Osteoporosis: A Silent Disease With Loud Consequences

May is National Osteoporosis Awareness Month. Osteoporosis is responsible for nearly 2,000,000 broken bones per year, but can be managed through lifestyle prevention measures and medications for bone loss.

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Osteoporosis Awareness and Prevention

As the days get longer and the nights get warmer, many people begin taking advantage of the flexibility of summertime. Whether this means taking time off work for a vacation, pulling out the grill for a barbeque, or riding a bike to work instead of taking the car, summertime opens up new ways to use the day. If you find yourself looking for ways to make the most of your summer, take time to consider implementing choices that make bone health a priority. From working outdoors (sunscreen please!) to creating indoors, taking care of your body should be a top priority this summer.

While many people know the importance of making heart healthy choices, not everyone is aware that neglecting bone health can have long-lasting implications and, as with most things health related, early intervention is key. Bone mass, for the most part, is determined by genetic factors; however, there are lifestyle choices, like diet and exercise, that can influence whether or not bone density reaches its full potential.

Osteoporosis literally means porous bones. Sufferers of this condition will experience a gradual weakening of their bones, increasing their likelihood of fractures and associated health complications (due to inactivity) like blood clots or pneumonia. Did you know:

  • Osteoporosis is responsible for nearly 2,000,000 broken bones per year.
  • Half of all adults 50 and older are at risk of breaking a bone due to low bone density.
  • One in two women and up to one in four men will break a bone due to osteoporosis.
  • Women have an osteoporosis incidence rate greater than that of heart attack, stroke, and breast cancer combined.

Because bones are made up of cells, they are constantly renewing. The best time to impact bone density is during times of rapid growth, such as childhood, adolescence, and early adulthood. Ideally, these time periods will be a time filled with exercise, quality foods, and avoidance of behaviors such as inactivity, smoking, and excessive alcohol consumption, which have been shown to decrease bone mass.

Maintain a Healthy Diet

Adults need at least 1,000 mg of calcium each day for optimal bone health. A few simple foods that can be incorporated into your diet are:

  • Orange juice with added calcium
  • Dairy products such as milk, cheeses and yogurts
  • Green leafy vegetables
  • Fish
  • Tofu

Additionally, Vitamin D facilitates proper calcium absorption. It can be difficult to get the recommended 1000 IU of Vitamin D, so often Vitamin D supplements are recommended.


Most people know the way to gain muscle strength is through exercise, but what they may not know is how beneficial those same exercises can be for bone health. Studies show that adolescents who exercise regularly typically achieve greater bone density and strength than those who don’t. These benefits don’t only extend to kids. For adults over 20, regular exercise can help prevent bone loss. Even adults who have already been diagnosed with osteoporosis can benefit from exercise, as it assists in maintaining strength and balance which can help prevent falls and fractures. Knowing that each age range can benefit from exercise, what types are shown to provide a person with the most benefit?

Weight-bearing exercises force a person’s body to work against gravity. The muscles and tendons will apply tension to the bones, signaling the body to produce more bone tissue. Examples of these exercises can include:

  • Walking / running / hiking
  • Tennis
  • Jump rope
  • Plyometrics
  • Basketball
  • Soccer
  • Volleyball

Strength training offers benefits beyond weight-bearing exercise by targeting bones most likely to fracture such as the hips, spine and wrists. One study showed that women who incorporated jumping and weightlifting into their exercise regimen improved their spine bone density by about 2% compared to a control group.

What to Watch For

Because all adults will start to lose bone around the age of 30, bone health discussions should be had during annual checkups. However, knowing that nearly 200 million people worldwide suffer from osteoporosis, also sometimes called the silent disease, it is wise to know to watch for the following signs:

  • Losing height – typically losing an inch of height or more
  • Stooped posture
  • Shortness of breath due to compressed disks
  • Bone fractures
  • Lower back pain

Often sufferers won’t know they have osteoporosis until they have suffered a fracture or break.

How is Osteoporosis Diagnosed

Bone measurement testing is recommended for postmenopausal women younger than 65 who are at increased risk of osteoporosis and women 65 years of age and older. Measurement testing is done with bone mineral density tests and give a provider a good overall picture of bone porosity. The results are referred to as a T-score and use a baseline of a healthy 30-year-olds bone density. Results are typically broken down as follows:

  • Normal: between 1 and -1
  • Low bone mass: -1 and -2.5
  • Osteoporosis: -2.5 or lower
  • Severe osteoporosis: -2.5 or lower with bone fractures

The treatment plan will depend on each person’s results, but if lifestyle modifications are not enough, medications are available. Most osteoporosis medications work by reducing the rate at which your bones break down, while others work by speeding up the bone-building process. Typically, bisphosphonates are the first choice for treatment. They can be administered through various mediums and on different timelines. This can look like:

  • Alendronate (Fosamax), a weekly pill
  • Risedronate (Actonel), a daily, weekly or monthly pill
  • Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion
  • Zoledronic acid (Reclast), an annual IV infusion

Bisphosphonate pills aren’t typically absorbed well by the stomach, so a common side effect is an upset stomach or heartburn. However, for users who take the medication with water, avoid eating anything else or lying down or bending over in the first 30 to 60 minutes after taking the medication, these side effects can often be mitigated.

If test results show a very low bone density, there are medications that can assist in the bone-building process. These include: Teriparatide (Forteo), Abaloparatide (Tymlos), and Romosozumab (Evenity). All three are administered through injection, although the frequency varies. Each medication carries side effects that make them not suitable for all populations. Additionally, these medications are not suitable for use after one to two years and bone-stabilizing medications like bisphosphonate are needed to protect the bone that has been built up.

The Role of a PBM

Injectable medications for the treatment of osteoporosis are classified as specialty medications. Specialty drugs currently account for about 17 percent of the average employer’s overall pharmacy costs. Left unchecked, this area of spend can become astronomical for providers. For osteoporosis injectable medication, IPM requires a clinical prior authorization review to determine if these medications meet criteria for approval. With a price tag of up to $4,000 monthly, IPM works to ensure these medications are utilized judiciously and prescribed for patients who are at high risk of osteoporotic hip fractures.

Osteoporosis can be managed. Whether this is through lifestyle prevention measures or treatment plans that include medications for bone loss. IPM is committed to managing each employer’s formulary in a way that allows members to receive the medication they need at a price the employer can afford.