What is Osteoporosis?
According to the National Osteoporosis Foundation, there are nearly 54 million Americans with low bone density and roughly 10 million with osteoporosis. Unfortunately, I see patients with osteoporosis all too often with associated spinal fractures. Typically, these patients present after some type of trauma, like a slip and fall on ice, with unrelenting back pain thereafter that significantly impairs their day-to-day function. Oftentimes this occurs, not simply from the fall, but because their bones were osteoporotic.
Osteoporosis = Porous Bones
So what is osteoporosis? Osteoporosis is a disorder where the body loses significant bone density, leaving bones weak and susceptible to fracture.  This occurs when the body makes too little bone, absorbs too much bone, or both. There is distortion of the bony architecture on a microscopic level that occurs, resulting in impaired structural integrity, and bones that break more easily.
How Can we Screen for Osteoporosis?
Since osteoporosis is a “silent” disease which does not cause significant pain, unlike osteoarthritis which can be quite painful, you may not realize you have osteoporosis unless you are screened for it. To screen for osteoporosis, one would undergo a bone density test known as a DEXA scan. Typically women are screened at age 65, while men are screened at 70. However, it’s important to note that you should discuss this further with your primary care physician as these rough guidelines are not applicable to everyone and sometimes early screening is warranted.
Unfortunately, if one isn’t screened for osteoporosis, a diagnosis is typically made after a patient breaks a bone. Ouch! Some of the most common sites for fracture are in the spine, hip, and wrist. From my experience diagnosing and treating many spine fractures, it can be incredibly painful for patients and often results in loss of height as well as a stooped forward posture.
The good news is, we have treatment options for patients that are unlucky enough to sustain a fracture. This will be discussed in further detail below, but first let’s focus on prevention and the steps we can take to ensure optimal bone health.
5 Steps for Optimizing Bone Health
Note: Before starting any interventions or new exercise routines, it is important to check with your doctor to see what treatment options are best for you.
1) Weight-Bearing Exercises: Exercises such as hiking, jogging, gardening, and step aerobics, to name a few, are great for combating osteoporosis. Most exercises that keep you upright, thus keeping your bones working against gravity should do the trick. Since pool therapy offloads bones given our buoyancy in water, this would NOT be considered a type of weight-bearing exercise.
2) Avoid Household Products Containing Triclosan: Triclosan is a chemical added to many cleaning products, toothpastes, and even mouthwashes to help prevent bacterial growth. There are also many other commonly found household items that may contain Triclosan as discussed in an article by Healthline, like certain fabrics, kitchenware, office supplies, carpets, and workstation surfaces. 
Recent epidemiologic studies have been performed that show a positive association between urinary triclosan concentration and osteoporosis.  Our knowledge of this product is still unfolding, however, for the time being, it may be best to opt for ticlosan-free products whenever possible.
3) Sunshine– aka Mother Nature’s Vit D: Vitamin D plays a number of important roles in the body. As it relates to bone health, Vitamin D helps send signals to cells within your gut to absorb calcium and phosphorus minerals which are key in maintaining good bone health. 
The recommended amount of time to spend soaking up sun rays is dependent upon where you live. Studies show that in the UK, 13 minutes of sunlight exposure should be adequate for maintaining healthy vitamin D levels, while in Oslo, Norway, this time is closer to 30 minutes. [5,6] Remember, although it’s important to get adequate amounts of vitamin D, it’s equally important to protect your skin from the damaging effects of UV rays so don’t forget to lather on the sunscreen afterwards! You can learn more about the damaging effects of UV rays in this post.
4) Vitamin Supplementation: If you’re trapped in a windowless cubicle somewhere where you can't sneak outside for a dose of vitamin D throughout your day, consider quitting your job. Ok, ok–maybe this isn't the best option, so for those of you that can’t make a sudden career change, oral vitamin D supplementation is available.
According to the National Osteoporosis Foundation, it’s recommended that “adults under age 50 get 400-800 International Units (IU of vitamin D every day, and that adults age 50 and older get 800-1,000 international units.” 
As an added bonus, Vit D also helps treat seasonal affective disorder to help combat the winter blues.
5) Medications: There are a number of FDA-approved medications for treating osteopenia and osteoporosis including, bisphosphonates, calcitonin, hormonal therapy, RANK ligand inhibitors, selective estrogen receptor modulators (SERMs), etc. To determine if you are a candidate for any of these options, it is necessary to discuss this further with your Primary Care Physician or an Endocrinologist as these medications require a prescription.
What happens if we don’t take these steps?
The unfortunate reality is, the lifetime risk of sustaining a fracture related to osteoporosis is 16% for women and 5% for men. In America, there are over 1.5 million osteoporotic fractures each year. This is an outrageously high number that results in significant pain, suffering, and impaired quality of life for people–that’s why it’s so important we take any steps possible to ensure good bone health.
Options for Treating Vertebral Compression Fractures
1) Bracing and Pain Medications:
If a vertebral compression does occur there are three different treatment options available. The most conservative route would be temporary bracing to immobilize the spine via thoracolumbar orthosis (TLSO) or lumbar orthosis (LSO). A patient’s pain would then be treated with oral medications until the fracture heals which typically takes upwards of 12 weeks.
2) Vertebral Augmentation
Unfortunately, bracing and medications don’t always work well for patients due to poorly controlled pain, limited function, etc., which necessitates further intervention. An option for these patients is vertebral augmentation. Although there are different types of augmentation, one of the most common is a procedure known as a kyphoplasty.
During this procedure, a needle with a removable stylet (essentially a needle within a needle) is placed into the fractured vertebra. After the inner needle is removed, a balloon is threaded through the remaining hollow needle. The balloon is then inflated which acts to restore vertebral body height and creates a cavity within the bone. The balloon is then removed and cement is injected which stabilizes the fracture and burns the tiny nerves inside the bone–both of which results in pain reduction.
3) Surgical Intervention
In certain cases, surgical intervention may be warranted. This is often considered when the spinal cord or exiting nerve roots are being compressed resulting in neurologic dysfunction or when the spine becomes unstable.
The take home here is, not all of us have to become victims of osteoporosis. Although it might not be completely preventable, there are actionable steps each of us can take to reduce our risk of developing osteoporosis. Having experienced the pain and suffering that goes along with complications from this disease all too often, I’d like to encourage you to start implementing the necessary lifestyle changes to ensure optimal bone health.
How about you? Do you or a loved one suffer from osteoporosis? What is your treatment strategy? Have you experienced any complications?
Cai, S., Zhu, J., Sun, L., Fan, C., Zhong, Y., Shen, Q., & Li, Y. (2019). Association Between Urinary Triclosan With Bone Mass Density and Osteoporosis in US Adult Women, 2005‒2010. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4531-4538.
Rhodes, L. E., Webb, A. R., Fraser, H. I., Kift, R., Durkin, M. T., Allan, D., ... & Berry, J. L. (2010). Recommended summer sunlight exposure levels can produce sufficient (≥ 20 ng ml− 1) but not the proposed optimal (≥ 32 ng ml− 1) 25 (OH) D levels at UK latitudes. Journal of investigative dermatology, 130(5), 1411-1418.
Cicarma, E., Porojnicu, A. C., Lagunova, Z., Dahlback, A., Juzeniene, A., & Moan, J. (2009). Sun and sun beds: inducers of vitamin D and skin cancer. Anticancer research, 29(9), 3495-3500.