Still More News About Maintaining Bone Health

Maintaining Bone Health

In today’s New York Times Science Section, there is an excellent article by Jane Brody entitled, “Fear of Drugs’ Hazards may Put Bones at Risk.” She reiterates a problem that I have seen evolving in clinical practice over the last several years. As the reimbursement for performing bone density tests had gotten so low that many facilities (including ours) could not stay open without losing money, the number of bone density tests being ordered nationwide has declined sharply.

In addition, the category of medications for preventing and treating osteoporosis known as bisphosphonates, of which the most well known is Fosamax, have come under scrutiny for a very small incidence of some untoward, rare complications that have been overly publicized. These include one called osteonecrosis of the jaw that has put fear into patients as well as dentists. It virtually never happens except for people who have received intravenous bisphosphonate or who are immunocompromised or have a malignancy. In addition, even rarer, are the atypical fractures of the femur that can occur. Both of these complications pale compared to the number of hip fractures that are prevented in women who do take bone health drugs when they are clinically indicated.

The data in Ms. Brody’s article talks about the fact that there was a steady decline in hip fracture in women over the age of 65 from 2002 until 2012. However, in approximately 2012, that reduction abruptly ended and has not continued as one would hope.

It is said that a 50-year-old woman who does not already have cancer or heart disease, has a life expectancy of 91. As women are living longer and longer, issues of maintaining bone health become extremely important. A woman who does suffer a hip fracture has a 20-30% chance of being dead within one year. In addition, about 50% of patients who fracture their hip are not able to ambulate without assistance and 25% may end up in long-term care facilities. Each year, there are more osteoporotic fractures (hip and spine) than all of the heart attacks, strokes, breast cancers, and gynecologic cancers COMBINED.

As many of you know, I have been extremely interested in bone health. I write the annual “Update on Bone Health and Osteoporosis,” for OBG Management Journal, of which, I am on the Editorial Board. I am constantly talking to my patients about bone density testing, if indicated, as well as fall prevention (balance exercises, non-skid rugs in the bathroom, nothing between your bed and bathroom in the middle of the night to trip on, etc.). In addition, adequate calcium in your diet (as opposed to supplements) and a supplement of vitamin D are also extremely important.

Next time you are in, if you have any concerns about maintaining bone health or related issues, let’s have a conversation.

Dr Steven R. Goldstein is a Menopause Specialist in NYC and was the Co-Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center from 1997 to 2016