Endocrine Care and Osteoporosis
Among bone diseases that endocrinologists help to treat, osteoporosis is by far the most common. That's because bones are constantly gaining and losing cells, and often this exchange becomes imbalanced. An individual can start to lose more bone mass faster than he or she is building it. In osteoporosis, the hard, dense material that forms bone becomes porous, and bones become weaker and subject to fracture. Osteoporosis takes place across years, with no symptoms, as it gradually sets up bone for an all-too-easy fracture. It is a leading, world health problem, and women are at greater risk than men.
The objective is not to let a broken bone become the first indication of osteoporosis.
Key to combating primary osteoporosis is preventing the condition in the first place. The most important preventive steps include:
- ensuring adequate calcium intake in the diet;
- engaging in a lifetime of regular exercise;
- getting sufficient intake of protein and calories;
- using vitamin D supplementation whenever vitamin D levels are low, especially in older individuals and especially in connjunction with calcium supplementation;
- and avoiding tobacco and excessive use of alcohol.
Endocrinologists, orthopedists, nephrologists and primary physicians all offer care for primary osteoporosis. Often, endocrinologists also care for patients with osteoporosis that is secondary to hyperparathyroidism or kidney failure—among other metabolic and hormonal conditions that can also lead to this condition. Additional causes also include long-term use of steroids. The hip, pelvis, wrist and spine are in particular danger when affected by osteoporosis.
Risk and Diagnosis
Endocrinologists can assess risk factors and confirm the diagnosis of osteoporosis as well as its severity. Risk factors include:
- age (which, in women, brings loss of estrogen and progesterone, especially at the time of menopause, and in men brings loss of the testicular hormone testosterone);
- early menopause (age <45 years);
- history of missed menstrual periods (amenorrhea);
- family history of osteoporosis;
- low body-mass index (BMI);
- history of eating disorders;
- smoking or excessive use of alcohol;
- and sedentary lifestyle.
A urine test can determine the rate at which an individual is losing bone calcium. X-rays of the hip, vertebrae or other areas check for fractures. In addition, the endocrinologist may refer patients for evaluation with ultrasound or with sophisticated DEXA X-ray test available in Lourdes' radiology service. A DEXA (dual energy x-ray absorptiometry) scan provides a bone-mineral density reading, indicating the location and degree of bone loss. Physicians with extensive knowledge of this testing, and who are specially trained and certified in understanding the results, should interpret these tests. Patients with confirmed osteoporosis should be re-evaluated with these tests annually.
Endocrine-Related Conditions that Can Cause Secondary Osteoporosis
Hyperparathyroidism. Using blood testing and assessing signs, endocrinologists can confirm the diagnosis of parathyroid overactivity. They can discuss care options, which often include recommending patients for removal of an abnormal gland. For these operations, they refer patients to colleagues who are experienced endocrine surgeons at Lourdes.
Kidney failure. A much more common causative factor for osteoporosis is kidney disease, which affects millions in the U.S. Weakened renal function can disrupt bone metabolism.
Treatment
For patients with normalized parathyroid function, including kidney patients, Lourdes endocrinologists can review the options in treatment of osteoporosis and develop a care plan. The best response to this bone-thinning condition is usually a regimen of drug and supplement therapy, as well as diet and exercise (the forces of which stimulate bone to reinforce itself). This modern, multifaceted approach to treatment can build bone density and replace lost calcium in bones.
For drug treatment, endocrinologists may prescribe one or a combination of the following to prevent and treat osteoporotic loss of bone:
- vitamin D supplementation (typically along with calcium supplementation
for maximum effectiveness);
Learn about the possible advantages of vitamin D
supplementation beyond just benefits to bones - estrogen therapy for women (though this therapy was more common in the past);
- male-hormone-replacement therapy for men;
- selective estrogen-receptor modulators (such as Raloxifene, which stimulate estrogen receptors in bone);
- bisphosphonates (medications that, in women, keep bone tissue from being reabsorbed);
- and supplementation with the thyroid hormone calcitonin, which inhibits bone resorption, or treatment with a teriparatide, a synthetic portion of the parathyroid hormone that actually stimulates new bone formation.
Measures aimed at decreasing the patient's risk of falls are also important.
Patients diagnosed with osteoporosis, or who have risk factors, should discuss screening, care and monitoring with a Lourdes endocrinologist.
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