If you’ve hit 50 and you’re a woman, chances are your bones have lost some strength over the years. Most people’s bones are as dense as they’ll ever be between the ages of 18 to 25. By the time you reach 35, density begins to gradually decrease until menopause. After menopause, bone loss happens more rapidly — as much as 20 percent in five to seven years.
Losing too much bone can lead to osteoporosis, which means bones are brittle and can break with little effort. I’m in a category called osteopenia — my bones are slightly less dense than normal, but not in the range of osteoporosis.
Osteoporosis risk factors
My biggest risk factors are that I’m a post-menopausal woman with a small frame and my mother and grandmother had osteoporosis. Do you know your risk factors?
You may be at risk of osteopenia and osteoporosis if you
- Are a women
- Are post menopausal or have low estrogen levels
- Have a thin, small body frame
- Are a man older than 70
- Are Asian or Caucasian
- Have a family history of osteoporosis
- Have a history of broken bones
- Take certain medications, such as steroids
- Have certain diseases, such as rheumatoid arthritis, lupus, diabetes or a thyroid condition
- Don’t get enough calcium and/or vitamin D
- Are inactive
- Have more than three alcoholic drinks a day
- Drink more than three cups of coffee a day
- Are shorter than you used to be
Measuring bone density
I recently attended an osteoporosis seminar at Central Maine Medical Center, where its Osteoporosis Center was offering free finger screenings. Screenings of the lower arm, wrist, fingers or heel, which you might find at an event like I attended or at a health fair, can be useful for general screening. They may show that you have bone loss, but for more precise results, a DEXA (dual-energy x-ray absorptiometry) scan is recommended.
Dr. Lauren Adey, a surgeon at Central Maine Orthopaedics, explained to seminar participants that a DEXA scan uses low dose radiation to measure the amount of bone mass in the hip and spine and compares results to those of a healthy 30-year-old. The comparison, known as a T- score, gives a good idea of how much bone mass you may have lost over the years.
.9 or above (0, .5, .9) = normal
.9 to -2.4 = osteopenia
-2.5 or lower = osteoporosis
Who should get a DEXA scan?
Unfortunately, says Dr. Adey, some people don’t find out they have osteoporosis until they break a bone, which is why it’s sometimes called the silent disease. The DEXA scan is currently considered the gold standard test for diagnosing osteopenia and osteoporosis.
DEXA scans are recommended for
- Women over age 65
- Men over age 70
- Anyone with a broken bone who is over age 50
- Postmenopausal women with risk factors such as height loss, medication use, certain diseases and family history
When we’re young, preventing osteoporosis is generally not top of mind — but it should be. Doing whatever you can to build and keep bones dense and strong can help you in the long run, and Dr. Adey says it’s never too late to start.
Bones need calcium
- Ninety percent of the calcium in your body is in your bones and teeth.
- Calcium needs to be ingested; the body can’t make it on its own.
- Women under age 50 and men under age 70 need 1000 mg a day.
- Women over age 50 and men over age 70 need 1200 mg a day.
- Calcium rich foods include dairy products and fortified foods and drinks.
- To reach your daily amount, fill any gap with a calcium supplement, such as calcium carbonate or calcium citrate.
Vitamin D helps bones absorb the calcium
- People under age 50 need 400 to 800 IU a day.
- People over age 50 need 800 to 1000 IU a day.
- The best source of Vitamin D is sunlight, which is in short supply in the northern hemisphere and is blocked by wearing sunscreen (which is important to prevent skin cancer).
- You can get some Vitamin D in wild caught mackerel, salmon and tuna and some fortified milk and orange juice.
- To reach your daily amount, fill the gap with a Vitamin D supplement. Most calcium supplements include Vitamin D.
Exercise helps build strong bones
Regular exercise is good for just about everything, including slowing bone loss and improving balance and flexibility, which can reduce your risk of falling. When you’re trying to prevent osteoporosis, the most important type of exercise is weight-bearing, which uses your own body weight to work against gravity. A brisk walk is weight-bearing; a brisk swim is not.
Examples of weight-bearing exercises:
- Brisk walking
- Tai chi
- Racquet sports
If you have a T-score of -2.5 or lower, your doctor may recommend treatment. Several medications are now on the market that either slow bone loss or build new bone. Some are taken daily and others weekly, monthly or once a year intravenously.
Because of the high risk of bone fractures, especially hip fractures, osteoporosis is a disease that needs to be taken seriously. But before rushing to take a medication, you need to consider your true risk, as well as understand the medication’s benefits and drawbacks.
Knowing your FRAX ® score may help determine your risk. It was developed by the World Health Organization (WHO) and uses the T-score from your DEXA scan, along with your weight and family and personal fracture history to calculate your risk of having a fracture over the next 10 years. I found the FRAX ® tool online, which you can try yourself, but you’ll need your T-score.
If you’re not sure whether you should have a DEXA scan, Maine Quality Counts’ Choosing Wisely® in Maine campaign offers advice in its handout: Bone-density tests: When you need them—and when you don’t. And of course, If you have any concerns, the important thing is to have a thorough conversation with your doctor.