Osteoporosis is a condition in which the bones become weak and brittle — so brittle that a fall, or even mild stresses like bending or coughing, can cause a fracture. Often called a “silent disease,” osteoporosis causes no symptoms until a fracture occurs. Dr. Adam Elisha, DO, is a board-certified rheumatologist in Duluth, MN who specializes in the evaluation, prevention, and treatment of osteoporosis.
What Is Osteoporosis?
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. As a result, bones become porous and less dense, increasing the risk of fractures — most commonly in the hip, spine, and wrist. Osteoporosis affects approximately 10 million Americans, with women over 50 at highest risk.
Risk Factors for Osteoporosis
- Female sex, especially post-menopause
- Age over 50
- Family history of osteoporosis or fractures
- Small, thin body frame
- Low calcium and vitamin D intake
- Smoking and excessive alcohol use
- Physical inactivity or prolonged bed rest
- Long-term use of corticosteroids (such as prednisone)
- Certain medical conditions including rheumatoid arthritis, celiac disease, and inflammatory bowel disease
- Hyperthyroidism, hyperparathyroidism, or chronic kidney disease
Diagnosing Osteoporosis: DEXA Scan
Osteoporosis is diagnosed with a bone mineral density (BMD) test called a DEXA scan (dual-energy X-ray absorptiometry). This quick, painless test measures bone density at the hip and lumbar spine and produces a T-score. A T-score of -2.5 or below indicates osteoporosis; between -1.0 and -2.5 indicates osteopenia (low bone mass that may progress to osteoporosis). The National Osteoporosis Foundation recommends BMD testing for all women age 65 and older, and for younger postmenopausal women with risk factors.
Treatment Options for Osteoporosis
Treatment depends on the degree of bone loss, fracture history, and underlying risk factors. Options include:
- Calcium and Vitamin D: The foundation of bone health. Most adults need 1,000–1,200 mg of calcium daily and 800–1,000 IU of vitamin D.
- Bisphosphonates (alendronate, risedronate, zoledronic acid): The most commonly prescribed osteoporosis medications, which slow bone breakdown.
- Denosumab (Prolia): A biologic injection given twice yearly that reduces bone breakdown.
- Teriparatide (Forteo) and abaloparatide (Tymlos): Anabolic agents that actively build new bone — used for high-risk patients with multiple fractures or very low bone density.
- Romosozumab (Evenity): A newer agent with a dual mechanism — it builds bone while also reducing bone breakdown.
- Exercise: Weight-bearing and resistance exercise stimulates bone formation and improves balance to reduce fall risk.
Osteoporosis and Inflammatory Diseases
Patients with rheumatoid arthritis, lupus, and other inflammatory conditions treated with corticosteroids have significantly elevated fracture risk. Monitoring and treating bone health is an integral part of managing inflammatory disease, and I routinely assess and address osteoporosis risk in all my patients on long-term steroids.
Osteoporosis Care in Duluth, MN
Don’t wait for a fracture to find out your bones are at risk. Dr. Adam Elisha at St. Luke’s Rheumatology Associates in Duluth provides comprehensive osteoporosis evaluation and treatment. Call (218) 249-6960 to schedule your appointment.