Understanding Osteoporosis: Q&A with Dr. James Gilbert

Published May 30, 2017

Today, more than 53 million Americans suffer from osteoporosis or are at a high risk for the disease. Osteoporosis is characterized by a decrease in bone marrow density, leading to the weakening of bones and an increased risk of fractures. But because it is a “silent disease,” there are few warning signs before a bone is broken.

The good news is that there are several steps you can take to preserve your mobility and bone marrow density at any age. We asked Dr. James Gilbert, a sports medicine specialist in our Metro Orthopaedics & Sports Therapy care center, about what patients should know to navigate – and prevent – osteoporosis.

What causes osteoporosis?

There are several factors that could contribute to osteoporosis, including certain medications, other disease processes, genetic predisposition and lifestyle choices such as smoking, drinking alcohol, and lack of exercise. The most common cause is simply age. Gender also plays a role, as osteoporosis tends to affect women disproportionally; the International Osteoporosis Foundation estimated that 80 percent of Americans with the disease are women. This is partially because hormonal changes that occur after menopause can cause women to lose bone density more quickly than men.

Are there any symptoms to be aware of?

Unfortunately, no. We typically discover osteoporosis when a patient comes in with an insufficiency fracture. That’s a type of stress fracture that’s caused by the pressure of normal activity on a weakened bone. Fractures caused by osteoporosis occur most often in the spine, hip and wrist.

What can a patient do to reduce their risk of fractures and keep their bones healthy?

Because bone mineral density peaks in the late 20s and early 30s, it’s important to develop a healthy lifestyle at an early age. You need regular exercise, a healthy diet and good nutrition to build bone mass while young, and then you need to continue this routine to keep your bone mass at the highest possible level.

What can patients do to preserve mobility if they have osteoporosis?

If a patient has confirmed osteoporosis – which can be documented with a DEXA scan on bone mineral density – the recommended treatment typically includes exercise and medication. Most patients take bisphosphonate medication to prevent bone loss in addition to calcium and vitamin D supplements. Regular exercise is also critically important. Studies have shown that weight-bearing exercises increase bone density, strengthen muscles and help to reduce the risk of fractures.

Weight-bearing exercises, such as walking, stair climbing or tennis require you to stay upright and work against gravity. Your bone tissue adapts to this resistance by building cells for greater density. Among elderly patients, this exercise helps to slow bone loss. In addition, the exercises improve both balance and coordination, which reduces the risk of falls. The American Academy of Orthopaedic Surgeons recommends 20-30 minutes of weight-bearing exercises three to four times a week.

Should parents focus on helping their child or teenager build bone health to prevent osteoporosis or other problems in later years?

Yes – it’s really important to educate children at an early age. They need to understand that their decisions as a teenager will affect them down the road, so it’s critical to encourage good, regular exercise and a nutritious diet. For female athletes especially, parents should be aware of stress fractures, the loss of regular periods, and anorexia. Very low body weight and a lack of estrogen (as indicated by the stopped menstrual cycles) can lead to bone loss during a teen’s peak opportunity to build bone mass.

Research shows that if you establish good habits early, when young athletes are going through puberty, they’ll have fewer health consequences down the road. It’s never too early to have this conversation with kids. In fact, taking care of their bone and muscle health should be a lifetime process of education. 

James Gilbert, M.D., is the President and CEO of the Metro Orthopaedics & Sports Therapy care center in Silver Spring, Maryland. Dr. Gilbert specializes in sports medicine and has served as head team physician in professional soccer for over 15 years. He has also served as an assistant team physician and consultant for Duke Sports Medicine, the Dallas Cowboys, the Dallas Mavericks, the Professional Bull Riders Association and the Special Olympics.