Longtime orthopedic specialist Dr. Seth Coren has a bone to pick with osteoporosis.
And he has a lot of company.
The International Osteoporosis Foundation says that one in every three women and one in every four men over the age of 50 will suffer broken bones due to osteoporosis.
The problem is so pronounced that the IOF claims an osteoporosis-related bone fracture occurs somewhere in the world every three seconds.
Here in the United States the National Osteoporosis Foundation puts the number of Americans suffering from the disease at close to 54 million, and flatly states “it is responsible for 2 million broken bones and $19 billion in related costs every year.”
For the record, 54 million is a good deal more than half the over-50 population in this country.
Osteoporosis, which means “porous bone” in Greek, is a downright sneaky disease, too. As the Mayo Clinic puts it, “There typically are no symptoms in the early stages of bone loss,” and worse, as the disease progresses, falls, minor bumps and even something as seemingly innocuous as a sneeze can result in broken bones.
Coren, who has been practicing here in Vero Beach since 1979, warns that “the consequences of this can be dire. Patients end up with multiple fractures. They end up losing their mobility and independence. They have disability from it. It’s a very expensive problem both from a financial point of view and from a lifestyle point of view.”
Healthy bones – when viewed under a microscope – look something like a honeycomb fresh from a beehive. Osteoporosis, however, attacks the bone and prevents it from growing new, replacement cells making those holes and spaces inside that honeycomb much larger and wider, and causing the bone to lose both mass and density.
In some cases, the bone can appear nearly hollow, making it extremely brittle and far more prone to breaking than healthy bone. That, in no small part, is why fractures of both the spine and hip are so common in the over-50 population.
It is, says Coren, “a function of age,” and he wryly adds: “We don’t have the evolutionary ability to replace our limbs.”
But with almost 40 years of orthopedic practice under his belt, Coren is not about to concede that osteoporosis is an inevitable fact of life. With better diagnostics and new, improved treatments, he is enthusiastic about taking on this disease.
“One of the things they teach you in medical school,” says Coren, “is that if you don’t think about the diagnosis, you can’t make the diagnosis,” and he says that’s one thing that has gotten much better in regard to osteoporosis.
“The family practitioners, primary care physicians [and] OB-GYNs are getting much, much more attuned to the diagnosis of osteoporosis and they’re doing a much better job,” Coren says. “I think, as an orthopedist, we really weren’t concentrating on this for many years. It’s only probably in the last five to 10 years that some of us have begun to champion this problem.
“You have to almost be relentless” in confronting the disease, he adds.
Relentless seems an apt word to describe Coren’s passion for preventing, diagnosing and properly treating osteoporosis; he quickly lists a number of things seniors should insist on.
“First of all, you need to be checked,” Coren states, citing safe and painless bone density scans as well as having vitamin D levels checked. “Everybody talks about calcium, but vitamin D is essential in building bone and vitamin D is very important in fighting other diseases. If [vitamin D] levels are low, it’s easily replaced and very inexpensively replaced. You can get over-the-counter supplements for that.”
Next, Coren points to balance issues and the loss of muscle mass, or sarcopenia.
“We’re just starting to look at how we can help patients build muscle mass so that they tend not to have as bad a degree or significant a degree of osteoporosis,” says Coren. “Muscle mass is important for balance. One of the big things that happens is that if you have osteoporosis and you fall, you’re more likely to get a fracture. If we can do things to help prevent patients from falling, work on their balance, things like that, then we can help prevent these fractures.”
Moreover, according to Coren, new drugs are also coming onto the scene. “It’s an ever-changing field. There are new medications that are coming through the pipeline that may be even more effective than the ones we have,” and there’s already quite an arsenal of drugs currently available.
In fact, the never-say-die Coren has just started his own Fracture Liaison Service.
“All the fractures that come in to our physicians [at Vero Orthopedics] get referred to me for an osteoporosis work-up,” says Coren, and “it’s now offered to anyone who wants to send patients to me. That’s what we want – to do the prevention. We want to do the diagnosis and keep people functioning. We have physical therapy that we use. We have the balance program. We have testing for sarcopenia.”
Coren says the National Osteoporosis Foundation “has a great website” at https://www.nof.org/patients/what-is-osteoporosis/ which he highly recommends.
Dr. Seth Coren is in the Vero Orthopedics Vero Neurology (VOVN) building at 1155 35th Lane in Vero Beach. The phone number is 772-569-2330.