What’s the link between osteoporosis and the gut biome? 

May is Osteoporosis Awareness Month. This condition, marked by severely weakened bones, is one that our board-certified endocrinologists treat daily here at Texas Diabetes & Endocrinology (TD&E).

While it is commonly known that calcium helps to strengthen bones and protect against osteoporosis, new research shows that good gut health (or the gut biome) can also play a large role in osteoporosis prevention and boosting bone density (the amount of minerals stored in bones to make them strong). 

The gut biome is the complex mix of microorganisms that live in the body’s intestines and helps with immunity and food processing. 

What is the connection between osteoporosis and the gut biome? 

new study recently published strongly supports previous findings that a healthy gut biome can in fact improve bone density and help protect against osteoporosis.  This important connection between the gut biome and the body’s bones is known as the gut-bone axis. 

Data shows that eating fruits and vegetables high in Vitamin C can increase production of the bone-making cells that protect them from weakening, or possibly fracturing and breaking, which is typically associated with osteoporosis. This conversion of Vitamin C into powerful bone-boosting cells takes place in the gut. 

Research also continues to show that foods rich in calcium (like dairy products) and high in protein (lean meats and legumes) help to fortify bones and keep them strong. 

Additionally, tracking certain types of bacteria that exist in the gut biome, and then supplementing with lacking bacteria known to boost bone-making cells, may become an increasingly more common option for osteoporosis prevention.  This can be facilitated by a physician recommending a mix of synbiotics (probiotics combined with prebiotics) to promote healthy bacteria in your gut biome.

According to TD&E endocrinologist Dr. Mauli Shah, along with keeping your gut check in health, other ways you can help prevent osteoporosis are with “regular exercise (weight bearing or resistance exercises are best), and taking Vitamin D and calcium supplements.” 

When should you see a doctor for osteoporosis?

Dr. Shah offers the following recommendations for when you should visit a doctor, or endocrinology expert, regarding your risk for osteoporosis:

  • All women 65 years of age and older 
  • Post-menopausal women with certain risk factors, such as those who’ve had a previous fracture or been treated with steroids
  • People who have a family history of osteoporosis or hip fractures 
  • People with rheumatoid arthritis
  • Women who have entered premature menopause or men with low testosterone

Osteoporosis Treatment at Texas Diabetes

Our endocrinology and osteoporosis experts will help develop the right treatment plan for you to address your unique bone health needs. We typically recommend lifestyle modifications to start, like getting more exercise and eating well. Then we’ll determine what combination of dietary supplements, medications, and/or injections and IV infusions are best suited to protect and strengthen your bones. 

Contact Us to Help Manage your Osteoporosis, Diabetes and Thyroid Conditions 

If you’d like to schedule an appointment with one of our specialists at Texas Diabetes & Endocrinology and discover how our diabetes services  and other endocrinology therapies can help you lead a full and active life, please contact us at (512) 458-8400 or request an appointment online.  

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FAQs with Dr. Pandit: Osteoporosis

Osteoporosis is a common and potentially debilitating disease that affects an estimated 54 million Americans. Often referred to as a silent disease, osteoporosis can progress with no symptoms or warning signs until a fracture occurs. At Texas Diabetes and Endocrinology, we believe that preventing bone fractures is a priority.

In honor of Osteoporosis Awareness and Prevention Month, endocrinologist Dr. Keta Pandit is sharing everything you need to know about the condition.

What are the most common signs of osteoporosis?

Osteoporosis is characterized by low bone mass that results in microarchitectural disruption which causes decreased bone strength and increased risk of fracture. Some people may develop small microfractures in the vertebral spine, which may result in loss of height or hunched posture, known as kyphosis. Unfortunately, osteoporosis has no clinical manifestations until there is a fracture.

What risk factors raise a person’s chances of getting osteoporosis?

Women are much more likely to develop osteoporosis compared to men. Upon menopause women are not exposed to Estrogen, which is responsible for promoting bone growth. Therefore, postmenopausal women are at an increased risk of getting osteoporosis. Those with a family history of hip fractures or osteoporosis are also at an increased risk and should inform their doctor so that screening can be done appropriately. 

