Osteoporosis, The Silent Killer
A Surgeons Perspective
Two patients who are good friends and who both suffer from osteoporosis came in together for a visit in my clinic this week. One had an osteoporotic fracture in her neck and the other in her low back, so together, they were quite the pair! As I discussed their fractures with them, I was reminded of how many common misconceptions patients have regarding the treatment of osteoporosis. This never fails to surprise me and so I wanted to prepare a summary of official info on osteoporosis care because it’s so important for spine health.
Osteoporosis is a disease where the bones become brittle and weak making them prone to break (fracture). This is particularly common after menopause in women and also starts to affect men in their 70s. Millions of osteoporotic fractures (most commonly in the hip and spine) occur every year and cause much suffering. They can suddenly take you from being otherwise active and healthy to immobilized and in pain. Osteoporosis particularly affects the spine not only causing fractures and deformity, but because the bone is so weak, makes my job as a surgeon more difficulty when I try to fix problems.
Most people think of osteoporosis as something benign and nothing to really worry about. In some sense this is true. Osteoporosis is for the most part a painless condition, unlike for example, osteoarthritis, which causes joint pain. In other words, you don’t notice your bones becoming weak until they break. By the time patients get to see me, usually for a bone fracture or some other kind of weakening of the spine, they have already been affected by osteoporosis.
Luckily there are many great treatments for osteoporosis. The problem is most people won’t take them! Many patients have heard rumors and stories about how terrible the treatments for osteoporosis are. The common fixture for this fear is alendronate (Fosamax®) which was a very common treatment for osteoporosis used 10-15 years ago. I have heard countless of my patients say things like “doesn’t osteoporosis medicine make your teeth fall out?” or “I was told I should take something for osteoporosis but heard the side effects are terrible, so I didn’t.” Many patients also have the perception that supplements alone are the cure for osteoporosis: “but doc, I take algaecal!” Even patients who have suffered from multiple fractures seem reluctant to pursue treatment for osteoporosis even though they are the highest risk population for having another fracture. While surgery is often mandatory to treat fractures of the hip and spine, many patients are still reluctant to have treatment of the underlying cause of their condition even after they have had surgery.
Both the prevalence of the disease and patients’ unwillingness to seek treatment make osteoporosis a silent killer. Fractures of the spine and hip cause chronic pain, disfigurement, and limit mobility. About 20-40% of patients who suffer a hip fracture related to osteoporoisis do not survive through the following year. Supplements alone are insufficient to treat raging osteoporosis.
But what if I told you osteoporosis treatment could extend your life following a fracture? The treatment of osteoporosis may not only reduce the risk of suffering from a subsequent fracture, but can also reduce your mortality by 30% in the three years following a hip fracture (1). In a Taiwanese study conducted in 2022 following over 45,000 patients, those who had medical treatment of osteoporosis following a hip fracture showed a lower risk of death up to ten years. There was an even greater benefit to survival when using some of the more modern drugs such as zoledronic acid (Reclast®) or Denosumab (Prolia®) (2). It’s not clear what causes this extended life yet, but newer research has shown that zoledronic acid may have anti-aging properties and reduce DNA damage that accumulates with age (3).
We need to change our perception of osteoporosis and not allow it to stalk us into our golden years. Osteoporosis is a chronic disease which can accumulate in the skeleton and cause suffering from pain or disfigurement leading ultimately to premature death. It’s by far the most common condition I treat as an orthopedic surgeon. Remember, just because you had one fracture, does not mean you won’t have another! If you are a post-menopausal female or a male older than 70 years you need to get a bone density scan before it’s too late. Learn more about osteoporosis.
1. Tai TW, Li CC, Huang CF, Chan WP, Wu CH. Treatment of osteoporosis after hip fracture is associated with lower all-cause mortality: A nationwide population study. Bone. 2022 Jan;154:116216.
2. Tai TW, Hwang JS, Li CC, Hsu JC, Chang CW, Wu CH. The Impact of Various Anti‐Osteoporosis Drugs on All‐Cause Mortality After Hip Fractures: A Nationwide Population Study. Journal of Bone and Mineral Research.
3. Misra J, Mohanty ST, Madan S, Fernandes JA, Hal Ebetino F, Russell RGG, et al. Zoledronate Attenuates Accumulation of DNA Damage in Mesenchymal Stem Cells and Protects Their Function. Stem Cells. 2016 Mar 1;34(3):756–67.