Osteoporosis FAQs

Who will be affected with osteoporosis?
Osteoporosis is an extremely common condition. Anybody can be affected with osteoporosis. 1 in 2 women and 1 in every 5-8 men will have an osteoporosis-related fracture.
What is the average requirement of calcium?
The calcium requirement for a person varies according age and gender. The approximate requirement of calcium for individuals above 50 years is 1200 milligrams/day. If the age is below fifty years 1000 milligrams/day is adequate. In usual practice, physicians advise 1200 milligrams. The amount of calcium in the diet along with vitamin supplements should be taken into account while assessing the daily requirement of calcium for a patient. People who get 1200 milligrams with their diet or supplements do not require an additional calcium supplement.
How does one know the amount of calcium they are getting per day?
The amount of calcium intake can be calculated by summing up the number of servings of dairy products that one eats on an average day, and multiplying it by 300 mg per serving. Then, add the amount of calcium obtained from calcium-fortified foods, specified in milligrams by the manufacturer on the label and add another250 milligrams of calcium for trace sources, such as broccoli, other green vegetables, eggs, nuts, etc. The resulting amount of calcium is your total daily intake.
Does osteoporosis affect specific part or the entire skeletal body?
Osteoporosis is a diffuse condition which affects the entire skeleton. However, in a certain percentage (15-20%) of the population, there is a difference in the extent of osteoporosis from one area to another such as hip or spine. However, any one of these measurements can be used in diagnosing osteoporosis.
Is osteoporosis inheritable?
Osteoporosis is definitely a genetic disorder. Individuals with family history of osteoporosis are at a relatively higher risk. For example, a person whose mother had a hip fracture is 100 percent more likely to have a hip fracture in the future compare to another person with no family history of osteoporosis. Due to the abundance of gene families, it is difficult to locate the disease risk through genetic testing.
What are the warning signs of osteoporosis?
The complex problem with osteoporosis is that there are very few warning signs. A fracture in adulthood that has occurred in the absence of major trauma, such as a motor vehicle accident, is a major warning sign of osteoporosis. An adult woman with a history of adulthood fractures should get a bone density test done to determine the presence of osteoporosis.
How do you test bone strength in an osteoporosis patient?
Bone density test, a non-invasive procedure with minimal radiation exposure is helpful in checking the bone strength of an osteoporosis patient. The patients with clinical risk factors of osteoporosis, especially women age 65 or above, and younger women at the time of menopause or afterwards must get the test done.
How is this bone density test performed?
The gold standard bone density test, the central dual energy x-ray absorptiometry test, is a painless procedure and takes less than 5 minutes to complete the test. It measures the bone density of the hip and spine. During the test the patient rests on a pitted table, fully clothed, but without zippers or buttons over the spine region. A minute amount of radiation is passed through the body at two different energies and the amount of absorption is calculated, which in turn gives a bone mineral density number. With the help of the bone mineral density number, T and Z scores are calculated and the bone density of the patient in reference to a normal person is measured. Osteoporosis is diagnosed if the T score is -2.5 or below, which indicates that the patient’s bone density is 21/2times below the average patient’s bone density.
Are bone density test and DEXA Machine testing the same?
Yes, DEXA (Dual Energy X-ray Absorptiometry) is the standard bone density test.
How routinely should patients be screened for osteoporosis?
Actually, the screening should be routine. All menopausal-women should be tested for bone density. But due to economic and cost concerns physicians often limit the testing only to those women with clinical risk factors. If lifelong calcium intake is considered, the majority of women would qualify for a bone density test. If cost is not a concern, all women are recommended to get the test done.
Whether osteoporosis is reversible?
Osteoporosis is not completely reversible, but is definitely treatable. An osteoporosis patient should follow certain universal prevention measures which include optimal nutrition, exercise, and lifestyle modifications such as quitting smoke. In addition, patients should use medications to treat the condition. The available medications include estrogens or hormones, raloxifene (EVISTA®), calcitonin, alendronate (Fosamax®), and risedronate (Actonel®).
Can taking too much calcium result in formation of kidney stones?
Excess calcium intake can cause kidney stones in patients with history of kidney stones or those who excrete too much calcium in the urine. Therefore, a 24-hour urine collection test should be done to check the amount of calcium in urine. Nevertheless, calcium intake more than 1200 milligram per day is not recommended. Excessive intake of calcium can produce abdominal discomfort, excess gas, and constipation.
How reliable are the foods claiming to have a full day’s calcium, like cereals?
Those cereals may not contain the specified amount of calcium. Even if is there an individual will not absorb all the calcium when taken at once, it should spaced out during the day. After the absorption of initial 500 milligrams of calcium, the proportion of subsequent calcium absorption will be reduced. Hence, it is not an effective way to get the appropriate calcium content.
What is the role of Vitamin D for absorption of calcium?
Vitamin D is essential for efficient calcium absorption, however in minimal quantities. And, it is not always necessary to take vitamin D as we make vitamin D through our skin upon exposure to sunlight. About 800 units of vitamin D per day is advised to elderly patients (≥65 years)because of their minimal dietary vitamin D absorption, and their inefficiency in making vitamin D due to advancing age. For post-menopausal women between 50 and 65 years, a multi-vitamin supplementation containing 400 units of vitamin D is sufficient.
What advice do you give to patients with osteoporosis?
Osteoporosis is both preventable and treatable. I recommend patients to get enough calcium, exercise, quit smoking, get the bone density test, and use medications that reduce their osteoporosis fracture risk. Recently several new medication shave come on the market.

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Dr. Nakul Karkare

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