By Steve Spencer

With 54 million Americans estimated to suffer from osteoporosis, this problem is only becoming more serious as our population ages. Many people are unaware that they have osteoporosis because we can’t feel our bones weakening. Reports have shown one in two women and up to one in four men over age 50 will break a bone due to osteoporosis.

With this in mind, Chris Heck, MD, a spine surgeon, started an osteoporosis clinic to go along with his practice at Southlake Orthopaedics. The motivation came about ten years ago when Heck had a patient return six months after he had repaired her broken hip.

“I assumed she was having more hip problems,” Heck said. “But she told me her hip felt great. She said that after I sent her to her primary care doctor, he told her that osteoporosis was a bone problem so she should see an orthopedist. I realized that if I’m not treating them, and I sent them to another doctor, and they’re not treating them then the patient’s just getting lost, falling into a never-ending loop.

“The clinic stays busy. Most of our referrals come from primary care physicians, OB/GYNs, and rheumatologists. The first thing we do with a new patient is get a bone density (DEXA scan) which gives us a risk assessment for bone fractures. It lets us know how thin your bones really are.”

After the DEXA scan, the clinic team gets the patient’s blood work. This is done primarily to check the patient’s kidney function because some osteoporosis medications, like Fosamax, can be harmful to the kidneys.

Heck and Lauren Bannon, PA, who serves as an osteoporosis specialist, also examine various hormone levels in the blood work. “In some evaluations, we’ve found benign tumors that secreted hormones that caused the bones to be weak,” Heck said. “If you don’t correct that problem, treatments for the osteoporosis won’t be effective. We’ll also check for low testosterone with male patients because that can be a factor. We finish with a 30 minute consultation where we go through personal history family, among other things.

“Osteoporosis is a condition where your body resorbs minerals from your bones. Your bones are strong because it’s a latticework of minerals and bone. Without the minerals, the bone has nowhere to grow. From the time we’re born, our bone density increases until about age 30. After the decade of our 30s, all of us start to lose bone density at a rate of about three percent per year. When women hit menopause, they start losing at about 10 percent per year. Men will also get osteoporosis, but it’s about 20 years later than women. So most of our female patients are in their 60s and most of the males are in their 80s.”

There are some variables with racial backgrounds, as well. Caucasians and Japanese have a much higher rate of  osteoporosis while African Americans and Latinos have lower rates.

There are several different treatment modalities for osteoporosis. Anti-resorptives were the earliest osteoporosis medications. This class of drugs, called bisphosphonates, are used to keep your body from resorbing the minerals out of your bones. Bisphosphonates include Fosamax, Boniva, and Reclast.

But what if your bone density is already very low? Bisphosphonates may keep it from getting worse, but if the bones are already thin, the patient is still at risk. If, while on these drugs, the patient still has fractures, Heck considers anabolic osteoporosis drugs.

“These drugs grow bone,” Heck said. “They are a little more high maintenance because they’re typically injectable and are usually done daily at home. There are some newer ones now that can be done with a monthly injection. But anabolics are only approved from one to two years. So at the conclusion of making your bone density go up with the anabolics, then you get on bisphosphonates (anti-resorptives) for life.

“Preventing and managing osteoporosis is so much more important than people think. Studies have found that one in three hip fracture patients will die within 12 months. They won’t die of the hip fracture. They die of the complications of the fracture. So dealing with osteoporosis is the epitome of preventative medicine.”