In orthopaedic and spine surgery practices, most of the focus has always been on secondary and tertiary prevention. That is, we try to treat various diseases of the musculoskeletal system after they become apparent and before they become a big problem. In some cases, patient’s come into the office with identified problems that have been ongoing and our focus becomes more on rehabbing and reducing the effects of the problem.
What if we could lessen or even avoid the onset of certain musculoskeletal diseases before they become apparent? This is known as primary prevention. It is the same reasoning behind going to your internist for a yearly physical to try and prevent problems before they start!
One of the areas that we like to focus on is bone health. Bones play a vital role in forming the human skeleton, protecting organs, and allowing us to perform weight bearing activities. The strength of your bones are derived from a combination of collagen (“connective tissue”), calcium and phosphate.
Bones are constantly in a state of remodeling. Early in life, bone forming process are greater than bone resorbing (“removing”) processes. This constant state of remodeling is based on the body’s attempt to maintain calcium levels. For most, we stop building bones somewhere in our early 20’s. This is a point where bone formation and bone resorption is nearly balanced. Peak bone mass starts to decline after age 30. In fact, when we perform a Bone Density test (DEXA SCAN) one of the results given is the “T” score. This is a measure of how your bone density compares to that of a 30 year old. There are many factors which can cause bone density to decline in time. Some of these are genetic and many are environmental. For example, one of the common treatments we use in orthopaedics are cortisone injections. We inject a “steroid” into a joint or muscle to decrease inflammation. The problem that exists is that too much cortisone can cause the body to decrease new bone formation and increase bone breakdown leading to weaker bones.
Going back to my earlier point about how bone remodeling is triggered by the body’s need for calcium, without enough Vitamin D, our body cannot absorb calcium. There have been many published articles suggesting that over 60% of the population is vitamin D deficient. It has also be theorized that taking calcium supplements while having low vitamin D levels can lead to calcification of arteries that lead to heart and kidney conditions. Your body stores a majority of calcium in your bones. When you do not consume enough calcium, your body will use that calcium that is stored in your bones. As you can imagine, when this occurs, your bones can become brittle.
There are various recommendations on the internet and in the medical literature about how much calcium and vitamin D to take. Which recommendation is correct? This question has yet to be answered. The one thing we do know is that calcium and Vitamin D derived from a healthy diet is the best and safest for your body. There are potential risks in taking too much calcium or Vitamin D from supplements.
The key to managing your bone health is knowledge. Having your bone density tested early in life (30’s and 40’s) may help identify the onset of declining bone strength early enough so that something can be done about it without having to resort to prescription medications to treat osteoporosis later in life. The same holds true for Vitamin D testing. The proper combination of diet, exercise, lifestyle, and vitamin supplementation (calcium and vitamin D) started early enough has the potential to lessen or diminish the onset of some musculoskeletal diseases.
From a financial perspective, consider this. Many insurance companies will only pay for a bone density test for women who are post-menopausal or have other medical conditions that necessitate the need to have the bone density checked. Most do not pay for a bone density study for healthy 30 and 40 year olds. Vitamin D testing may or may not be included with your annual physical lab work. Consider this, bone health testing usually costs $100-$200. The costs of prescription medication to treat low bone density starts at around $200 per year. If you had the option of paying $100-$200 now for bone health testing to detect your current status and help your physician recommend some lifestyle changes to minimize the risk of bone loss or had the option of paying $200+ per year for the first line of drug treatment for osteoporosis (that may or may not work and has side effects) from age 50 on, what would you chose? I might add that $200 per month does not cover the costs associated with treatment for broken bones (remember bones become brittle with osteoporosis).
Primary prevention of some bone related diseases can be achieved through early testing and lifestyle changes. For most, there is an out-of-pocket cost to this, but that cost is far less than a lifespan of treatments for poor bone health.
– Jason Mazza, M.Sc, OA-C, CSA, SA-C, OTC, CCRC
- McLeod KM, Johnson S, Charturvedi R, St Onge J, Lionel A, Verma A. Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000-2013: an unchanging landscape in Saskatchewan, Canada. Arch Osteoporos. 2015;10:227. PubMed PMID: 26173601