February 27, 2016

Tall and skinny like her Finnish-born mother, the effects of osteoporosis first started impacting Disa Paoli at age 35, when she entered into early menopause. Since then, the now 59-year-old Manchester resident and certified home health aide has broken her tailbone, dislocated her kneecap, broken her right pinky twice, torn her rotator cuff and suffered from tendonitis.

“I was always klutzy, but in my mid-30s my arms and legs started to hurt and feel sore, like someone had whacked me with a baseball bat,” she said. “Eventually, I couldn’t manage a manual car because of my knee pain and my knee would make crunching sounds like there was broken glass in there.

“I’ve had to redo my whole lifestyle because of osteoporosis,” Paoli said of the condition she was officially diagnosed with in 2000, which has claimed more than two inches of her height and necessitated a variety of career changes to accommodate her pain and physical limitations.

‘A silent epidemic’

According to the National Osteoporosis Foundation, 10 million Americans suffer from osteoporosis, a disease in which the bones become extremely porous, are subject to fracture and heal slowly, while another 34 million have osteopenia, a preliminary stage of osteoporosis defined by low bone mass.

“Normal bone is hard, sturdy and made to withstand stress, but as we age, bones can become softer, less strong and marked by holes, almost as if termites or woodpeckers got at them,” Dr. Thomas Nordstrom, an orthopedic surgeon at The Center for Orthopedic Care in Bridgewater, said of the condition that will lie at the heart of an estimated $25 billion in health care costs by 2025.

“However, because osteoporosis doesn’t ‘hurt’ until you break something, it’s truly a silent epidemic,” he said.

Though the compression or fragility fractures of the spine, wrist and hips that typically result from the condition all can be debilitating, Nordstrom acknowledges that “hip fractures are the most serious, because those injuries can often lead to a downward spiral and are associated with a mortality rate of 25 percent.”

From his more than 30 years in practice, Nordstrom said that typical osteoporosis patients are small-boned women in their 60s who hail from cultures that don’t eat a lot of dairy, such as those in Western Europe, Asia and India. Larger-boned cultures and residents of warmer climates where sunlight is prevalent traditionally have a lower incidence of the disorder.

“It’s a combination of genetics, size, activity level, geographics and diet,” Nordstrom said, but the unfortunate fallout is predictable. “Patients can experience back or bone pain as well as vertebral collapse from compression fractures of the spine, which can cause patients to stoop, hunch over or get shorter,” he said. “Ultimately, the biggest symptom is when something breaks, and this can occur in any bone.”

Though the onset of osteoporosis has clear hormonal ties — the decline in estrogen and progesterone that woman experience during and after menopause impairs their ability to mobilize calcium, which gives bones their strength — Nordstrom notes that males can be at risk for this disease as well.

“Men contract osteoporosis less than women, but it’s still prevalent,” he said. “They’ll experience broken hips, just a decade later than women.”

A range of treatments

According to Nordstrom, traditional treatments for osteoporosis range from dietary changes involving foods high in calcium, such as yogurt, cheese, green vegetables, and fish high in Omega 3 fatty acids to vitamin D and calcium supplements. For patients with more advanced osteoporosis, treatment also can include a class of medications known as bisphosphonates (popular brands include Boniva, Fosamax, Zometa and Reclast), which decrease bone turnover and slow down resorption.

“Bisphosphonates have been shown to prevent osteoporosis-related breakage in up to half of all patients, though they can result in upset stomach,” Nordstrom said. “Other treatments include estrogen and thyroid therapy and a calcium-based nasal spray called Miacalcin.”

At the base of all treatment, however, is a measure that Nordstrom views as one of the most important as it relates to osteoporosis.

“Doctors and patients can really benefit from DEXA scanning, or dual energy X-ray absorptiometry, which is a simple, painless process that tests the bone density of the hip and spine and provides an accurate picture of a patient’s degree of osteopenia or osteoporosis,” he said.

Nordstrom recommends this measure for all women older than 50.

For Paoli, who suffers from both osteoarthritis as well as osteoporosis, a regimen of calcium supplements and medications including Fosamax, Celebrex and Vioxx have brought much needed relief, as well as an understanding of what she can and can’t do.

“I love walking, swimming and working out on an elliptical slider and a stationary bicycle,” she said. “I definitely avoid jolting exercises and am looking forward to riding a three-wheel Harley.”

“Disa has suffered multiple fragility fractures, but under continued treatment, she’ll avoid others in the future,” Nordstrom said. “The key is awareness and prevention and the understanding that osteoporosis is a preventable, treatable disease.

“If identified and properly treated, we can reverse the risk, slow down its progression and increase bone density,” he said. “It’s about awareness and education on behalf of ourselves, our grandmothers and our teenage daughters.”

Fully cognizant of her condition and prudent about managing it, “osteoporosis is something you have to deal with, but it doesn’t have to be front and center in your mind or run your life,” Paoli said. “I’m grateful for every day, and I’m happy to know that I can still dance.”

The Center for Orthopedic Care, 215 Union Ave., Suite B in Bridgewater, can be reached at 908-685-8500 or


. For an assessment of your fracture risk, utilize the World Health Organization’s Fracture Risk Assessment Tool at www.shef.ac.uk/FRAX/tool.jsp?country=9.

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Deborah Gilboa, MD

Doctor G (Deborah Gilboa, MD) of AskDoctorG.com empowers parents to raise respectful, responsible and resilient kids. Around the country and around the world, she works with parents to increase their knowledge and to use the parenting instincts they already have. Doctor G focuses on practical tools and teaching skills, not just dishing out advice.

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