Approximately 1 in 2 women and up to 1 in 4 men 50 years and older will break a bone due to osteoporosis.
Osteoporosis is becoming more common worldwide. According to the National Osteoporosis Foundation, about 54 million Americans have osteoporosis and low bone mass, which places those individuals at increased risk of developing osteoporosis. Approximately 1 in 2 women and up to 1 in 4 men 50 years and older will break a bone due to osteoporosis.1
What Is Osteoporosis?
Osteoporosis means “porous bones.” It affects both men and women, typically as they age and their bones become weak and brittle. The most common locations for fractures due to osteoporosis are the spine, hip, and wrist.
Our bones accumulate until about age 30. Osteoblast cells tend to build up the bone, causing strength and formation. After age 30, however, osteoclast cells take over and cause bone breakdown and resorption. Bone breakdown tends to double at an increasing rate after women experience menopause and continue to break down at an alarming rate until 10 years following menopause, after which time the breakdown rate begins to slow.1
Modifiable ones include alcohol intake, smoking, low calcium and vitamin D intake, low levels of physical activity, and inadequate nutrition. Nonmodifiable risk factors are genetics, old age, menopause, lactation, and several conditions, including multiple sclerosis, HIV/AIDS, rheumatoid arthritis, and lupus.
Taking certain medications can also put an individual at increased risk of osteoporosis, the biggest contributor being long-term steroid use (typically ≥5 mg of prednisone for at least 3 months). Some other risk-increasing medications include anticonvulsants, loop diuretics, proton pump inhibitors, selective serotonin reuptake inhibitors, and excess thyroid hormone.1
Pharmacists should spread awareness to prevent patients of all ages from developing osteoporosis because the condition is common and it’s never too early to start prevention. Encourage all patients to perform weight-bearing exercises daily, such as walking, swimming, jogging, or Tai-Chi. Encourage them to also try muscle-strengthening exercises, such as weightlifting.
Several measures can also be put into place within households to prevent falls, which can lead to fractures. These include:
· Making sure lighting is appropriate
· Removing rugs around the house that can cause individuals to trip
· Adding nonslip mats in the bathtub, along with a safety bar
· Installing handrails in stairwells
Making sure patients are receiving adequate amounts of both calcium and vitamin D is the most important preventive measure of all. Although dietary intake is preferred, the amounts individuals receive from their diets are usually insufficient and require additional supplementation.
According to the National Institutes of Health, individuals up to 70 years old should receive 600 IU of vitamin D daily, while those 71 years and older should receive 800 IU. Individuals 19 to 50 years old should receive 1000 mg of calcium daily, and 51- to 70-year-old women should increase their intake to 1200 mg because of the rapid increase in bone breakdown due to menopause.
The body needs vitamin D to absorb calcium properly, so it’s important to combine these 2 supplements. The body can only absorb 500 to 600 mg of calcium at one time, so doses >600 mg should be divided throughout the day.2
When recommending calcium products, make sure patients know that calcium carbonate formulations like Oscal or Tums are acid-dependent formulations that must be taken with meals in order to be absorbed. Also remember to consider patients’ other medications when making these recommendations. For example, calcium carbonate might be a poor choice for a patient taking a proton pump inhibitor, so recommend calcium citrate formulations instead because they have better absorption and can be taken with or without food.
It’s important to educate patients about osteoporosis and the steps they can take to prevent it at any age. Check your patients’ medications list, counsel each patient on any medications that can induce osteoporosis, and recommend that they start supplementation.
1. What is osteoporosis and what causes it? National Osteoporosis Foundation website. nof.org/patients/what-is-osteoporosis. Accessed August 17, 2016.
2. Calcium: dietary supplement fact sheet. National Institutes of Health Office of Dietary Supplements website. ods.od.nih.gov/factsheets/Calcium-HealthProfessional. Accessed August 17, 2016.