Like our other organs, bones are living tissues going through their own “circle of life.” Different types of bone cells are each responsible for forming, maintaining, and reabsorbing bone tissue. When we are young and still growing, bone cells create bone tissue faster than the tissues die and are reabsorbed. Osteoporosis is a bone disease in which the bone cells can’t make new bone as fast as the old bone degenerates.
For those with osteoporosis, bones are brittle and fragile and at risk of fracture. It can be so severe that a minor impact, or even a cough, can be a fracture risk. Osteopenia is not a diagnosis. It’s a description, a state. This is a key difference between osteopenia and osteoporosis. The word “osteopenia” means “low bone mass”— stating an observation that your bone mass is lower than that of a woman in her late 20s—someone at the peak of their bone-building and strength. Women’s peak bone mass occurs in their late 20s.
Osteopenia, if it happens at all, usually occur near age 50. The exact age depends on how strong your bones are when you’re young. If you have hardy, healthy bones, you may never get osteopenia. If your bones aren’t naturally dense, you may get it earlier.
Osteopenia usually doesn’t have any outright symptoms. This makes it difficult to diagnose unless you have a bone mineral density test. Osteopenia will lead to osteoporosis but may lead to full-on osteoporosis if ignored.
As we age, our bone strength decreases, hence the risk of developing osteoporosis increases. Women, especially white and Asian women, are more susceptible to the disease than men. This is why we encourage pre- and post-menopausal women to talk to their physician about their concerns, and start taking preventative measures while their bones are still relatively healthy.
Symptoms of Osteoporosis
One of the dangers of osteoporosis is that there are no outward symptoms to warn you until you already have the disease. After many years, you may notice signs like back pain, a loss of height, or a stooped posture. For some people, the first sign they have of the disease is a broken bone, usually in the spine or hip. However, there are some things you can do to reverse some of the effects of osteoporosis even after you’ve developed some symptoms.
Bones weakened by osteoporosis may cause:
- Back pain
- Stooping or slouching posture
- Shrinking stature over time
- Unexpected bone fractures
If you’re experiencing these symptoms, it is important to talk to your health care doctor about how to prevent further bone loss. You may also be at higher risk if you went through early menopause, if your parents had any hip fractures in their old age, or if you took corticosteroids (i.e. cortisone, hydrocortisone, and prednisone) for a long period of time.
Risk Factors for Osteoporosis
There are some risk factors for osteoporosis. These include:
According to some estimates, approximately one-third of women over 50, often postmenopausal women, will have an osteoporotic fracture, compared to one in five men.
As you get older, your risk of developing osteoporosis increases.
Osteoporosis is a hereditary condition. If your family history reveals that close relatives have osteoporosis or has broken a hip at some point, this puts you at a higher risk.
Your Body size
Those who are short and petite are at a higher risk because they have less bone mass to begin with when their renewal rate starts to slow down.
Asian and white women tend to suffer from osteoporosis at higher rates than Black and Hispanic women. It’s not clear exactly why, but it’s most likely due to a combination of several factors, including heredity, differences in body size, hormonal status, bone density, and cultural practices that may affect diet and physical activity.
Since estrogen has a protective effect on bones, the decrease in estrogen during menopause can weaken bones. This is one of the reasons why women suffer from osteoporosis at higher rates than men.
There are also modifiable risk factors that can contribute to osteoporosis. These include:
Some steroids increase the risk of osteoporosis when taken long-term. Corticosteroids, like prednisone, cortisone, and hydrocortisone, weaken bones by damaging the bone-renewal process. Some medications used to treat cancer, seizures, gastric reflux disease, and transplant rejection have also been known to increase the risk of osteoporosis.
Anorexia, another disease more common in women than men, can deprive the body of nutrients and weaken bones.
Weight-bearing exercise forces the body to build strong bones. People who live a sedentary life are generally at a higher risk for osteoporosis.
Alcohol and Tobacco
Both of these bad habits have been shown to increase the risk of osteoporosis.
The risk of osteoporosis is higher in people who have certain medical problems, including:
- Celiac disease
- Inflammatory bowel disease
- Kidney or liver disease
- Multiple myelomas
- Rheumatoid arthritis
Preventing Bone Loss and Fractures
Preventing osteoporosis and osteopenia may not be possible for some people. There are many uncontrollable risk factors that may affect your chances. However, reducing your risk starts with living a healthy lifestyle. If you’ve built up enough bone mass in your youth, you may be able to avoid osteoporosis as you age.
Get enough calcium supplements and vitamin D. This may be the most important thing you can do for your bones at any stage of life.
You can help your bones stay strong and avoid osteoporotic fractures by:
- Avoiding smoking.
- Avoiding alcohol. Drinking any more than 2 drinks per day might hurt the renewal process.
- Preventing falls. Run a safety check on your home for stray electrical cords, loose rugs, and slippery floors. Have grab-bars and non-slip pads installed in your shower and bathroom. Wearing non-slip shoes are also a good option.
Visiting the Doctor
Please talk to us, and seek medical advice, if you have any concerns about your bone health. There are many therapies available to menopausal women to treat osteopenia and osteoporosis.
A bone density scan, also known as a DEXA scan, is a quick, painless, and non-invasive test for bone health. During the procedure, your wrist, hip, and spine are scanned with a low-level X-ray machine. This can tell us whether your bone density has reached unhealthy levels.
Treatments for Osteopenia and Osteoporosis
Based on the bone density result and risk factors of the patient, we can recommend an individualized treatment plan. Sometimes, only minor lifestyle changes are needed. Other times, patients need prescription medication. The most common medication for osteoporosis treatment is a group of drugs known as bisphosphonates, which includes Fosamax, Atelvia, Reclast, and Boniva. Bisphosphonates can be taken orally (weekly or monthly) or intravenously (quarterly or yearly).
If bisphosphonates aren’t right for you, then hormone replacement therapy may be another option to help increase bone density. However, estrogen therapy does carry some risks. It is important to discuss all options with your physician and see which treatment is best for you.