Bone health

New osteoporosis treatment can strengthen bones

 

Special to The Miami Herald

Maria Fernandez was just 49 when she was diagnosed with osteoporosis.

The South Miami mother of two had no symptoms and the bone disease was discovered during a routine check-up and bone density test. With an 88-year-old mother with osteoporosis who had broken her hip, Fernandez was at risk for developing the post-menopausal condition.

For several years, Fernandez was on the popular drug Fosamax, until recently the only drug approved to treat osteoporosis. But the medicine had no effect on her condition, so she stopped taking it.

A year ago, Fernandez began a newly approved drug for osteoporosis, Prolia, receiving an injection every six months. Her latest bone density test brought some good news: her condition has improved and her bones are becoming stronger.

“I’m so happy my doctor recommended this,’’ Fernandez said. “Since my mother has osteoporosis, they said I was at risk.’’

Approved in 2010 by the FDA, Prolia is the new generation of osteoporosis drugs, and is being warmly received by many doctors, who have been short on solutions for the common condition that they say appears to be on the increase.

Osteoporosis has traditionally been the disease of grandmothers, hitting one out of every two women in their twilight years. Diagnosed primarily through bone density tests, osteoporosis causes bones to became fragile and leads to fractures. Some 80 percent of patients are female, although men are increasingly being treated for the condition.

The condition is closely linked to the lack of estrogen production following menopause, and doctors say it is on the rise now that doctors are reluctant to prescribe post-menopausal estrogen treatment because of cancer concerns. Additionally, a sedentary lifestyle, poor diet and lack of sunlight are contributing factors, all leading to a troubling trend.

“You can lose 10 to 20 percent of your bone in the first five to seven years after menopause,’’ said Dr. Silvana Levis, director of the Osteoporosis Center at the University of Miami. “I encourage every woman to have a bone density test after menopause. It’s a very easy test ... and low in radiation.’’

Noted Dr. Juan Suarez, an orthopedic surgeon at Cleveland Clinic Florida: “Osteoporosis is very prevalent not only because of less estrogen therapy but because of people drinking more alcohol, being less active, smoking — all these things come into play. It’s also being recognized more in men these days.”

Like all diseases, early detection is key, so many doctors routinely screen for osteoporosis in all post-menopausal women. Dr. Bernard Brijbag, a Miami internist with Baptist Hospital, also recommends the bone density test every other year. However, he noted, there can be false positives with the test. Therefore, Brijbag screens for osteoporosis in other ways, looking for low weight and changes in height, doing a nutritional and exercise evaluation as well as a blood test to check vitamin D levels, magnesium levels and to see if the parathyroid is elevated — all of which could be signs of the disease.

“We are looking for such risk factors as being post-menopausal, small frame, low weight and decreased activity level,’’ he said.

Like many doctors, Brijbag uses a computer program called Frax to rate a patient’s potential for having osteoporosis. Frax assigns a score based on such criteria as age, sex and height.

After he diagnoses a patient with osteoporosis, Brijbag starts by recommending lifestyle changes — a diet rich in calcium and vitamin D or supplements, an increase in sunlight for its vitamin D benefits, and exercise, particularly weight training.

Foods that are rich in vitamin D include coldwater fish such as salmon, mackerel and tuna; eggs; mushrooms; and fortified dairy products. He counsels patients to quit smoking and to avoid caffeine, particularly soda, which studies have shown can actually decrease bone mass.

If these alterations don’t help, Brijbag may recommend estrogen replacement therapy, making sure the patient is aware of the cancer risks and is not at high risk for cancer.

Once a patient starts fracturing bones, the disease is considered advanced and doctors usually turn to medication to treat it. Up until recently, Fosamax and other bisphosphonates were the only medications available. But recent studies showed increased risk of fracture after prolonged periods on the drugs and doctors began recommending “drug holidays’’ of several years for the patients.

Dorothy Honig, 80, was on Fosamax for several years for her osteoporosis. Not only did the drug not help, but she claims it caused her to lose her teeth. She stopped taking Fosamax a few years ago and is now just taking calcium and vitamin D supplements. The Hallandale widow’s disease is now so advanced she walks stooped over and says she has constant back pain as well as difficulty breathing because of her bent spine pressing into her lungs.

“I take Aleve all the time,’’ Honig said. “I’ve been dealing with other problems in the interim. I tore my hamstring and then I had a knee replaced. I just kind of gave up on the osteoporosis.’’

The Osteoporosis Center at the University of Miami opened in 1992. Not only do the three physicians on staff see hundreds of patients a year, but the center also does major clinical research of new medications and supplements and educates the community on the condition.

“We recommend prevention, which is crucial, and early diagnosis, we do bone density testing, and clinical trials,’’ Levis said. “We try to address the problem from all points of view. At a university setting, you have multiple roles.’’

One trend with osteoporosis is the push for early treatment and diagnosis, particularly with patients who have other medical conditions that could lead to the disease.

“Before we were only referred patients after they had fractures,’’ Levis said. “Now we see patients being referred when they have Crohn’s disease or had chemotherapy.’’

Sometimes what looks like simple osteoporosis could actually be a more serious underlying condition. Brijbag recently saw a patient who had numerous fractures, including a hip fracture. After further investigation and examination, he discovered she had multiple myeloma, a blood cancer that causes bone loss. She is now being treated for the cancer as well as the osteoporosis.

Osteoporosis has a genetic component, and if a family member had the disease you are more prone to get it. However, like most illnesses, how you live in your youth is a major causal factor.

“Bone density reaches a maximum at 30 and then starts declining,’’ Brijbag said. “If you live a healthy childhood ... and maintain good nutritional and exercise habits early on, you don’t start at a lower setpoint at menopause.’’

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