The skinny on bone density and aging

When we were kids, we loved having our height measured because it was exciting to see how we were growing. As we age, though, we may come to dread it. Why? Because if you're getting shorter, it's a sign of osteoporosis, a potentially dangerous weakening of the bones.

Brittle and fragile bones often lead to hip fractures, which 300,000 Americans - most of them women - experience each year. Such fractures are a major reason families call on patient advocates like myself, to help sort things out when mom can no longer live on her own because a hip fracture has so impacted her mobility. Even if the hip is surgically repaired, according to a 2019 study, the one-year mortality rate after a fracture is 21%.

The incidence of osteoporosis is so concerning that the federal government has established an Osteoporosis Workgroup as part of its Healthy People 2030 initiative. Its objectives are to reduce osteoporosis and hip fractures among older adults and increase osteoporosis screenings and use of proven medications.

Inside your bones

We think of a skeleton as a rigid framework for the body, but it's actually an organ that adapts to the stresses we put on it. When you lift weights or groceries, you can actually build bone, and when you're sedentary you can lose it.

Your bones allow you to walk and move, protect vital organs and allow the lungs to function, and they produce cells in the marrow that are critical for survival.

In childhood, adequate calcium, vitamin D and plenty of exercise make for strong bones. But adults tend to drink less milk and get less activity than children, so bone density starts to decline around the age of 50 in many people.

Signs of osteoporosis

Osteoporosis develops slowly and silently, so many people don't know they have it until either they get screened or something breaks. Signs may include:

• Losing an inch or more of height.

• Changes in posture, such as the so-called dowager's hump, a curving of the upper spine.

• Shortness of breath if disks in the spine are compressed enough to reduce lung capacity.

• Lower back pain.

Medicare generally covers bone density scans, known as DXA scans, every other year for women over 65 and men over 70. Earlier scanning may help those with heightened risk factors. For example, in women, bone mass drops most rapidly in the four to five years around menopause because of less estrogen production. A woman experiencing early menopause in her 50s might benefit from an earlier bone scan.

Both men and women are subject to additional risk factors, which may include the use of corticosteroids for autoimmune diseases or chemotherapy in the treatment of cancer; and diseases such as diabetes and digestive disorders, which may reduce the body's uptake of calcium. It's a good idea to talk with your doctor about whether any of your medical conditions or treatments could harm bone density.

Prevention and treatment

I sound like a broken record, but a healthy diet, adequate calcium intake and weight-bearing exercise will help keep bones strong. However, lifestyle changes may not be enough if you have lost a lot of bone density.

Your doctor may recommend calcium supplements along with a medication such as Boniva (ibandronate), a bisphosphonates that works to slow the breakdown of bone and increase the amount of tissue in your bones. There are other options as well, including estrogen therapy for women.

The Osteoporosis Workgroup noted that the use of medications to treat osteoporosis has decreased and the incidence of hip fractures is no longer declining. They think this may be because of publicity around the rare-but-scary side effects of the medication, such as a sudden fracture of the thigh bone (femur). There's also little data about the effects of long-term use.

Scientists are always looking for new ways to treat osteoporosis. Researchers at Florida International University identified a hormone involved in bone growth that could be effectively delivered with a tablet, but it'll be years before it's at your pharmacy.

Meanwhile

If you have osteoporosis, clear your surroundings of trip hazards such as cords and throw rugs; avoid activities that involve twisting your spine (sorry, golfers!), and work on improving your balance.

Someone once said, "The human skeleton is the architecture of the body." Do your best to keep it standing.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her book, "How to Be a Healthcare Advocate for Yourself & Your Loved Ones," is available on Amazon. She is offering a free phone consultation to Daily Herald readers; call her at (312) 788-2640 or email teri@northshorern.com.