Diagnosis of osteoporosis

It is very important to detect osteoporosis early or whether the patient is at high risk for osteoporosis.

1. A simple set of self-assessment methods (one-minute self-ratings) can be used first, as shown in the table below.

• Assuming you are in the yellow or red block after evaluation, your risk of developing osteoporosis will increase.
• Assuming you are in the green block after evaluation, but with the risk factors for osteoporosis mentioned above, the risk of developing the disease is relatively increased.

2. A peripheral bone densitometer (e.g., ultrasound instrument) can then be used for an initial screening.
3. Lastly, it should be confirmed with a neutral-axis dual-energy X-ray absorptiometry (DEXA). This is a type of radiography that measures bone density. The procedure is painless, with the patient lying flat on a platform similar to an X-ray exam bed and the machine able to scan the whole body in five to 10 minutes. The amount of X-rays used in the test is very small and therefore very safe.

The World Health Organization's criteria for osteopenia are based on the fracture rate of Caucasian women, with BMD T-scores between -1 and -2.5. The diagnostic criteria for osteoporosis with a T-score less than -2.5 should be applicable to Taiwanese women.

Preventing osteoporosis - never too early, never too late

Control of osteoporosis should begin at an early age. By taking some steps early on, you can reduce your chances of developing osteoporosis.

1. Abstaining from risk factors for the development of osteoporosis

Be aware of any risk factors for osteoporosis in your life or in your past medical history. (e.g., smoking, excessive alcohol consumption, etc.), and if so, quit as soon as possible.

2. Regular and moderate exercise

Everyone's physical condition is different and you should find an optimal exercise for you and do it in moderation. Be moderate at first, then work your way up to the target. Before starting an exercise program, talk to your doctor about what kind of exercise is right for you. Exercise doesn't need to be sweaty, a regular workout is what's important. But if you have been diagnosed with osteoporosis, you should avoid exercise that can cause the following:

• A sudden, violent movement, such as squash.
• Exercises that may result in a sudden fall.
• Too much pressure on certain parts of the body, like pushups.

3. Eat foods high in calcium

Calcium intake in the diet is particularly important, and enough calcium of about 1,200 mg per day should be absorbed during adolescence to accumulate sufficient bone mass. About 1,000 mg/day for adults under 65 years of age and about 1,500 mg/day for those over 65 years of age. If you are not getting enough calcium from your food, your doctor can tell you if you need to take calcium supplements.

4. Sun exposure or vitamin D supplementation

Some of the body's vitamin D comes from the sun, so some sun exposure can be helpful. If you don't get a lot of sun exposure on a regular basis or if your condition is not suitable for sun exposure, you can talk to your doctor about whether you need vitamin D supplementation or adding vitamin D to your diet (including sardines, black carp, salmon, tuna, milk or other dairy products).

What should I do if I have osteoporosis?

There are several treatments that can prevent continued deterioration and strengthen bones. These treatments, coupled with a changed lifestyle to reduce the risk of falls, can reduce the chances of a fracture.

1. Change your lifestyle

If you have osteoporosis, you must wean yourself off the risk factors for osteoporosis immediately to prevent the condition from progressing and to avoid fractures.

2. Prevent falls

The most common cause of fractures in patients with osteoporosis is falls, so you need to minimize your chances of falling.

• Get your vision checked quickly and maintain good vision: if you have poor vision, get the right pair of glasses.
• Remove obstacles in your home that could cause you to fall (e.g., carpets not laid out flat, small furniture, foot mats).
• Find something that supports your body (a cane or mobility aid) to help you walk with balance.
• Be especially cautious if you are taking sedatives, antihypertensives or antihyperglycemics, especially if you get up in the middle of the night to go to the bathroom.

3. Drug treatment

• Bisphosphonates

Bisphosphonates block bone-destroying cells (osteoclasts) to prevent further bone loss in osteoporosis patients and are currently the preferred treatment for osteoporosis.

• Calcitonin

It prevents bone loss and relieves pain from fractures. Since the stomach breaks down calcitonin, it must be injected or inhaled into the body.

• Anabolic steroids

Anabolic steroids can stimulate bone formation, but they are less used in women with osteoporosis and have some side effects, such as lowered voices, hoarseness and increased body hair.

• Fluoride

Fluoride (e.g. sodium fluoride) increases bone mass in the bones, but further research is needed to determine its efficacy. Side effects of fluoride therapy include foot pain, nausea and vomiting.

• Hormone (estrogen) replacement therapy

Hormone therapy may reduce bone loss, but its effects are not seen in the short term, and hormone replacement therapy is not suitable for everyone, and it is necessary to consult an OB/GYN to find the best hormone medication for you, and regular follow-up visits to the OB/GYN are required.

Treatment tracking and visits

1. All patients with a T-score of less than -1 regarding bone mass density (BMD) should receive annual nutritional counseling, risk assessment and lifestyle health education; or assessment of medication compliance.
2. If there is a significant decrease in bone mineral density (in the case of the current DEXA instrument, a decrease of more than 5% as measured by the same instrument), consideration should be given to increasing or changing the antiresorptive agent, so it is appropriate to use it for at least one year.
3. Consideration should be given to consultation with a medical professional who deals with osteoporosis in the following situations:
   1. Those with the above risk factors for osteoporosis.
   2. Secondary osteoporosis such as steroid users.
   3. Diseases that can cause osteoporosis, such as rheumatic autoimmune diseases.
   4. Those with a significant decrease in bone mineral density during medication.
   5. Those who still develop fractures during treatment follow-up.

Conclusion

Osteoporosis usually builds up over many years, making the bones thinner and more fragile. We must confirm the presence of osteoporosis before the bones have been severely damaged and a fracture has occurred, and treat and prevent it urgently so that it does not continue to progress. Unfortunately, osteoporosis is an silent killer and usually does not produce any pain, so patients often do not realize that the disease is eating away at them until after a fracture has occurred. That's why it's important to know if you're facing the threat of osteoporosis so you can take preventive measures: If a risk factor for osteoporosis is identified, see a professional as soon as possible to find ways to prevent or stop the progression of osteoporosis.

Bisphosphonates are currently the preferred treatment for osteoporosis and are taken once a week, but there are restrictions on their use, including that they must be taken on an empty stomach, with plenty of water, preferably standing for half an hour to an hour after administration, and that there may be a burning sensation in the stomach. A new generation of bisphosphonates has been developed overseas to make it easier to take one pill per month. The biggest benefit of this medication is that it is much more convenient to take once a month, and it is a good medication choice for people who have osteoporosis, or have experienced a fracture.