‘The Big O’ Ain’t What It Used To Be – Osteoporosis 101 - Ellen Dolgen

‘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!”

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.

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.

Detecting osteopenia

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 manage 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.

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.”

Medical options

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.

Non-medical options

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!

Suffering in silence is OUT! Reaching out is IN!

Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause.


10 thoughts on “‘The Big O’ Ain’t What It Used To Be – Osteoporosis 101”

  1. Hi Ellen:) Love this article! After my bone scan showing beginning stages of osteoporosis, i got proactive taking natural supplements. They worked! I GREW BONE!! Also being proactive with ALL hormones is so important as you have mentioned. So thankful Ellen:) Would like to add to anyone reading this… Please get a complete thyroid test from your dr. If he won’t give this very important test, find a Dr that will. It changed my life, and now I’m on my way to better health. Blessings to all, Linda

    1. Wow,Linda, this is fantastic! I love hearing that you caught your bone health in time! Sounds like you found the right combination that worked for you. You are so right about the Thyroid Panel…it is so important to know your numbers. Thanks so much for sharing your story with the sisterhood. We can learn so much from each other.

  2. This is a great summary of a confusing topic, Ellen. Thanks.
    I discovered that I have osteoporosis when I fell and shattered my ankle. I knew it was bad when the surgeons told me “we put most of it back together.” Apparently the bones were so fragile that some pieces simply couldn’t be reattached.
    It came as a shock to discover that I have this condition, but I’m doing my best to fight it with calcium, vitamin D, and exercise. I’ll be getting another scan shortly, so hope the results will be improved a bit.

    1. I am so sorry you are going through so much, Karen. Sounds like you are on top of the situation now. Good Luck! Help me spread the word about the big “O” as I want women to be proactive about this not reactive after a fall. Keep me posted on you. Fingers crossed that you next scan shows improvement!

  3. This article is very informative. I thought that i already know a lot about osteoporosis but I still learned some new ones here. I would definitely share this to my friends and family. I have this one friend that is always in such great pain on her back whenever she falls asleep not completely laid down and I feel really bad for her because she is forced to take pain killers and sometimes she takes more than she is supposed to because she feels like one pill doesn’t alleviate her of the pain. She is only in her late 20s and I’m worried that it might have something to do with osteoporosis but it is really hard to tell it to her because she might say she’s too young for it. Thanks for this post I think that osteoporosis is something that a woman should be aware of even at an early age.

    1. I would definitely suggest that she go to her internist to find out what specialist to go to so that she can have this pain checked out properly.

  4. I found this really interesting – thank you. At age 50 my DXA scan results showed osteoporosis and osteopenia(hip/spine) and I started taking fosomax. My numbers improved and then leveled off at borderline osteopenia, and after 4.5 years I stopped taking the medicine because I was getting nervous based on what I was reading about the drugs. I continued with calcium supplements but also dropped those when my doctor said that I should only take a very small dose (250mg or less) spread throughout the day, due to recent findings about the effect of calcium on the arteries. Now I just try to get calcium through diet. It’s so hard to know what to do for bone health because the research is still evolving! At least the weight bearing exercise advice is consistent, and I’ve tried to do that regularly. I would love to hear your thoughts on calcium supplements in the future.

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