Osteoporosis
Welcome back, Bestie. Thanks for stopping by to chat. Today, I wanted to talk about osteoporosis, or low bone density. Osteoporosis is a condition that tends to occur in females who are post-menopause, but can affect anyone. Let’s get into it!
What is osteoporosis?
Osteoporosis is a disease of the bone. It is characterized by low bone mass. To explain how osteoporosis works, let’s talk about the way bones are made. Bones are made up of different types of cells called osteoblasts, osteocytes, and osteoclasts. The term “osteo” is the Greek word for “bone,” so when you see that term, know it is referencing bones in some way. Osteoblasts are cells that build new bone. Some osteoblasts eventually turn into osteocytes, which are the cells inside the bone. These osteocytes are the main cells that make up the substance of the bone. Osteoclasts are cells that break down bone. These are important because your bones are constantly being remodeled. Old bone is removed and replaced with new bone. This constant balance between discarding old bone cells and replacing them with new, healthy bone cells is what keeps bones strong. In cases of osteoporosis, however, the osteoclasts remove bone faster than it can be replaced by the osteoblasts. This leaves bones weaker and more brittle.
You may have also heard the term “osteopenia.” Osteopenia refers to lower than expected bone mass. It is a stage of lowered bone density that occurs before osteoporosis. While osteoporosis and osteopenia are not reversible, they are preventable. More on that in a bit.
Osteoporosis is what some refer to as a “silent disease.” This is because it doesn’t tend to come with very many symptoms. It is not associated with pain or disability, unless a bone is broken. The main issue associated with osteoporosis is bone fracture. Folks with osteoporosis most often experience fracture in the spine, hip, and forearm (1).
You might be wondering: “Why does osteoporosis affect so many more females than males?” Great question. If you know anyone with osteoporosis, chances are they’re female. It is way more common for ladies to develop osteoporosis and this has to do with the changes in bodily hormones that occur following menopause. After menopause, there is less estrogen available in the body which causes bone to be lost at a faster pace.
Causes of Osteoporosis:
As mentioned above, osteoporosis may be the result of decreased bodily estrogen following menopause, but this isn’t its only cause. Folks that have been taking glucocorticosteroid medication (steroids) for six or more months are at a much higher risk for developing osteoporosis. Bone loss resulting in osteopenia or osteoporosis is also common among folks who have suffered a stroke and do not return to walking, as well as folks with mobility disabilities. Further, conditions such as diabetes mellitus, cystic fibrosis, and cancer are also associated with increased risk for osteoporosis due to medications and/or the nature of the diseases themselves.
How is it diagnosed?
Osteoporosis is diagnosed based on bone mineral density (BMD). BMD can be measured via multiple methods but is most commonly assessed with a DEXA scan. A DEXA scan is a Dual-Energy X-ray Absorptiometry imaging technique that is quick and painless. It is typically recommended to have your BMD checked at age 65 for females and age 70 for males. After the scan, your BMD is compared to the average BMD of an adult of your same sex and ethnicity at the age of highest bone mass. Bone mass is usually highest between ages 25 and 30. This assessment method gives you what is called a “T-score.” Your T-score will tell you whether you have normal bone density, osteopenia, or osteoporosis.
A T-score between -1 and +1 demonstrates normal BMD. A T-score between -1 and -2.5 is considered osteopenia. Finally, a T-score lower than or equal to -2.5 indicates osteoporosis. The lower the T-score, the higher your chances are for bone fracture.
How is it treated?
Osteoporosis is managed with a variety of treatment techniques. Bisphosphonates, such as Fosamax, are widely used to treat osteoporosis, as are estrogen replacement medications and calcitonin. These medications block the resorption of bone as bones remodel, helping to maintain higher levels of bone mass. Teriparatides are the only medications available that can help bones to actually improve bone formation, rather than just blocking bone resorption.
Osteoporosis can also be addressed in physical therapy as you work on exercises that can help you maintain bone mass. Your therapist will also help you improve your balance and home setup in order to avoid falls and therefore reduce potential for fractures. In physical therapy you will talk about exercises that are safe to perform if you have osteoporosis, as well as those that are not safe to perform. Such exercises include flexion-based activities, such as crunches, or anything where you are curving your spine in a forwardly bent position, as this puts extra pressure on the bones of the spine that are already at risk for fracture.
Is it preventable?
As discussed above, osteoporosis and osteopenia are preventable! In some cases, it can be hard to prevent. One such case would be in someone with cancer, who must undergo lifesaving chemotherapy and/or radiation treatment. However, in otherwise healthy folks, osteoporosis can be avoided if appropriate precautions are taken throughout life.
It is essential to have enough calcium intake throughout life in order to maintain appropriate bone mass. The body also needs vitamin D in order to absorb calcium, so it is important to get adequate amounts of both calcium and vitamin D. If you are over the age of 25, it is recommended to consume at least 1,200 mg of calcium per day (2). Adults up to 65 years old should get 400 international units (IU) of vitamin D daily, and 600-800 IU for those over 65 years (3).
Finally, exercise is one of the most important tools in preventing osteoporosis. Exercise stimulates bone growth and keeps bones at their strongest. The most helpful exercises are resistance exercises and weight-bearing exercises, such as running or walking (4). When in doubt, exercise! Your bones literally depend on it.
If you or a loved one has been diagnosed with osteoporosis, the most important things are maintaining your current bone mass and avoiding falls. Osteoporosis can be a scary diagnosis, but it is not a life sentence and you can still live a happy, healthy, and full life with the condition. You’ll be just fine—I feel it in my bones!
XOXO,
Your Pelvic Bestie
References:
1. Cooper C, Melton LJ III. Vertebral fracture: how large is the silent epidemic? Br Med J 1992;304:793–794.
2. Bryant RJ, Cadogan J, Weaver CM. The new dietary reference intakes for calcium: implications for osteoporosis. J Am Coll Nutr 1999;18 (Suppl):406S–412S.
3. Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003;111:908–910.
4. Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. 2018 Dec 23;2018:4840531. doi: 10.1155/2018/4840531. PMID: 30671455; PMCID: PMC6323511.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
