‘The Big O’ Ain’t What It Used To Be – Osteoporosis 101
In our younger days, “the big O” brought to mind mood music, our favorite lover, and moans of ecstasy. These days, for those in menopause and postmenopause, “the big O” might evoke thoughts of mood swings, our favorite munchies and moans of “Oh no!”
That’s because for many postmenopausal women, the new “big O” is osteopenia or osteoporosis. While osteoporosis has been a hot topic (pun intended), there’s a lot of confusion about osteopenia. According to the latest figures released by the National Osteoporosis Foundation, 43 million Americans over 50 have osteopenia.
When it comes to your bones, being dense is a good thing. Osteopenia means low bone mass that places you at increased risk for osteoporosis and broken bones. However, Dr. Diane Schneider, author of The Complete Book of Bone Health, explains, “A diagnosis of osteopenia doesn’t necessarily mean you’ll develop osteoporosis. Osteopenia is not a disease, either.”
In order to determine bone density, you’ll need to schedule a bone scan or bone mineral density (BMD) test. The most common – and most accurate – test is a dual-energy X-ray absorptiometry (DXA) scan. Try saying that real fast! The bones most commonly tested are those in the spine and hip and sometimes the forearm is added. If you’re worried about radiation, have no fears. A DXA scan uses low-dose X-rays. According to the National Institutes of Health, you receive more radiation from a chest x-ray.
To scan or not to scan, that is the question. Are you a candidate for a bone scan? The National Osteoporosis Foundation suggests that you should consider it if you can answer “yes” to these two questions
- Are you a postmenopausal woman or man age 50 or older?
- Have you recently broken a bone?
The test itself only takes about 10 minutes, so you can’t use “I’ve got no time” as an excuse. However, not all insurance plans cover bone scans, so be sure to check with your carrier first. The average cost of a DXA scan of the spine and hip is $140.
Looking at the numbers
After your test, you’ll be given a T-score (and we’re not talking golf). The Mayo Clinic explains that your T-score compares your bone density with that of a healthy young adult of your sex. According to the criteria established by the World Health Organization, here’s what your T-score means:
|-1 & above||normal|
|Between -1 to -2.5||osteopenia or low bone density|
|-2.5 & lower||osteoporosis|
If you have a T-score of -1, you have twice the risk for bone fracture as someone with a normal BMD. If your T-score is -2, you have four times the risk.
A study published in the Journal of the American Medical Association in 2001 reported that a 50-year-old white woman with a T-score of -1 has a 16 percent chance of fracturing a hip, a 27 percent chance with a -2 score, and a 33 percent chance with a -2.5 score.
Looking beyond the numbers
“Over the past decade, we have learned to use bone density scan results in the context of assessing one’s overall risk of fracture,” Dr. Schneider said. “The result of osteopenia must be evaluated along with other risk factors. For instance, if you compare a 55-year old woman with a 75-year old woman who both have the same T-score of -2.0, the 75-year old woman will have a higher risk of fracture based on her age alone. Various tools are being used to quantify fracture risk like the FRAX calculator. As a result, fewer early postmenopausal women are being treated with osteoporosis medicines.”
The National Osteoporosis Foundation recommends drug treatment for osteopenia in postmenopausal women and men age 50 and older who have at least a 20 percent risk of any major fracture (spine, forearm, hip, or shoulder) in the next decade or at least a 3 percent risk of a hip fracture.
Johns Hopkins Medicine warns that taking bisphosphonates or other bone-building medications for osteopenia means you may be treating a condition that might never develop. These medications also can be costly, which may be a determining factor on when – or if – you begin taking them. You will want to make sure your risk is high enough to warrant starting on medicines.
Medications used to treat osteopenia/osteoporosis include alendronate (Fosamax and Binosto), risedronate (Actonel and Atelvia), ibandronate (Boniva), and raloxifene (Evista). Other medical options include denosumab (Prolia) as twice a year injections, zoledronic acid (Reclast), given intravenously once a year or every two years, and teriparatide (Forteo), daily injections for a total of two years only. Estrogen is FDA-approved for prevention of osteoporosis if other options are not viable.
Some doctors recommend taking medication for five years, taking a break, and then going back on medication. This may mitigate any potential rare negative side effects, such as femur fractures, jawbone decay and more.
Harvard experts suggest if your T-score is closer to -1, you’re better off getting more weight-bearing exercise, calcium (1000 mg/day), and vitamin D (800 mg/day). Weight-bearing exercises are usually those where your feet (not your tatas) touch the ground, such as running and walking. Strive for at least 30 minutes a day.
Sorry, ladies, but you’ve got to lay off the bottle… in moderation. One alcoholic drink a day for women and two a day for men is considered moderate. Heavy drinking, however, can increase your risk of osteoporosis.
It goes without saying, but we’ll say it anyway – you shouldn’t smoke. Period.
Doctors did overmedicate osteopenia in the past. Now that fracture risk is assessed, those with low fracture risk do not benefit from medicine, but those with high risk, as defined by the National Osteoporosis Foundation, do.
If you’ve been diagnosed with osteopenia, consult with your physician to determine the best course of action.
Keep the “O” in the bedroom and out of your bones!
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