Thoughts on Osteoporosis
This morning I fell down the stairs. I’m fine - a bit scraped up on my elbow and sore in my shoulders and back, but no major injuries. My first thought as I was laying stunned on the landing is wow, I am turning into my mother. But that immediately led to whew, thank goodness it wasn’t my mother who fell! As women age, especially women who are slight like my mom, their bone health declines. This is something triggered by the loss of estrogen that occurs with menopause, hence the reason most society guidelines recommend a screening DEXA scan for all women at age 65. Other risk factors that might necessitate earlier screening include smoking, excess alcohol intake, long term steroid use, low body weight, and parental history of hip fracture.
A DEXA scan will show one of three findings - normal bone density, osteopenia, or osteoporosis. Osteopenia is the in-between finding, with not quite normal bone density but not quite osteoporosis either. The report will also estimate a 10 year risk for fracture. The ultimate goal of addressing bone density is to prevent fractures, and more specifically fragility fractures. If you fall down the stairs and fracture your forearm, it’s not necessarily a sign of low bone density, depending on how dramatic the fall was. But if you fall from a standing height and shatter your tibia - I would suggest investigating for osteoporosis.
As with most conditions, prevention is key! To prevent loss of bone density, focus on weight bearing exercises with strength training. Weight bearing exercises include walking, jogging, jumping etc, as opposed to exercises like biking and swimming which are great for cardio but not overly helpful for your bones. In your diet, look to get about 1200mg of calcium per day. If you don’t think you are getting this much, which those who have to avoid dairy likely aren’t, then start an over the counter supplement. Most over the counter calcium supplements come with Vitamin D, which is necessary to absorb calcium.
If, despite all of the above prevention, you are diagnosed with osteoporosis, then there are several treatment options available to help rebuild and strengthen bones. Those with osteopenia or osteoporosis, on medication or not, are recommended to have follow up DEXA scans every 2 years. Interestingly, it’s important to have DEXA scans done on the same exact machine, otherwise the results can’t be compared. This is different than most other radiologic studies - it doesn’t matter if you get your mammogram in Bel Air one year and Towson the next. The radiologist can still pull the images and compare them easily. However, with DEXA scans, the instruments have to be calibrated and the positioning and labeling of bones can be variable. So when you go for your first DEXA scan, make sure it’s somewhere local!
I encourage everyone to discuss bone health with their primary care, as well as ways to prevent falls - stay active, stay healthy, and stay vertical!!
