Kulsoom Naqvi, MD, is a family medicine physician with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Silver Spring Medical Center.
You may have heard since you were a kid that you should drink milk to keep your bones healthy and strong. This is great advice!
Keeping your bones healthy is vital to well-being. As we age, our bones become less dense and more brittle. This can lead to bone fractures, which, particularly in older adults, can greatly diminish independence and quality of life. Sometimes, complications from bone fractures can be life threatening.
As a family medicine doctor at Kaiser Permanente, I want everyone to know about osteopenia and osteoporosis, and I want patients to feel empowered to take steps to prevent these conditions.
What Is Bone Density?
Bone density refers to how strong and thick your bones are. Low bone density means your bones are thinner, weaker and more porous, making them more prone to fractures, even from minor falls or bumps.
Osteopenia means your bone density is below normal, but not yet at the point where fractures are highly likely. Osteopenia is the stage between normal bone density and osteoporosis. Most people don’t have symptoms of osteopenia until they break a bone.
Osteoporosis is a condition in which bones lose mass and become weak and brittle. Bones are likely to break, sometimes even from a minor bump. Just as with osteopenia, many people don’t have symptoms of osteoporosis. Some people may feel bone pain or experience loss of height.
Diagnosing Osteopenia
Most people don’t feel any symptoms of osteopenia, yet an estimated 34 million Americans have this condition. That’s why regular bone screenings are important. If we catch osteopenia early, we may be able to halt its progression to osteoporosis.
The gold standard for diagnosis is a DEXA (dual-energy X-ray absorptiometry) scan, a specialized low-radiation X-ray that measures bone mineral density. Guidelines recommend:
- Women: Begin screening at age 65
- Men: Begin screening at age 70
Earlier screening may be necessary if you have risk factors. Your doctor will tell you when to begin screening and how often to have follow-up scans. DEXA scans are painless and noninvasive.
Risk Factors for Low Bone Density
Some risk factors are out of your control for low bone density, but many are manageable. Here’s what increases your risk for osteopenia and osteoporosis:
- Age. Peak bone density is usually in your 20s and 30s. As we age, bones become weaker and frailer.
- Being female, especially post-menopause. Women are at significantly greater risk of developing osteopenia or osteoporosis than men.
- Family history of osteoporosis
- Previous fractures
- Poor nutrition
- Smoking or excessive alcohol use
- Low estrogen in women (including due to surgical menopause)
- Sedentary lifestyle
- Certain cancer treatments, such as chemotherapy or medications that block estrogen production
- History of eating disorders, such as anorexia or bulimia
What You Can Do: Diet and Exercise
If you’re diagnosed with osteopenia or want to prevent it, try focusing on two key areas: diet and exercise.
Calcium and Vitamin D
Calcium is essential for bone strength. Recommended daily intake:
- Women under 50 and men under 70: 1,000 mg per day
- Women over 50 and men over 70: 1,200 mg per day
Good sources of calcium include:
- Dairy products, such as milk, yogurt and cheese
- Leafy greens, particularly kale
- Fortified foods, such as some breakfast cereals, orange juice and bread
Vitamin D helps your body absorb calcium. You can get it from sunlight; fortified foods such as egg yolks, milk, liver, and salmon; and supplements.
If you can’t reach your recommended dietary intake of calcium and vitamin D from foods, supplements may be helpful. Combination supplements that include both calcium and vitamin D are readily available. Always talk to your doctor before taking supplements to ensure they are safe for you and won’t interact with any medications you may be taking.
Resistance and Balance Training
Exercise is another way to keep bones strong. In general, aim for 150 minutes of moderate aerobic activity each week. Also, mix in resistance training, which strengthens muscles and bones. Try:
- Brisk walking or jogging
- Yoga
- Balance exercises, such as standing on one foot
- Wall push-ups
- Calf raises
- Bicep curls with light weights or resistance bands
Avoid high-impact activities such as jumping or contact sports, such as basketball. These can increase fracture risk.
When Medication Is Needed
If osteopenia progresses to osteoporosis, medications such as bisphosphonates may be prescribed. This class of drugs is designed to slow the cells that break down bone. These are typically taken orally weekly and help slow bone loss. Infusions may be considered for some patients.
You don’t need to wait for a diagnosis to start protecting your bones. A healthy diet, regular exercise, and avoiding smoking and excessive alcohol can go a long way in maintaining bone strength. And if you’re over 65 (or 70 for men), talk to your doctor about getting a DEXA scan.
Osteopenia doesn’t have to lead to osteoporosis. With the right steps, you can take control of your bone health and stay strong for years to come.
Feature image, stock.adobe.com
