures that occur easily Common fracture site include the vertebrae, wrist, femur, and ribs. Other reasons for pain in osteoporosis include secondary causes such as cancer. If a patients with low bone mass is presenting with bone pain and there are no fractures to be seen, the provider should rule out other causes of bone pain. Late signs of Osteoporosis Fractures Back pain can be a warning sign. It might be the result of a collapsed or broken spinal vertebra precipitated by bone loss. Dowager’s hump (or hump back) of the thoracic spine that occurs with multiple vertebral compression fractures. Loss of height: Getting shorter is an almost infallible sign of bone loss. Because the bones have lost their density. Height loss > 4 cm in 10 years is significant! Scoliosis Low extremity strength, balance, gait, and postural reflexes Red Flags Multiple fractures Fatigue Easily Bruising Generalized pain Gait abnormalities Height loss > 4 cm in 10 years Complications   include fractures, falls, pulmonary embolism, pain, decrease in quality of life, lost work days, disability, collapse of vertebrae secondary to compression fracture, recurrent fracture, death!

The USPSTF recommends screening for osteoporosis in Women aged 65 years or older and Younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors Men Concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men Re-screening There are no current guidelines on the value of rescreening women whose initial screening test did not detect osteoporosis is to improve fracture risk prediction The World Health Organization recognizes three classes of bone loss Osteopenia is the term used for minimal bone loss which is still clinically significant. Osteopenia is diagnosed if the bone mineral density test shows a bone loss standard deviation of -1 to -2.5. Patients with osteopenia are deemed up to 250 percent more likely to experience a bone fracture than a healthy person. Osteoprosis: A bone loss of greater than -2.5 is diagnosed as osteoporosis. Severe osteoporosis is diagnosed if the bone loss is -2.5 or greater and at least one fracture has occurred that is related to bone loss.

Which tests are used to evaluate osteoporosis will depend on your age, symptoms, and current health. In determining a patient’s risk from bone loss, a doctor is likely to use BMD test and FRAX calculator The USPSTF recommends using FRAX to calculate risk with subsequent testing of the following groups: All women 65 and older Women 50-64 with 10-year risk of fracture of 9.3% or more FRAX Fracture Risk Assessment Tool Is a fracture risk assessment tool that allows for calculation of future risk of fracture based on patient characteristics Calculates the 10-year risk for osteoporotic fractures FRAX is a free online tool, invented by the World Health Organization, that accurately predicts a patient’s risk of fracture. Because osteoporosis is so common among people over fifty, FRAX is particularly useful to primary care physicians who can use it with or without a bone density test. Patients can use this tool themselves though they will need to convert height and weight to centimeters to get accurate results. The FRAX is available at no cost through the University of Sheffield at this address: https://www.shef.ac.uk/FRAX/tool.jsp Imaging The most common test for osteoporosis is a non-invasive x-ray of bones. This procedure, known as a bone mineral density (BMD) test, commonly targets the bones most at risk for problematic breaks:

Prevention with proper diet and exercise should be the main focus! Much of osteoporosis bone loss is irreversible. Due to the high incidence of osteoporosis in people over fifty, anyone in that age bracket is advised to adopt healthy preventive measures to avoid developing osteoporosis. Ideally, prevention with proper diet and exercise should begin before puberty, when bones are growing. This is needed lay done a proper foundation of strong bones. Adequate intake of calcium Dairy Products; milk, yogurt, cheese. Spinach, Kale, Okra, Collards, Soybeans, White beans,  Some fish; sardines, salmon, perch, and rainbow trout Foods that are calcium fortified, such as some orange juice, oatmeal, and breakfast cereal 1000mg/d for men and premenopausal women 1200-1500mg/day for postmenopausal (between 4-5 cups of milk) Calcium sources Calcium supplements: calcium carbonate and calcium citrate for those unable to obtain enough calcium from diet alone Adequate vitamin D intake  (Vitamin D insufficiency <32ng/mL) 800-1000IU intake daily Sunlight, 15 minutes a day Beef liver, Cheese, Egg yolks, Fatty fish; tuna, mackerel, and salmon Foods fortified with vitamin D; some dairy products, orange juice, soy milk, and cereals Weight bearing exercise to increase bone density Exercise alone is not effective for post-menopausal women as effects of exercise are estrogen dependent Maintenance of normal body weight   Avoid cigarette smoking and excessive alcohol intake

There is a debate within the medical community as to whether osteoporosis is reversible, but the condition can definitely be stabilized and symptoms reduced with proper treatment. When it is caught early, treatment consists mostly of lifestyle changes consisting of proper exercise, diet, and avoiding substances that weaken the bones. Adequate intake of calcium Dairy products are high in calcium, but if a patient cannot tolerate dairy, many other foods, especially fish, soy products, fortified cereals, and dark leafy vegetables, have natural or added calcium. Calcium can also be taken as a pill supplement. When taking calcium tablets, it is important not to exceed the recommended daily dose of calcium, because calcium overdose can cause a multitude of health issues. For women over fifty, the daily recommended allowance of calcium is 1200 milligrams. Under no circumstances should a woman take in more than 2000 milligrams of calcium a day. For men aged 51-70, the recommended daily allowance of calcium is 1000 milligrams, and the upper safe limit is 2000. When a man turns 71, his recommended allowance increases to 1200  milligrams, but the upper limit remains 2000. Calcium food sources and overview Dairy Products; milk, yogurt, cheese. Spinach, Kale, Okra, Collards, Soy beans, White beans,  Some fish; sardines, salmon, perch, and rainbow trout Foods that are calcium fortified, such as some orange juice, oatmeal, and breakfast cereal 1000mg/d for men and premenopausal women 1200-1500mg/day for postmenopausal (between 4-5 cups of milk) Calcium supplements: