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Osteoporosis-The Silent Bone Thief

Osteoporosis is a common, preventable and treatable form of metabolic bone disease. Fifty seven million Americans—mostly women—are affected by osteoporosis and low bone mass.

According to the National Osteoporosis Foundation, ‘a woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined. Additionally, ‘a man age 50 or older is more likely to break a bone due to osteoporosis than he is to get prostate cancer.’

Early identification and treatment of low bone density is most effective in increasing bone mass and avoiding painful fractures. Osteoporosis, the ‘silent thief of bone,’ can be prevented, detected and treated.

Although there are uncontrollable risk factors, such as age and being a woman, there are ways to improve bone health. While various medications can treat osteoporosis, early detection of low bone density and prevention strategies that focus on balance and falls, vitamin D intake and the amount of calcium in your diet are the most important measures to ensure bone health.
Osteoporosis-The Silent Bone Thief
Featured Speaker:
Chad Deal, MD, Cleveland Clinic Rheumatology Specialist
Chad Deal, MD is Head of the Center for Osteoporosis and Metabolic Bone Disease, Department of
Rheumatology at Cleveland Clinic Orthopaedic and Rheumatologic Institute.He has specialty interests in osteoporosis and related conditions. Dr. Deal did his undergraduate work at Washington University, St. Louis, Mo. He attended medical school at the University of Arkansas, was inducted into Alpha Omega Alpha, and graduated in 1977. His internship and residency were at Boston City Hospital in Boston, Mass. He completed a fellowship in arthritis and connective tissue diseases at Boston University School of Medicine in 1982.He has been named one of the best doctors in Cleveland.

Center for Osteoporosis and Metabolic Bone Disease


Melanie Cole (Host): Osteoporosis is a common preventable and treatable form of metabolic bone disease. My guest is Dr. Chad Deal. He is the head of the center for osteoporosis and metabolic bone disease in the Department of Rheumatology at Cleveland Clinic. Welcome to the show Dr. Deal. Tell us a little bit about what is osteoporosis?

Dr. Chad Deal (Guest): Hi Melanie, osteoporosis is a disease characterized by low bone mass that increases the risk for fractures. We call it skeletal fragility. It’s a common disease. There are probably over 10 million people with osteoporosis in the United States defined as a T-score on the bone density test and another 35 million with osteopenia or low bone mass.

Melanie: Who is more likely to get osteoporosis, man or women?

Dr. Deal: Both men and women get osteoporosis and it's a common misconception that only women have osteoporosis, for instance, about 20% of all hip fractures in this country are male, so it’s a substantial minority of osteoporosis patients are male, but females are more likely to get it mainly because they go through menopause and the withdrawal of estrogen leads to rapid bone loss whereas men do not have an abrupt testopause, they have more of a gradual reduction in hormones over their lifetime.

Melanie: Dr. Deal, although there are uncontrollable risks factors, you know age and gender that sort of thing, what are some of the risk factors we can control to help us prevent getting osteoporosis?

Dr. Deal: There are a number of risk factors that we can do something about probably the biggest ones would be excess alcohol intake defined as three units per day, three glasses of some kind of alcohol is a risk factor, and smoking actually is a huge risk factor, nicotine is very bad for the skeleton, not having an active lifestyle is a risk factor because weightbearing exercise and by weightbearing, I am not talking about lifting weights, I am talking about heel strike activity that kind of activity sends a mechanical stimulus to the skeleton that stimulates bone formation, proper nutrition is really important with calcium and vitamin D, either in your diet or if you are not getting it in your diet and in your supplement. Those are all things that the individual can do to reduce their risk for developing this disease.

Melanie: How is it detected? One of the tests you mentioned T-score and people have heard about bone density tests, you know now these are being offered in many various places, but tell us really what is the good gold standard bone density test and what is that T-score mean?

Dr. Deal: The way to detect is a bone density test and this test is inexpensive and widely available. It’s paid for by most insurance companies. It’s certainly paid for by Medicare every two years. A bone density test just is a simple test that measures the amount of calcium in your skeleton and we have a system for evaluating the severity based on T-score which is the terminology with the standard deviation unit below peak bone mass, so we compare where the patient is to where average women are at age 30 and we give them this T-score and the World Health Organization has defined osteoporosis as a T-score less than -2.5 and for the National Osteoporosis Foundation in this country recommends that women and men with a T-score less than -2.5 be considered for pharmacologic therapy.

Melanie: Tell us about the pharmacologic therapy. What you do? What’s your first line of defense if somebody is headed towards osteopenia or osteoporosis?

Dr. Deal: So, we have two ways to decide on treatment. One is, if a patient has osteopenia and that’s a T-score between -1 and -2.5, we apply an algorithm or a tool called the FRAX measurement. FRAX is a World Health Organization absolute fracture risk tool that tells us the 10-year risk for fracture and based on guidelines published by the National Osteoporosis Foundation, if you are 10-year risks or above a certain level, treatment is recommended. Treatment is generally recommended in all patients if their T-score is less than -2.5. Thus, the mainstay of treatment in this country and over the world, are bisphosphonates and these are Fosamax, Actonel, Boniva, and Reclast. They have been around since 1995 and they are very effective at reducing the risk for fracture. We also have other option. Certainly, a woman who is on estrogen for menopausal symptoms, we know that estrogen is effective therapy at preventing bone loss. We also have a medicine called Denosumab or Prolia for patients with every six-month injection and we have an anabolic therapy and by anabolic I mean a bone building therapy, it has been out since 2002 called Forteo which is actually a daily injection.

Melanie: So, then what can patients do that have been diagnosed with osteopenia headed toward osteoporosis, they are going on Fosamax, they are doing some of these modalities. What can they do at home as a lifestyle to really help them increase their bone mineral mass.

Dr. Deal: So, we talked about things to avoid like alcohol or tobacco and we talked about things that you should do like some kind of exercise that involves sending a stimulus to the skeleton and that is just can be as simple as walking or as tough as you know aerobics and step aerobics or anything that's very important and then having an assessment of the amount of calcium in your diet, the current recommendation for calcium either in the diet or supplement are 1200 to 1500 mg per day, and vitamin D about 1000 international units per day all those things in addition to the medications are very important for helping to maintain or increase bone mass.

Melanie: And do you like to work with your patients nutritionally, so that they learn some of the foods that can also help them and the exercises that can help them to maintain strong bones.

Dr. Deal: Yes, every patient in our clinic does a diet history and we do an evaluation and an assessment of the amount of calcium and vitamin D in their diet and we either asked them to increase their calcium in their diet if it is subpar or take a supplement and the same thing is true or vitamin D. For the patients for instance who are older and might have risk for falls as assessed in the examination room, physical therapy is a very important component for them to increase muscle strength and do balance exercises, reduce the risk for falling because we always say you can treat somebody with a medication from now until the cows come home, but if you don't address their fall risk, you're not going to prevent the fracture because even the patients with normal bone density, if they fall can have a fracture.

Melanie: And Dr. Deal in just the last minute if you would for us, please give us your best advice for people with osteoporosis and why they should come to see you at Cleveland Clinic?

Dr. Deal: Well, the first advice is be sure to get a bone density test at the appropriate interval, so every woman over 65 and every men over 70 should have one and if you are younger than that for instance a woman after menopause between age 50 and 65 if you have risk factors like family history, low body weight, current smoking or if you're on medication that might result in or accelerate bone loss like chronic steroid therapy or Aromatase inhibitors and the breast cancer, you need to get a bone density, so getting that first test to make an assessment, your fracture risk is really critical, so take advantage of that. Like I said insurance will usually cover that and then after that you need to have a discussion with your healthcare provider about whether or not you need pharmacologic therapy or whether you can just do some lifestyle modification and increase calcium and vitamin D and do some exercise to maintain bone mass and then get another bone density in two years to assess the impact of those interventions.

Melanie: Thank you so much, Dr. Chad Deal. We are Talking About Your Health with Cleveland Clinic. For more information, you can go to That's This is Melanie Cole. Thanks for listening.