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.’’