Osteoporosis/ Osteopenia

Question: At the most recent trip to my doctor’s office, she informed me that I have osteopenia. As a woman in her sixties who exercises regularly and eats healthy, I did not even think I could be at risk! I was wondering if you could provide me with information about exactly what this diagnosis means? Is there anything I can do to help strengthen my bones?

Answer: 

What is Osteopenia?

Osteopenia means that your bone mineral density is somewhat lower than "normal" but not low enough to be osteoporosis.  Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense they are. Bone mineral density is found using a bone density test which gives you your results as a t-score (comparing your density level to that of a "normal" woman). A bone density test uses X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. Osteopenia is defined as a bone mineral density T-score between -1.0 and -2.5. 

It is important to note that having osteopenia is not the same as having osteoporosis, and that technically, osteopenia is not in and of itself a disease, as osteoporosis is. Instead, osteopenia is an indication that your BMD is below the statistical norm and that you could eventually develop osteoporosis or be at risk of a future fracture. Please keep in mind that most BMD tests base the norm density on a healthy woman in her 20's which does not accurately reflect the same health as an older healthy woman. 

What is Osteoporosis?

If your bone density is 2.5 or more standard deviations below the average bone density (T-score of -2.5 or lower) you have osteoporosis (according to the World Health Organization).

Women go through two periods of increased bone loss. The first begins when a woman’s periods begin to become irregular and ends 4 years after her last period. The second occurs in our 70s.

Many women have osteoporosis and never find out or only find out after breaking a bone.

Causes & Risk Factors 

Bones naturally become thinner as people grow older because, beginning in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker and increasing their risk of breaking. Osteopenia is more common in women than in men and typically occurs in people age 50 and over.

Some people who have osteopenia may not have bone loss. They may just naturally have a lower bone density. Osteopenia may also be the result of a wide variety of other conditions, disease processes, or treatments. Women are far more likely to develop osteopenia and osteoporosis than men. This is because women have a lower peak BMD and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause.

Listed below are several osteoporosis risk factors:

• Getting older, which increases your risk of osteoporosis because bones become weaker as you age
• Ethnicity — for instance, women who are white or of Southeast Asian descent have the greatest risk of osteoporosis, and African-American and Hispanic men and women have a lower, but still significant, risk of the disease
• Low body weight, or under 125 pounds (56.7 kilograms) if you're of average height
• A personal history of fractures after age 40
• A parental history of osteoporosis or hip fractures
• Using certain medications – corticosteroids, aromatase inhibitors (breast cancer treatment), SSRIs (antidepressants), methotrexate (cancer treatment), protein pump inhibitors (acid blockers), some anti-seizure medications, and aluminum-containing antacids.
• Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
• Chemotherapy, or medicines such as steroids used to treat a number of conditions, including asthma
• Exposure to radiation
• Oophorectomy (removal of ovaries)
• using steroids for more than 3 months
• high doses of thyroid medication

In addition, having a family history of osteoporosis, getting limited physical activity, smoking, regularly drinking soda, and drinking excessive amounts of alcohol also increase the risk of osteopenia and, eventually, osteoporosis.

Treatment

Osteopenia is treated by taking steps to keep it from progressing to osteoporosis and, for a few people, by medication. We encourage you to talk to your doctor about treatment options that are right for you. Lifestyle changes can help reduce the bone loss that leads to osteopenia and osteoporosis. A good exercise routine and the right diet have been proven to help keep bones strong and healthy. Below I have listed several types of exercise and diet ingredients that are particularly good for bone health that you might want to consider in your weekly routine.  

Exercise

Strength training

Strength training includes the use of free weights, weight machines, resistance bands or water exercises to strengthen the muscles and bones in your arms and upper spine. Strength training can also work directly on your bones to slow mineral loss.  Exercises that gently stretch your upper back, strengthen the muscles between your shoulder blades and improve your posture can all help to reduce harmful stress on your bones and maintain bone density.

Weight-bearing aerobic activities

Weight-bearing aerobic activities involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing and gardening. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss. They can also provide cardiovascular benefits, which boost heart and circulatory system health.  Swimming and water aerobics have many benefits, but they don't have the impact your bones need to slow mineral loss. 

