If a woman isn’t sure whether or not she needs a bone-density test, an answer could be a few keyboard strokes away.
Maxine Lingurar, M.D., encourages women to consider taking the simple FRAX test for an overview about the need for the bone exam. May is National Osteoporosis Awareness and Prevention Month, and Dr. Lingurar is using the opportunity to share information about the condition that results in debilitating bone loss.
She practices at the Women’s Health Center, which is owned and operated by St. Rose Ambulatory & Surgery Center.
The FRAX tool was developed by the World Health Organization and is now available online. Most of the dozen questions can be answered with a "yes" or a "no."
"This great tool evaluates fracture risks," Dr. Lingurar said. "The FRAX shows the 10-year probability of a hip fracture and the 10-year probability of a major osteoporotic fracture in areas such as the spine, forearm or shoulder."
Treatment may be indicated for those with a probability of over 3 percent for a broken hip, or over 20 percent for other breaks. She recommends patients talk with their health-care providers about the FRAX results.
Dr. Lingurar noted that even though the test is quick and easy, a couple of questions might be a bit confusing. One asks about bone mineral density, or BMD. "If you don’t know your BMD, you can leave that answer blank," Dr. Lingurar said. "The tool works without the answer."
The other somewhat confusing question refers to secondary osteoporosis.
"This is just asking if the patient has a condition associated with osteoporosis such as steroid use, hyperthyroidism or early menopause," Dr. Lingurar explained. "It is even more fully defined under ‘risk factors’ indicated just under the FRAX calculation tool.
"It takes just a few minutes. But it is time well spent because you can determine if you are at increased risk of osteoporosis," she added, noting the condition can cause a humped back and breathing problems, along with pain.
New guidelines recommend that younger post-menopausal women be screened if their risk is similar to that of the average 65-year-old woman. For women as young as 50, risk factors include low body weight, smoking, heavy alcohol use and a parent who has broken a hip.
When medication is called for, bisphosphonates are sometimes the answer. "These drugs, such as Boniva, are the gold standard for stopping the progress of osteoporosis," Dr. Lingurar said. "They allow the body to build new bone because they disable cells that chew up the old bone.
"All of them reduce spine fractures and most reduce hip fractures," she explained. "The downside is they can cause atypical fractures, such as the large thigh bone, with long-term use."
Another rare side effect is osteonecrosis of the jaw. Those anticipating major dental surgery should discuss this with their dentist and physician. A more common bisphosphonate side effect is esophageal upset and bone/joint pain.
"In most people, however," Dr. Lingurar commented, "these risks are quite small. The risk is most likely worth the benefits. That being said, women treated for five to 10 years with these medications should talk with their physician about a ‘drug holiday.’ This could help prevent atypical fractures."
A new drug called Prolia, which is given as an injection every six months, does the same job as bisphosphonates in a different way, she added. Other osteoporosis-related medications are Fosamax, Actonel, Reclast, Fortical, Miacalcin, Evista and Forteo. Each group of drugs has its own benefits and risks. Finding the right drug for a particular woman requires a discussion of her medical history and other medications with her provider.
Dr. Linguar recommends calcium and vitamin D intake to virtually all patients because both have been shown to help prevent osteoporosis. A few sources are low-fat dairy products, canned sardines and salmon, shrimp, broccoli and fruits. Vitamin supplements are sometimes recommended. She also recommends a regular program of weight-bearing exercise to strengthen bones.
Osteoporosis affects 44 million American women and men, but it is more common in women because of a lower initial bone mass. "Maximum bone density develops during the teens and 20s, which is a time when women may not consume enough calcium," Dr. Lingurar said. "Excessive dieting, smoking and some types of birth control may also lead to bone loss.
"Osteoporosis prevention and treatments are like all other health-related issues," she added. "Patients should get as much education as they can and discuss the issues with their doctors."