Better Bones

Featured Article, Healthy Living, Osteoporosis, Women's Health
on May 1, 2011

At 23, Ginny Temple Franks of Birmingham, Ala., wasn’t thinking about osteoporosis. Why would she? Even though the disease ran in her family, she thought, like most people, she’d be near retirement age before she really had to be concerned. But a simple bone density screening at a health fair told another story. After her doctor performed a more indepth bone scan, Ginny got the verdict: She had osteopenia, or low bone mass, a precursor to osteoporosis.

“I knew that my mother and grandmother had osteoporosis,” Ginny says. “But I had no idea that I would have to worry about it so early in life.”

It turns out we all do, especially women, who are diagnosed with osteoporosis four times as often as men. Osteopenia, although not itself a disease, is a red flag indicating that a woman may be at risk for osteoporosis, a disease characterized by low bone mass and deteriorating bone tissue, greatly increasing the risk of bone fractures.  Both conditions are expected to affect 35 million women in 2010 and 41 million by 2020.

Why the increase?  For one thing, many menopausal women have stopped taking bone-preserving hormone replacement therapy as a result of a 2002 study suggesting that drawbacks outweigh benefits.  The loss of estrogen that comes with menopause causes our bone density to drop an average of 2 percent per year for 10 years. “People are also living longer with chronic illnesses like cancer and those or the treatments for those can impact bone,” says orthopedic surgeon Dr. Kim Templeton, associate professor of orthopedic surgery at the University of Kansas Medical Center in Kansas City, Kansas. “And we’re now finding osteoporosis in populations—men, Hispanics, African-Americans—where we once thought it didn’t occur.”

Still, osteoporosis doesn’t have to be our fate. The key to prevention is a focus on bone health from infancy on. “There are two components when you’re looking at bone density,” Templeton says. “How much did you make growing up, and how fast are you losing it?  If you never achieved full bone mass, then you are apt to get osteopenia and osteoporosis at a much younger age.”  

For adults who grew up in a fast-food culture that encouraged sofa sitting, packing on bone before bone mass peaks at age 30, became more difficult—as it is for children now. “Kids are not getting enough calcium or vitamin D,” Templeton says. “A lot are not getting weight-bearing exercise.” Calcium, of course, helps build bone; vitamin D enables our bodies to make the best use of the calcium.  And weight-bearing exercise stresses bone, stimulating growth.

Fortunately, it is never too late to pack in calcium, vitamin D and exercise. The challenge is making it faster than you lose it. Ginny, for one, is determined to stay ahead of the curve: In addition to taking ibandronate (Boniva), a once-monthly drug that keeps bone from breaking down and can even increase bone density, she takes 1200 milligrams of calcium and 800 international units of vitamin D a day. Until graduate school and a full-time corporate communications job swallowed her days, she also lifted weights and exercised on the treadmill three times a week. She’s hoping that once her bone levels return to normal, she can go off the drug.


5 Steps to Stronger Bones


Her optimism matches that of the doctors: A diagnosis of osteopenia doesn’t inevitably lead to osteoporosis, says endocrinologist Dr. Errol Rushovich, director of the Center for Bone Health at Mercy Medical Center in Baltimore. Nor does it mean you have to hop right onto medicine, as Ginny did because of her youth and family history.

A T-score on a DEXA, or bone, scan of -1 to -2.5 indicates that you have osteopenia: Your bone mass is lower than the bone mass of a healthy 25-year-old. “But it’s important to see the number in context of other health parameters such as family history, if you have already had a fracture, if you smoke or have a low body weight or have another major disease process like rheumatoid arthritis,” Rushovish says. “If you just look at a low DEXA score without looking at other factors, you tend to over-treat low-risk patients.”

Another factor is the Z-score on the DEXA scan, the measurement of how your bone density compares to someone your own age and sex. “You may have osteopenia but your bone density may have a normal Z score,” says Templeton, a less serious diagnosis than if you are also losing bone faster than others your age.

The key is to watch out for your bones the way you watch out for your heart, brain or teeth. The National Osteoporosis Foundation recommends that all women 65 and older have a DEXA scan. Rheumatologist Dr. Nathan Wei, clinical director of the Arthritis and Osteoporosis Center of Maryland, has a different view: “A bone density scan should be part of every woman’s physical exam starting at age 40, if she has no risk factors and earlier, if she does.”

And if your doctor tells you that you have osteopenia, together you can weigh options. Be cautious of overtreatment: Two 2010 studies—one at Columbia University and another at the Hospital for Special Surgery in New York City—have found that in some patients taking bisphosphonates, a common osteoporosis medication, for four years or more, bone may become more brittle. “You need to talk to your provider to see if there are things—medications, exercise, calcium, vitamin D—that can be changed,” Templeton says. “You don’t necessarily need to go straight to medication. But the fact is that everyone should be concerned about bone health as soon as they are born.”