A breakdown of osteoporosis prevention, diagnosis

Osteoporosis has been diagnosed in more than 10 million Americans and an additional 40 million have been designated with low bone mass, thus falling within the proverbial "red zone" for developing the disease. Given the enormous scope of the issue, it is imperative physicians further develop their osteoporosis prevention and treatment habits to halt the onslaught. In an effort to head the resistance, osteoporosis experts Gautam Kakade, MD, Orthopaedic & Sports Medicine Specialists, Fort Dodge, Iowa, and Jacob Teitelbaum, MD, director of The Annapolis Center for Effective CFS/Fibromyalgia Therapies and bestselling author, shared valuable tips on how physicians can better prepare patients for a future less brittle.

Prevention breakdown
As with any condition given predominantly to the wiles of chance, if it can be avoided, avoid it.

“Preventing osteoporosis is far more important than treating it,” Kakade said. “Although osteoporosis treatment can reduce the risk of fractures, it cannot reverse the effects osteoporosis has on the structure of the bones. Knowing this, prevention and education should start during childhood, even prior to adolescence.”

Kakade suggested educating patients consistently about the added benefit of a decreased osteoporosis risk that accompanies regular exercise routines and intake of vitamin D and calcium. Teitelbaum championed a similar prerogative, dubbing an increase of weight-bearing exercise and proper vitamin/nutrient intake as more of a lifestyle enhancer rather than an alternative lifestyle.  

“You’re here to inform people about how to get pleasure in a way that is good for them,” Teitelbaum said of the physician’s role. “You want to keep pleasure — you want to take doctors out of the role of being the rabbi or priest or minister who's trying to say give up everything that is pleasure — [physicians are] moderators, and moderation is good in all things.”

Below are the informative measures physicians should take to be successful moderators for patients regarding osteoporosis prevention, according to Teitelbaum and Kakade:

  • Carb watch — Encourage patients, even children, to steer clear of carbonated soft drinks. Excessive soda intake has been a known factor in increasing osteoporosis risk.
  • Butt in — Inform patients about how smoking, among many other risks, can increase one’s chance for contracting osteoporosis. “Avoiding [smoking] can go a long way in preventing this condition,” Kakade said.
  • Weigh in — Adults who are underweight or normal weight can be at a higher risk for osteoporosis and should include weight training as part of a continuous exercise routine.
  • Pass it on — Tell patients to keep alcohol consumption in the moderate range. “If [patients] are drinking more than 3 drinks a day on average, or they have an alcohol problem, alcohol in excess can be a major cause of osteoporosis,” Teitelbaum said.
  • Shades on — Vitamin D can be an osteoporosis deterrent, so make sure patients are spending enough time outdoors. “The current fad is to tell people to avoid sunlight, and that’s been a rather deadly fad. The proper advice is to avoid sunburn, not sunshine,” Teitelbaum said. “Sunshine is critical...not only to create the vitamin D needed for strong bones, but also to prevent the falls that occur.”
  • Calcium plus — Calcium alone was characterized by Teitelbaum as a “bad idea,” so make sure patients are receiving their calcium either naturally through “milk, cheese, cottage cheese, yogurt,” and other dairy products, or supplementary with “magnesium, vitamin D, Boron, Vitamin K and other nutrients.”
  • Steroid avoid — Dissuade patients from the use of steroid therapy if possible. “Steroid therapy increases the risk significantly and should be used in the lowest possible dose when necessary and for the shortest duration of time,” Kakade said.
  • DEXA do — Recommend that women in their 40s and men in their 50s receive a DEXA scan. It’s a proper “tune-up” measure, according to Teitelbaum.
  • Walk on — Patients should know that exercising to maintain a healthy weight also decreases osteoporosis risk. “Your body has a use-it-or-lose-it approach to efficiency, so if you’re not using it, you’re going to lose it. If you want to keep walking, walk,” Teitelbaum said.

Broadening the mindscape
The crusade against osteoporosis isn’t just limited to the bones of patients; several battles also happen to rage within the mind of the physician. Both medical experts had a bone to pick with osteoporosis ideologies, especially the creed which designates older patients as the parties who should be most concerned with contracting the disease. Treatment trends for osteoporosis have trained physician to hone concern for the disease on the older-age demographics, putting a chink in prevention pursuits. Kakade in particular was passionate about physicians adopting a more rigorous incentive to inform younger patients about the risks of osteoporosis.

“It is my opinion that if we spent one dollar in prevention for every one hundred dollars we spend treating osteoporosis and its complications, we would achieve a far better return for our healthcare dollar. Unfortunately, this is also true for many preventable epidemics like obesity and diabetes. Under our current medical system, funding for preventive medicine is negligible compared to treatment. It is therefore a patient’s personal responsibility, and healthcare providers’ ethical obligation to concentrate on preventive care. Giving incentive to patients by reducing insurance premiums for adopting healthy habits and paying physicians for preventive visits with adequate time may be effective as well.”

Teitelbaum spoke of a need for physicians to research on their own and understand where their information is coming from. In the case of Fosamax — which “has been known for a long, long time to probably cause more bone fractures than it prevents after 5 years of use” — Teitelbaum was only able to discover a longer lasting alternative for his patients in the mineral Strontium after he made an effort to avidly consume more medical literature on his own accord.

“It’s not good guys or bad guys, every system has its strengths and weaknesses, and the weakness of our current medical system is that if something is not patentable, it can’t make it through the FDA process, which means doctors won’t hear about the research,” he said. “We need to be patient advocates as physicians, instead of being shills for whoever is spending the advertising [dollars], blindly repeating what they’re told.”  

Parting diagnosis
Kakade spoke of the need to give patients continual reminders of the subsidies healthy habits can provide even though “it can be a difficult task to work against the headwinds of corporate interests and the barrage of constant advertising supporting unhealthy habits.” He advised that physicians follow the guidelines presented by the National Osteoporosis Foundation and the National Institute of Health as well as take part in local events focusing on osteoporosis education.

Teitelbaum vied once more for the necessity that physicians self-educate, for they have the prescribing power to sway the industry. “It’s time for the doctor to recognize that while drug companies are good, they’re doing a very big service, we still need to distinguish between  science and science advertising,” he said.

Image courtesy of Tyne & Wear Archives & Museums.