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Treating Osteopenia


Vitamin D and calcium are key to helping low bone density

According to the American Congress of Obstetricians and Gynecologists, about 13 percent to 18 percent of women in the United States who are at least 50 years old have osteoporosis and an additional 37 percent to 50 percent have osteopenia.

This may come as a surprise given that many women, and men alike, have never heard of osteopenia and others may have the condition and not even know it. “Osteopenia means your bone density is somewhat low but not low enough to be osteoporosis,” says Jill Ryan, director of communications and marketing at the National Osteoporosis Foundation.

The bones work in interesting ways. “Fortunately, in the bones there is a system for recovery so you have bone cells being made and bone cells that are being taken away,” says Dr. Alan Burshell, section head of endocrinology at Ochsner Health System in New Orleans. This leaves us with two basic terms. “We call the removal of bone resorption and the formation of one bone formation,” says Burshell. Some bone loss is to be expected. “Coupling these factors is well-maintained in the pre-menopausal period of time, but in women as they are into menopause, there may be a net loss of bone each time they go through a cycle,” says Burshell.

Women often suffer most. “In women, the sex hormone estrogen protects bone, so bone loss increases after menopause when estrogen levels drop sharply. So if you go through menopause early, your risk increases,” says Ryan. The same holds true if your ovaries are removed because they produce most of the body’s estrogen. “For men, testosterone protects bones so low levels mean there is an underlying disorder to be evaluated,” Ryan says. A blood test can determine if hormone levels are normal. “People with depression are also more likely to have low bone density,” says Ryan.

But don’t fret, Ryan says, because a lower bone density may be considered normal for you. “If you learn that you have low bone density after your first bone density test, it does not necessarily mean you are losing bone; you may be a person whose bone density has always been lower than average,” says Ryan. Some people, due to genetics, body size or certain disease or conditions, never have normal bone density. “Only after your second bone density test will you know if you are losing bone density because your health-care provider compares the second bone density test to the first one to find out if your bone density is staying the same or changing.” Sometimes it even takes a third or fourth test to be sure.

Know if you need a bone density test. “You should have a bone density test if you are a woman above 65, a man over 70, you break a bone after 50, you are a woman of post-menopausal age with risk factors, you are a postmenopausal woman under 65 with risk factors or you are a man between 50 and 69 with risk factors,” Ryan says. A T-score between -1.0 and -2.5 means you have low bone density or osteopenia. The DEXA, or dual energy X-ray absorptiometry, scan is not hard. “It takes about 5 minutes as women lie on their backs, put their calves up on a foam block and it is a combination of ultrasound technology and X-ray radiation, which in low dose looks at the hips and back and tells where weak areas may be,” says Dr. Stephen Champlin, obstetrician/gynecologist at East Jefferson General Hospital in Metairie.

Besides the bone density test, sometimes FRAX, or a fracture risk assessment tool, is done. “FRAX can be used to guide decisions about treatment in people who meet the following three conditions: post-menopausal women age 50 and older, people with low bone density or osteopenia and people who have not taken an osteoporosis medicine,” says Ryan. Family history can play a role as well.

It is important not to skip out on the opportunity to get screened. “Now that we have good technology and good machines to pick up bone density, we can pick up osteopenia years in advance of it actually turning into osteoporosis so women can get started on medication, get their bones stronger and never have to deal with an osteoporotic fracture or deformed posture,” says Champlin.

Exercise can be helpful. “There is some information that you can improve bone somewhat as far as strength by weightlifting, but you have to be careful and cautious in that circumstance because you can also do damage,” says Burshell. Weight-bearing exercises such as jumping rope, walking or running as well as using exercise bands or resistance machines can make a difference.

Watch what you eat and get enough calcium. “Adults under 50 need 1,000 milligrams of calcium every day and adults 50 and older need 1,200 mg of calcium every day,” says Ryan. There are countless advantages to calcium. “In addition to building bones and keeping them healthy, calcium helps blood clot, nerves send messages, muscles contract and other body functions,” Ryan says. Since your body cannot produce calcium, you have to get it through the foods you eat. “When you do not get enough calcium for your body’s needs, it is taken from your bones,” says Ryan.

If you do not like foods with calcium, you can incorporate calcium into foods you do like. “You can add calcium to foods because a single tablespoon of nonfat powdered milk contains about 50 milligrams of calcium and you can add it to puddings, homemade cookies, breads or muffins, soups or gravy and casseroles,” Ryan says. Stay away from cigarettes because in addition to all their detrimental effects on your health, they are bad for your bone cells and make it harder for you to absorb calcium.

Vitamin D is equally important. “Adults under 50 need 400 to 800 IUs every day and adults 50 and older need 800 to 1,000 IUs every day, which can come from sunlight, a few foods, multivitamins, supplements and medicines,” says Ryan. There are a variety of sources so there are no excuses to come up short. “Foods that are high in vitamin D are fatty fish like salmon, tuna and mackerel, which are also heart healthy and high in omega-3s,” says Rebecca Lee, dietician at East Jefferson General Hospital in Metairie. Additionally, magnesium, potassium and vitamin K have shown to be beneficial for bone health.

For treatment, some people with T-scores between -1.0 and -2.5 should consider taking osteoporosis medicine if they have certain risk factors. There have been new findings in recent years. The American Congress of Obstetricians and Gynecologists says that another medication used to slow the breaking down of bone is calcitonin, which can be given by injection or nasal spray. Parathyroid hormone can be used to increase bone density and reduce the risk of fractures as well. Hormone therapy protects bones for as long as you use it but when you stop taking hormone therapy, bone loss resumes. It is recommended to take the smallest dose of hormone therapy that works for you for the shortest amount of time.

Decisions about when to take medicine to prevent bone loss do not come easy. “The health-care provider looks at your age, gender, if you have broken a bone in the past, your chances of breaking a bone in the future using the FRAX tool, other diseases and conditions you have, medicines you take, your lifestyle, your family medical history, your chance of falling and other factors,” says Ryan. A final precaution is to know that concerns about the effects of depot medroxyprogesterone acetate (DMPA), the contraceptive shot, on bone mineral density should not prevent clinicians from prescribing this method of contraception, according to the American Congress of Obstetricians and Gynecologists. Women should be counseled about the risks and benefits in order to make an informed decision about whether it is appropriate for them.

Do not underscore the importance of knowing where you stand in terms of bone density. Remember that osteopenia is not a disease; it just means you have a greater chance of getting osteoporosis if you were to lose bone in the future.

-Jamie Lober