The latest thinking on osteoporosis, which weakens bones

The bone density test used to screen for osteoporosis is a low-dose X-ray known as a DEXA scan. (Getty Images)


by Consumer Reports May 21 at 2:00 PM

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If your doctor has suggested undergoing screening for osteoporosis — a disease that weakens bones and makes them more likely to break — there are things you should know about this common condition.

About 10 percent of Americans 50 and older have osteoporosis, and many more eventually develop a less severe form of low bone density called osteopenia, according to a 2014 review published in the Journal of Bone and Mineral Research. And an analysis published this past December in the journal Osteoporosis International found that hip-fracture rates in older women are rising, after a decade of overall decline.

Here’s the latest thinking on osteoporosis — including the bottom line on who needs to get screened and when you should go on medication, plus the research on what you can do to keep your bones strong for decades to come.
Know when to get screened

The bone density test used to screen for osteoporosis is a low-dose X-ray known as a DEXA scan. It’s painless and takes just five to 10 minutes.

Women are about twice as likely as men to break a bone because of osteoporosis, according to the National Osteoporosis Foundation. So if you’re a woman 65 or older, you should have a baseline screening, according to the latest draft guidelines from the U.S. Preventive Services Task Force.

There’s less evidence for such screening in men, but preliminary research suggests that starting around age 80 is optimal, says Robert Adler, chief of endocrinology and metabolism at McGuire Veterans Affairs Medical Center and a professor of epidemiology at Virginia Commonwealth University School of Medicine.

People who have rheumatoid arthritis or who smoke, consume more than three alcoholic drinks a day, have had prolonged prednisone treatment or previously experienced a fracture from only minimal impact should talk to their doctor about starting screening earlier.

If you’re a healthy women 65 or older with a normal result on a bone density scan, you may not need another one for 10 years — as long as your risk factors don’t change. If you find you have osteopenia, you will need a follow-up scan three and five years later; if you have osteoporosis, go for repeat testing every two years.
Test your steadiness

“Poor balance is one of the leading reasons for falls, which can cause a potentially devastating fracture even in people without osteoporosis,” explains Marvin M. Lipman, Consumer Reports’ chief medical adviser.

You can easily gauge your balance through two quick self-tests. Try both: Heel-to-toe walking (taking steps with one foot directly in front of the other) and standing on one leg for 30 seconds at a time. If you flunk either one, Lipman says, “you may have a balance problem” and should speak with your primary-care provider. Studies have shown that physical therapy can improve your balance.
Eat a well-balanced diet

Women who ate a diet rich in vegetables, fruits, fish and whole grains had better bone density and (in Caucasian women younger than 63) fewer hip fractures, according to a large study published last year.

Along with plenty of veggies and whole grains, you should also eat foods rich in calcium. Other research has found that consuming plenty of magnesium and potassium — two nutrients found in fresh fruits and vegetables — is associated with better bone density in people older than 69.
Try exercise before drugs

If you’re one of the 44 million Americans diagnosed with osteopenia, your doctor may suggest medication. But most of the time that’s unnecessary.

In fact, two-thirds of new prescriptions written after a DEXA scan may be inappropriate, according to a 2016 study in JAMA Internal Medicine. And the drugs prescribed can have side effects such as stomach upset and heartburn.

For most cases of mild bone loss, try weight-bearing exercises first, such as lifting weights or walking at least 30 minutes a day. Exercise can reduce the risk of fracture by helping to maintain bone density and can reduce risk of falls by improving balance and strengthening muscles.

There are situations where it may make sense to take medication if you have osteopenia, especially if your bone density is on the cusp between osteopenia and osteoporosis.

“If your physician performs a fracture risk assessment [called FRAX] and you have a 10-year risk of osteoporotic fracture of at least 20 percent or a risk of hip fracture of at least 3 percent, then you should definitely consider drugs,” says Susan Hingle, chair of the Board of Regents for the American College of Physicians.
Understand your meds

If you and your doctor decide you need medication for osteoporosis or osteopenia, a group of drugs called bisphosphonates should usually be your first-line treatment, Adler says. These drugs bind to the surface of your bones, thereby slowing erosion.

For patients with severe osteoporosis, however, most doctors now recommend a different class of drugs, called anabolics, Adler says. Research shows they may be more effective in severe cases than the bisphosphonates, but there are downsides: Anabolics are very expensive, require daily injections and shouldn’t be taken for more than two years.

Even bisphosphonates shouldn’t be used for more than five years — beyond that, research suggests, there’s no benefit. Two years after stopping, have another scan. If your bone density is stable, you don’t need to restart meds. But if it decreased again, you can either go back on a bisphosphonate or try a different drug, such as the semiannual injectable denosumab (Prolia).
Supplements or calcium-rich foods?

Just a decade ago, doctors were advising everyone — especially post-menopausal women — to take calcium and vitamin D supplements to ward off bone thinning and risk of fractures.

But research hasn’t borne out these benefits. Our experts still recommend getting adequate calcium. But the right way is through diet, not supplements, so your body can better absorb it, Lipman says.

Vitamin D is trickier because most of us don’t get enough from either food or sunlight, the two main sources. So it’s reasonable, Lipman says, to take a daily supplement of 400 to 800 international units of vitamin D if you’re younger than 50, and 800 to 1,000 IU if you’re older.

 Copyright 2018, Consumer Reports Inc.

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