Flexibility exercises

Being able to move your joints through their full range of motion helps you maintain good balance and prevent muscle injury. Increased flexibility can also help improve your posture. When your joints are stiff, your abdominal and chest muscles become tight, pulling you forward and giving you a stooped posture.

Stretches are best performed after your muscles are warmed up — at the end of your exercise session, for example. They should be done gently and slowly, without bouncing. Avoid stretches that flex your spine or cause you to bend at the waist. These positions may put excessive stress on the bones in your spine (vertebrae), placing you at greater risk of a compression fracture. Ask your doctor which stretching exercises would be best for you.

Stability and Balance exercises

Stability and balance exercises help your muscles work together in a way that helps keep you more stable and less likely to fall. Simple exercises such as standing on one leg or movement-based exercises such as tai chi can improve your stability and balance.

Diet

Get enough calcium every day. 

This is important throughout your life for healthy bones.  If you get enough calcium from the foods you eat, then you shouldn’t need to take a supplement. The total amount of calcium you get includes the calcium in the foods you eat, plus your multivitamin and supplements. Although diet is the best way to get calcium, calcium supplements are an option if your diet falls short. Before you consider calcium supplements, though, be sure you understand how much calcium you need, the pros and cons of calcium supplements, and which type of calcium supplement to choose. You should consult your doctor before starting a calcium supplement regimen. 

How much calcium you need depends on your age and sex. Note that the upper limit in the chart represents the safe boundary — it's not how much you should aim to get. If you exceed the upper limit, you increase your risk of health problems related to excessive calcium.

Your body doesn't produce calcium on its own, so you must obtain it through other sources. Calcium can be found in a variety of foods, including:

• Dairy products, such as cheese, milk and yogurt
• Dark green leafy vegetables, such as broccoli and kale
• Fish with soft bones that you can eat, such as sardines and canned salmon
• Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices

Be sure to get your vitamin D.  Adults age 50 and older need 800-1,000 IU of vitamin D every day. Some people may need more. There are several ways to get vitamin D: from sunlight, foods such as dairy and fish, multivitamins, supplements and medicines. Vitamin D helps your body absorbs calcium.

Be careful with salt, caffeine and cola drinks. Too many of these “treats” is not good for your bones.

Avoid too much alcohol. Heavy drinking weakens bones. Drinking more than two to three alcoholic drinks a day can have a serious detrimental effect on your bones.

 Medical Treatment for Osteoporosis

There are a few different methods that are commonly prescribed for osteoporosis, each with their own risks and benefits. Hormones like estrogen and estrogen-progesterone have been shown to reduce the risk of osteoporosis and bone fracture. Learn more about the Networks stance on hormone treatments here.

Bisphosphates sold on the market as Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and Reclast are also often prescribed. They have been shown to slow bone breakdown, to decrease spine fractures, and some have been shown to also decrease hip fractures.  It was hoped that they would be a safe alternative to hormone treatments but have been found to make bones denser but also more brittle. Additionally, bisphosphates have been associated with rare but severe jaw ulcers and deterioration and unusual fractures of the middle of the thigh bone.

Selective Estrogen Receptor Modulators (SERMs) like Evista (raloxifene) are also used to prevent bone loss. They have been shown to reduce the risk of spine fractures without the risk of breast or uterine cancer. However, they may increase hot flashes and have the same risk of blood clots as taking estrogen.

As with all medications you should discuss with a healthcare provider which method could be best for you based on the risks and benefits.

Additional Resources you may wish to consider for more information:

http://www.mayoclinic.com/health/calcium-supplements/MY01540 - Information on Calcium and its benefits in your diet

http://www.nlm.nih.gov/medlineplus/osteoporosis.html - National Institutes of Health Fact Sheet on Osteoporosis

http://www.nof.org/learn - National Osteoporosis Foundation

http://courses.washington.edu/bonephys/ - Osteoporosis and Bone Physiology from the University of Washington

http://center4research.org/medical-care-for-adults/osteoporosis/osteoporosis-how-to-avoid-it-and-how-to-treat-it/ - National Research Center for Women and Families