Osteoporosis: A Physician’s Perspective

SARAH BERRY, MD, MPH, has dedicated her life to the study of bone health. She is the associate director at the Musculoskeletal Research Center, associate scientist at the Hinda and Arthur Marcus Institute for Aging Research and associate professor of medicine at Harvard Medical School, Beth Israel Deaconess Medical Center. Dr. Berry’s primary research has focused on outcomes following hip fractures both in the community and nursing homes. Given the strong link between falls and fractures, she is also interested in studying novel and modifiable risk factors for falls and is at the forefront of osteoporosis research.

BSTQ: Have you seen or been involved in any promising research for how to effectively treat or manage osteoporosis?

Dr. Berry: Currently, I am participating in a multisite study to test the effects of low-dose testosterone combined with exercise in older women recovering from a hip fracture. We don’t yet know the results of the trial and whether the testosterone will be helpful, but it is exciting to consider and learn about new approaches.

BSTQ: What dietary changes can help prevent osteoporosis?

Dr. Berry: Dairy foods are high in calcium, which is important to maintain bone health. It is particularly important that children and teenagers consume enough calcium since this is a period of rapid bone growth. There is some evidence to support adequate protein intake is also important to maintain bone health.

BSTQ: What is a little-known fact about osteoporosis?

Dr. Berry: Osteoporosis is a silent disease. Typically, people don’t realize they have weak bones until they have a fracture. Because of that, it’s better to focus on preventing osteoporosis rather than waiting to find out you have it.

BSTQ: At what age should someone request a bone density screening?

Dr. Berry: Women should get screened beginning at age 65, and men beginning at age 70. However, if a man or woman has risk factors such as paralysis or a history of adult fracture, they should get screened earlier.

BSTQ: How do you screen for osteoporosis?

Dr. Berry: A bone density test is similar to an X-ray (but with less radiation than a chest X-ray). It measures how tough your bones are. Another option is to use the FRAX model, an online tool developed by the World Health Organization that assesses the risk of osteoporosis over a 10-year period based on age, weight, family health history and other factors.

BSTQ: Is it ever too late to “grow” new bones?

Dr. Berry: Your skeleton turns over every 10 years. After age 30, the rate of bone loss outpaces the rate of bone growth. Bone loss also increases in women after menopause. However, it is possible to rebuild bone and increase bone strength.

BSTQ: What advice do you have for patients with high-risk factors for osteoporosis?

Dr. Berry: I recommend speaking with your doctor. Exercise, especially weight-bearing exercise like walking and dancing, is helpful to strengthen bones.

BSTQ: What factors make osteoporosis a life-threatening disease?

Dr. Berry: Most people don’t realize it can be deadly because of common complications such as infections, blood clots and loss of mobility. Pain medications can affect cognition and cause confusion. Twenty percent of people with hip fractures die within a year, while another 20 percent end up needing long-term care.

BSTQ: Your research encompasses risk factors for falls. Tell us more about that.

Dr. Berry: Prescription medications are one of the most common risk factors for falls because so many cause side effects. It’s important for patients to speak with their doctor regularly about their medicines and ask about the lowest dose available that still works for them.

BSTQ: What lifestyle adjustments can people make to strengthen their bones and prevent osteoporosis?

Dr. Berry: It is so important to exercise because it strengthens the bones, which can prevent falls. Talk to your doctor to see if you are getting enough calcium and vitamin D or if you need to be taking a prescription medication to prevent fractures. Understand the indication for all your medications, and work with your doctor to use the lowest dose effective for you. It’s important to lay the foundation for strong bones now, no matter your age. By incorporating good healthy habits, you can reduce the risk of fracture later.