La Jolla-based Howell Foundation for Women’s Health held a luncheon May 28 at La Jolla Country Club, inviting guests to “bone up” on their knowledge of osteoporosis. Speaker Heather Hofflich, osteoporosis expert and associate clinical professor of medicine at UCSD School of Medicine explained the causes, treatments and recent developments in viewing the disease that affects approximately 54 million Americans.
Osteoporosis, Hofflich explained, is caused by low bone mineral density and poor bone quality. As such, bones become porous and weak, and can fracture or break easily, especially from falls. Hofflich recommends that all women have their bone density screened starting at age 65, and men at age 70. However, she said, anyone who has experienced a fracture after age 50 should also have their bone density screened.
How it’s measured
When bone density is screened, the patient gets what is known as a T-score. “People come in my office all the time and say ‘I don’t know what these numbers mean,’ ” she said. “A T-score of -1 to -2.5 registers bone density as having something called osteopenia. There has been some debate about this term because it’s essentially pre-osteoporosis and while fractures still can happen at this stage, your risk for fractures is lower. T-score of -2.5 and lower is considered osteoporosis.” The number is used as a comparison to the T-score to those of a healthy adult of the same sex and ethnicity.
Patients under age 50 who need their bone density screened are provided with a number known as a Z-score, which compares their bone density to a normal adult of the same sex, ethnicity and age. Z-scores are read the same way as T-scores.
Extended use of certain medications can contribute to osteoporosis, Hofflich said, particularly steroids of more than 5 milligrams a day for longer than three months or long durations of acid-reducing Proton-Pump Inhibitors, such as Prilosec or Nexium, which are thought to reduce calcium absorption.
Other risk factors include age, tobacco products, excessive alcohol consumption, being underweight (less than 125 pounds), previous fractures and family history.
Medications that cause dizziness contribute to falls, which she said is a leading cause of broken bones among those with osteoporosis, especially in the hips and spine. Being mindful of medications that affect stability and removing trip hazards from the home reduces one’s risk of a fall.
Hofflich said the best way to prevent osteoporosis is to increase one’s calcium intake to “safe levels.” Whenever possible, do so from food sources rather than from supplements. “We recommend 1,200 milligrams daily for women over 50 years old; 1,000 milligrams for men over 50,” she said. However, some people take too much calcium in the form of supplements. “I hear people say they eat chocolate calcium chews all day, and I have say no, that’s too much!” she said.
She pointed out that a glass of milk has 300 milligrams of calcium, as does six ounces of yogurt. Leafy greens such as kale, turnip greens and lettuces are also high in calcium. However, excess intake of calcium can contribute to the risk of heart attack if calcium deposits in the heart.
When it comes to calcium supplements, she said there are two kinds: Calcium Carbonate, which needs to be taken with food to best be absorbed, and Calcium Citrate, which does not need to be taken with food. She added the bottle should identify which type of calcium it contains. She also recommends looking at dosage on the bottle, as some are two tablets per serving, others are only one.
Changes in treatment
“In the past, we would take your T-score and if you were a certain age and had a score below -2, you automatically went on medication. Now we look at those that have osteopenia, and say to ourselves ‘they don’t have osteoporosis but they are at risk, so what do we do?’ ” she said. “Someone with a low T-score but with no risk factors might not need treatment, but monitoring.”
With a focus on monitoring, the frequency at which patients are checked depends on the individual, she added. “Medicare suggests screening once every two years; however, if you are on a certain treatment you might be screened every year,” she said. “Studies are underway looking at how often people should screened. If you have osteopenia, you could actually wait five years between screenings.”
There is an osteoporosis education and support group that meets at noon on first Wednesdays at UCSD’s Thornton Hospital, third floor, SDG&E Room, 9300 Campus Point Drive. All meetings are free and open to the public. (858) 657-7236.
■ The Howell Foundation presents luncheons throughout the year to discuss various women’s health issues. The next will be Aug. 5 with speaker Karen Nelson from the J. Craig Venter Institute on “The Human Biome.” Details at howellfoundation.org