Thanks to the support of Amgen and working in partnership with American Bone Health, we are excited to provide you with a special series of emails, blogs and additional resources that will help prepare you for this life-changing event, as well as year-round health.

It Takes More Than a Number to Prevent Bone Loss and Fractures

Special Guest Contributor: Risa Kagan, MD, FACOG, CCD, NCMP

I have been working in the bone world for many years. I know it’s challenging for people to keep up with the emerging science and research, so here is a look at where we came from and where we are now.

Advances in medicine over the past several decades have helped us live longer, and because many women previously didn’t live long past menopause, we didn’t know the impact of the loss of estrogen on bone mass.

In the 1980s, bone density testing machines gave us the ability to identify the quantity of bone mass and monitor changes in the trabecular structure of bone. This is when we started using the terms “osteoporosis” and “osteopenia.” In 1994, the World Health Organization (WHO) established a definition of osteoporosis based on the statistical concept of a normal distribution. A consensus of scientists determined that a T-score — which is a standard deviation from the average 30-year-old — of more than 2.5 standard deviations below the mean should be defined as “osteoporosis.” “Osteopenia” became the standard term for a T-score between -1.0 and -2.5. Osteopenia is not a disease, but a term created by the WHO to describe low bone mass. Anyone with a T-score greater than -1.0 was consider “normal.”

It’s not perfect, but it’s a start.

One of the main reasons this isn’t perfect is because scientists didn’t do a bone density test on a person when they reached peak bone mass at age 30. So, it’s not clear whether a T-score at age 50 was the result of bone loss. It could have been the peak bone mass/density they ever achieved.

As the science has improved, we have learned to focus on bone quality as well as density. The quality of the bone is important in understanding fracture risk. Just like high cholesterol is a risk factor for heart attacks and high blood pressure is a risk factor for stroke, osteoporosis on a bone density test is a risk factor for fracture. We think of fractures as “bone attacks” and are now developing treatment that focus on fracture prevention, rather than just bone density. As a result, we realized not all people were candidates for osteoporosis medicines, especially women and men who are relatively young, without any risk factors for breaking a bone.

Having a better understanding of bone quality is encouraging us to engage in more conversations with patients about fracture risk. We use calculators to understand individual’s risk and their chances of breaking a bone. This helps us focus on a bone health plan that is appropriate for an individual.

You have an important role to play in this discussion. Knowing your risks and taking action by talking with your doctor to prevent bone loss can help you avoid a “bone attack.”

Not all people will have the luxury of prevention strategies alone. Whether it’s a medical condition, a medicine you take, or a family history of bone loss and fractures, you could be someone who benefits from a medication to reduce the risk of a “bone attack.” 

All the medications used for the prevention and treatment of osteoporosis have good safety data, and they reduce the risk of fractures – especially spine and hip fractures. We know that up to 25 percent of people with hip fracture die within a year and most others are not able to have mobility without assistance. We know now how to determine who is a good candidate for treatment based on fracture risk and what medicine would be best.

In December 2017, a study using the Medicare data found the decline in hip fractures had leveled off. The researchers estimated 11,464 additional hip fractures (costing $459 million) occurred from 2013-2015 due in part to a decline in screening and treatment and an increase in other chronic conditions, like diabetes. We are now facing a public health crisis in our older population.

Let’s remember that knowing our risk factors and our bone density scores is just the start. Doctors and patients need to work together to take action and prevent bone loss and fractures. 

About Dr. Kagan

Dr. Kagan is a board-certified obstetrician-gynecologist and Clinical Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. She serves on the Medical and Scientific Advisory Board of American Bone Health (FORE) and is the principal investigator on numerous women’s health clinical research studies. Dr. Kagan is well known as a communicator and teacher and is often approached by media and public forums for her expertise and frequently an invited speaker at national and international scientific meetings.