Other factors that can increase osteoporosis risk can include: 

  • smoking
  • daily use of alcohol
  • history of steroid use
  • early menopause in women
  • low testosterone in men
  • excessive use of thyroid hormones or history of hyperthyroidism
  • hypercalciuria
  • chronic medical conditions like diabetes and HIV

At what age should patients start thinking about osteoporosis prevention?

​The National Bone Health & Osteoporosis Foundation (NBOF) and the U.S. Preventive Services Task Force(USPSTF) both recommend screening for osteoporosis in women of age 65 and above. NBOF also recommends screening early for all postmenopausal women with known risk factors. Regardless, all women of postmenopausal age are recommended to have adequate calcium and vitamin D to prevent bone loss.

For men, the recommendations have varied. NBOF recommends screening for all men over age 70 and as early as 50 years or older for men with risk factors. On the other hand, USPSTF has not provided a set guidance for what age men should be screened for osteoporosis.

What is one of the most common misconceptions patients have about osteoporosis?

One of the most common misconceptions about osteoporosis is that it presents pain in your bones or joints. Osteoporosis is a silent disease, and it does not present with any pain, unless there is a fracture or a bone deformity that comes from a previous history of fracture. 

Many people believe that adequate intake of dairy in their diet is sufficient to prevent bone loss. However, you may not necessarily have adequate calcium despite daily use of dairy products. 

Does osteoporosis affect men and women differently?

Women tend to have younger onset of bone loss and lose bone at a faster rate compared to men. Estrogen deficiency plays an important role in osteoporosis development, which is one of the factors that makes women more susceptible to osteoporosis compared to men. 

How can someone best protect themselves from osteoporosis?

Prevention of osteoporosis begins with ensuring you have enough calcium and Vitamin D in your diet. Other steps you can take to maintain bone density include:

  • eating a well-balanced diet
  • regular exercise with weights
  • avoiding alcohol and smoking

How is osteoporosis treated?

The landscape of medications for osteoporosis has changed in the last two decades. All medications work in a different pathophysiology, but the goal is to build bone and reduce fracture rates. 

Oral bisphosphonates, IV bisphosphonates and denosumab work by reducing the rate at which bones break down. Oral bisphosphonates including weekly Alendronate (Fosamax) or monthly Residronate (Actonel) and Ibandronate (Boniva) are the standard of treatment for osteoporosis in the beginning stages. However, these medications are known to cause reflux. 

Those that cannot take the oral bisphosphonates can resort to annual IV zoledronic acid (brand name Reclast), which is also a bisophosnate. Alternatively, denosaumab (Prolia) can also be utilized which is an injection given every 6 months.

For patients that have severe osteoporosis, which is defined as a history of a fracture in the hip or spine or wrist, or very low scores on their bone density scans, stronger medications can be used. These medications belong to a class of medications called anabolic treatment, known as Teriparatide (Forteo), Abaloparatide (tymlos) or Romosozumab (Evenity). These medications build stronger bone by speeding up the bone building process. Teriparatide and Abalopartide are daily injections approved for two years and Romosozumab is a monthly injection approved for one year. After their recommended time frames, patients will generally switch to either IV Reclast or Prolia depending on how they respond to the treatment. 

Long term use of osteoporosis medications is discouraged as there is a risk for developing atypical femoral fracture or osteonecrosis of the jaw. Therefore, we recommend stopping medications temporarily, known as a drug holiday. After 3-5 years of treatment (or up to 8-10 years of treatment in some cases), a drug holiday is recommended. During the ‘drug holiday’, bone density is measured annually or every two years, and treatment can begin after 2-3 years of drug holiday if bone loss progresses.

Dr. Keta Pandit is a board certified endocrinologist and obesity medicine specialist with a special interest in the treatment of adrenal and pituitary disorders. She sees patients at our Central Austin office. 

If you’d like to learn more about our osteoporosis and fracture treatment services, please call Texas Diabetes and Endocrinology at (512) 458-8400 or request an appointment online

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