The Inside Press

Magazines serving the communities of Northern Westchester

get screened

Osteoporosis Fear vs. Facts: Why Many Patients Avoid Treatment

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Osteoporosis is often called a “silent disease.” But its consequences are anything but quiet. The condition weakens bones, making them thinner, more fragile, and more likely to break, and a hip or wrist fracture after a minor fall is often the first warning sign. Understanding your risk and treatment options could prevent a life-altering injury.

Who Should Be Screened?

Screening for osteoporosis remains a major gap in care. Bone density testing is generally recommended for all women age 65 and older and for younger postmenopausal women with risk factors, such as family history of hip fractures. However, several high-risk groups are frequently overlooked:

  • Men over 70, particularly those with risk factors such as low testosterone levels. This includes men receiving androgen-deprivation or other hormone-lowering therapies for prostate cancer, which accelerate bone loss.
  • Women taking aromatase inhibitors for breast cancer, which significantly increase the rate of bone loss.
  • Individuals who are underweight (BMI ≤19) or women who are under 127 pounds, consume more than three alcoholic drinks per day, or smoke.
  • People taking chronic steroids.
  • Individuals with rheumatologic disease, including but not limited to rheumatoid arthritis, lupus, alkalizing spondylitis psoriatic arthritis.
  • Individuals with endocrine disease, including: type 1 diabetes, hyperthyroidism, parathyroid disease.
  • Women who experienced menopause before age 45.
  • Adults over 50 with a personal or family history of fragility fractures, particularly fractures of the spine, hip, forearm, humerus, or pelvis.

Recognizing these often-overlooked risk factors can mean the difference between preventing a fracture and responding to one.

The Treatment Gap

Dr. Eric Rudin

Even after a fracture occurs, treatment rates remain surprisingly low. Many patients who experience a hip or wrist fracture never receive osteoporosis medication, despite clear evidence that they are at high risk for another fracture.

This treatment gap has serious consequences. Beyond mortality, fractures often lead to:

  • Loss of independence
  • Chronic pain
  • Long-term disability

Putting Medication Risks into Perspective

One of the main reasons patients decline treatment is fear of side effects. Media coverage and online discussions often highlight rare complications such as atypical femur fractures and osteonecrosis of the jaw. While these risks are real, they are extremely uncommon.
In contrast, the benefits of osteoporosis medications are substantial. Many approved therapies reduce the risk of spine fractures by up to 50–70% and hip fractures by approximately 35-40%. For patients at high risk, the reduction in fracture risk far outweighs the rare possibility of serious side effects.

The Good News

Osteoporosis is both detectable and treatable. Bone density scans are simple, noninvasive tests that provide valuable information about fracture risk. Medications are effective, and lifestyle measures, including weight-bearing exercise, adequate calcium and vitamin D intake, smoking cessation, and fall prevention strategies, further support bone health.

While osteoporosis may be silent, its consequences are not. If you or a loved one has experienced a fracture, has risk factors, or is receiving cancer therapies that affect bone health, it’s important to speak with a physician about screening.

With appropriate screening, informed discussions about medication risks and benefits, and proactive treatment when indicated, we can significantly reduce the burden of this common and often underestimated disease.

Colorectal Cancer: A Growing Concern for Younger Adults

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Dr. Eric Silberman

A quiet but significant change is underway in colorectal cancer trends, one that is increasingly affecting adults well before traditional screening age.

Colorectal cancer includes cancers of the colon and rectum, the last segments of the gastrointestinal tract. Colorectal cancers begin as polyps – small growths inside the intestine – that slowly develop into cancer over time. When detected early, colorectal cancer is highly treatable, which is why timely screening and early recognition are so critical.

Since the mid-1990s, rates of colorectal cancer have declined among older adults. In contrast, the rate of colorectal cancer diagnosis among adults under the age of 50 have steadily increased, with an annual rise of approximately 2% among adults ages 20-39. In fact, colorectal cancer is now one of the fastest-increasing cancers in young adults.

And it’s not just a numerical increase; there are increasing cancer burdens as well. Studies have shown that younger patients are more likely to present with later-stage disease and, in some cases, more aggressive cancers. Younger patients may also face unique challenges compared to older adults, including concerns related to fertility, family planning, career development, and financial stability.

In response to these rising rates, screening guidelines have evolved. In recent years, both the American Cancer Society and the U.S. Preventive Services Task Force have lowered the recommended starting age for colorectal cancer screening in average-risk adults from 50 to 45 years.

Encouragingly, these updated screening recommendations are already making an impact, with more adults between 45 and 49 undergoing these life-saving tests.

While expanded screening has improved early detection, researchers continue to investigate why colorectal cancer rates are increasing in younger populations. Several theories are being explored, including:

  • changes in diet and lifestyle
  • alterations in the gastrointestinal microbiome
  • rising obesity rates
  • environmental exposures

A major ongoing challenge is in patients younger than the screening age of 45 years old, in whom gastrointestinal symptoms may still be dismissed or attributed to stress, diet, or benign conditions like hemorrhoids or irritable bowel syndrome. Increased awareness of the symptoms of early-onset colorectal will be essential in guiding patients to the proper care going forward.

The symptom most strongly associated with early-onset colorectal cancer is rectal bleeding; other concerning symptoms include persistent changes in bowel habits, unintentional weight loss, and unexplained abdominal pain, cramping, or bloating. When these symptoms persist, they warrant medical evaluation.

Individuals with a family history of colorectal cancer or inflammatory bowel disease are at higher risk and may need earlier screening. However, many young adults diagnosed with colorectal cancer have no known risk factors, highlighting the need for vigilance among both patients and healthcare providers.

Colorectal cancer screening is typically performed with a colonoscopy, which allows a gastroenterologist to sample or remove concerning polyps during the same procedure. Blood-based and stool-based tests are also available for average-risk patients, though any abnormal result will need to be followed with a colonoscopy. Importantly, anyone experiencing concerning symptoms should be evaluated by a gastroenterologist regardless of age or screening history.

Early detection saves lives. Understanding symptoms, recognizing risk, and knowing when screening is appropriate can make a profound difference as the demographics of colorectal cancer continue to change.