Orthopedic Surgery Professor's Myths and Truths About Osteoporosis Medications | Prof. Ha Yong-chan, Department of Orthopedic Surgery, Bumin Hospital

1. What is osteoporosis?

Osteoporosis, simply put, is the loss of bone. The bone is absorbed, which increases the risk of fractures. When a bone has a hole, it becomes weak and breaks easily. So, osteoporosis is a disease that causes bones to fracture when they become holes. Osteoporosis is called by many names. It's also called the silent disease, the silent killer, and the bone-hole skeletal disease. The reason for these nicknames is that osteoporosis has no medical symptoms.

2. Is osteoporosis difficult to diagnose?

Osteoporosis is relatively difficult to diagnose. For example, high blood pressure can be seen as an increase in blood pressure, which can lead to headaches, heart attacks, or blocked blood vessels. And sphygmomanometers are also very common, so you can easily check them at your nearby blood pressure monitor. On the other hand, osteoporosis requires bone density to be measured for diagnosis.You can spend as little as two minutes or as late as five minutes. As a result, it's less accessible than a blood pressure test. 

Many people ask when to have a bone density test and if it is covered by their health insurance. For women, the government provides free bone density tests when they turn 54 or 66. In addition, menopause occurs in women after the age of 50, and the risk of osteoporosis always increases after that, so you can take care of it within your health insurance.

But now, if you are going through early menopause, you need to have a bone density test. Female hormones not only make the skin glow, but they also store calcium in the bones, which leads to rapid bone loss when menopause comes.

The same goes for men. In men, a decrease in androgens, the male hormone, leads to bone loss. However, male hormones tend to be relatively less affected because they decline more slowly than female hormones. However, a drop in male hormones also increases the risk of osteoporosis.

3. Why hip fractures are dangerous

Osteoporosis-induced fractures are called "silent killers" because of their high mortality rate. Even healthy elderly people have a hip fracture that can lead to a sudden deterioration in their health. A hip fracture is a central bone, so you can't move after a fracture.Because of the restriction of movement, you are confined to your room, which leads to inability to recover, pneumonia, and pressure ulcers. Also, because you lie down, you get constipation and you can't urinate properly, so you get a bladder infection. Then, for these reasons, the infection progresses again and generalized sepsis is likely. As these chronic diseases worsened, he died.

4. Osteoporosis, how is it treated?

Treatment for osteoporosis can vary depending on age. Osteopenia is more common in people in their 50s, and exercise therapy can help. And if you take good care of it with calcium and vitamin D, you can maintain bone density. If you are diagnosed with osteoporosis in your 50s and you are going through menopause, you should definitely take osteoporosis medication. When taking medications, you should take drugs that act similarly to female hormones, rather than stronger osteoporosis drugs.

And when you're in your 60s, it's been 10 years since menopause. It is generally believed that women develop osteoporosis 10 years after menopause. So, people who were normal in their 50s will develop osteopenia after 10 years, and people who were osteopenic in their 50s will develop osteoporosis after 10 years. In your 60s, unlike in your 50s, you may want to take stronger medications, such as bisphosphonates or injections that you take every six months.

5. Treatment of high-risk osteoporosis

Age is also important in osteoporosis, but osteoporosis patients are divided into high-risk and low-risk groups. Even if you are 50, those with a history of hip fractures or spinal compression fractures are considered high-risk. If you are in a high-risk group, you may first receive osteogenesis stimulants and then bone-building injections. The next step is to use drugs that inhibit bone resorption.

There are many types of osteogenesis stimulant injections that have been clinically tested, ranging in duration from 1 year, 2 years, or 1 year and 6 months. These injections may seem good to use for 1, 2, or 3 years in a row, but after 1 year, they become less effective. So, in this case, you can take a break for a few years and then use it again and it will get better. There are several types of injections, but each one costs about 200,000 won, so there is a cost problem. The reason why these injections are expensive is that osteogenesis stimulants are classified as second-line drugs according to insurance regulations in Korea, so they are not insured.

6. Misconceptions about osteoporosis drugs

There is a rumor that 'osteoporosis medication must be taken for life, you can't get implants', but this is half right and half misunderstood. Just like taking blood pressure medication for life, osteoporosis is the same. It doesn't mean that you have to eat for the rest of your life because you have osteoporosis, but you eat it for the rest of your life because you eat it as a control. 

Even though osteoporosis is a disease, people see it as a concept of prevention because they prevent fractures. Don't think of it this way. Also, if you take osteoporosis medication well and reach the osteopenia stage, the risk of fractures decreases slightly, but it is not a condition that does not require treatment. Therefore, even if it gets better, it needs constant care.

If you can't get an implant because you're taking osteoporosis medication, it's actually because one of the osteoporosis drugs has such a drug. This is the case with bisphosphonates and bone resorption inhibitors. These drugs are effective and cost-effective. And once it is in the body, it will take 10 or 20 years, so you just have to be aware of the risks and take countermeasures. So you don't have to worry too much. In addition, the Society of Bone Metabolism has created guidelines that inform patients who need dental treatment how they should be treated, so you can refer to them.

6. Osteoporosis, what to keep in mind

Osteoporosis can miss early treatment. But once you have a fracture, you know it's osteoporosis. You can get treatment at this time, but there are some people who miss that time. Data shows that after a compression fracture of the spine, the risk of re-fracture is threefold. The next fracture is 9 times, then 23 times. Therefore, osteoporotic fractures can cause re-fractures with a high probability if left untreated, so it is essential to receive treatment to prevent re-fractures.