Strong Bones, Strong Body By Devra Krassner, ND
ost people think of bone as hard, sturdy and never changing. Actually, this could not be further from the truth! Bones are constantly changing, being remod- eled, replacing old and brittle bone with strong and healthy tissue. As we age, the rate of bone loss (resorption) out-paces the rate of formation of bone, and we become susceptible to osteo- penia and osteoporosis.
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What are Osteopenia and Osteoporosis? Both osteopenia and osteoporosis refer to loss of bone
mineral density, with osteoporosis representing the greater loss of bone mass. The signifi cance of bone loss is that fragile bone is more susceptible to fracture. Osteoporosis-related fractures ac- count for two million broken bones a year, according to the Na- tional Osteoporosis Foundation. A cycle of pain and immobility can signifi cantly affect a person’s ability to function and even to survive. In fact, 12-20% of people who fracture their hips die of related complications. The good news is, although there are no signs and symp- toms of osteoporosis, there are many steps we can take to maintain healthy bones and prevent bone loss. The fi rst step is to assess your risk factors. Women are far more likely to develop osteoporosis, and post-menopausal women are most affected. This is because of the sudden drop of estrogen at menopause, which leads to dramatically increased bone resorption. Other risk factors include a family history of osteoporosis, smok- ing cigarettes, heavy alcohol use, inactivity, short and slender stature, being Caucasian or Asian, medical conditions such as rheumatoid arthritis, and certain medications.
How are they diagnosed? Dual energy X-ray absorptiometry (DEXA) is the most accu-
rate measure of bone density techniques now available. Low- dose radiation is used to scan the body and assess the density of representative bones. The bones most commonly measured are the spine, hip and forearm. Heel ultra-sound is a newer test that
10 Essential Living Maine ~ May/June 2014
does not involve radiation, and may be a good screening test. However it is less precise than the DEXA, which remains the gold standard for evaluating bone density. The DEXA is reported as T scores, which compare your bone density to that of a young adult of the same gender. A nor- mal bone mineral density (BMD) is considered to be between 0 and -1. The reason it is reported in negative numbers is because it represents a bone loss. Between -1 and -2.5 standard devia- tions (SD) below a young adult is considered to be osteopenia. Osteoporosis is more than 2.5 SD below a young adult (2.5 or below).
In addition to the DEXA report, other factors are considered
in assessing fracture risk such as blood tests, history of fracture, and the risk factors discussed previously.
What are the Medical Treatments for Bone Loss?
Bisphosphonates are the group of medications most com- monly prescribed. These work by slowing the process of bone breakdown. Some of these can be taken orally (swallowed), such as Fosamax and Actonel, while others are given IV. The oral forms can cause stomach upset and heartburn, so it is recom- mended that they are taken with a full glass of water and that one remains upright for 30-60 minutes after taking them. Both oral and IV forms have been associated with two rare but seri- ous conditions. The fi rst is osteonecrosis of the jaw, which is the death of the jawbone due to lack of blood supply. The second is fracture of the femur, the long bone of the leg. There is also some controversy as to whether the bisphosphonates actually decrease the rate of fracture, or increase bone density with the formation of brittle rather than healthy bone. Other medical treatments include estrogen and hormone-
like meds such as Evista. These have become less popular due to potential risk of heart attack and certain types of cancer. Natural hormonal replacement (bio-identical hormones) is be- ing explored as another option for prevention and treatment of osteoporosis and osteopenia.
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