Osteoporosis is the condition in which bone has lost its mineral content and strength. It has known risk factors, which can be identified early on, which can help prevent future problems. Bone mineral density (BMD) is the hallmark test that screens bones for their density. BMD uses the bone density of a healthy, young 30-year old as the norm. If you are 1-2.5 standard deviations below the young normal mean, you are rated as osteopenia. If your BMD is 2.5 standard deviations or more below the norm, then you have osteoporosis. You may find out your BMD from a DEXA scan, typically taken at the spine and hip. Your doctor decides if you need a BMD test based on your risk factors. (BMD does not equate directly with bone strength, as there are other factors in the micro-architecture of the bone that may be screened in more detail.) Current data on rates of fractures estimate that 40% of white women and 13% of white men will sustain at least one fracture attributable to osteoporosis in their lifetime. Fractures most often occur in the hip, spine, and wrist regions. Fractures may cause a brief break from work and daily activities, or, require long -term care or institutionalization.

Risk factors for osteoporosis:

Your metabolism must be functioning well in order to create bone, and those on steroids, or with thyroid or other metabolic disorders may not build bone to an optimum level. If your weight is less than it was at age 25, that is also a risk.

Underweight or highly active teen girls may not have a normal menstrual cycle, or lack of a cycle, termed amenorrhea. In amenorrhea, there is usually insufficient body fat to produce estrogen, which is required for the metabolic process in building bone. Teen girls with amenorrhea are also at risk for stress fractures with sports, due to the metabolic deficiency. The estrogen loss that occurs during and after menopause is another risk factor. Menopause is a time recognized for osteopenia or osteoporosis to develop. Males who participate in wrestling and seek extreme weight loss, or have a testosterone deficiency, may also be at risk. Sustaining a fracture after age 50 may be a sign that osteoporosis is present. Inactivity, smoking, and a family history of osteoporosis are also risk factors. Chronic illnesses such as kidney disease, diabetes, or other metabolic disorders have an elevated risk of developing osteoporosis.

Bone Building:

The best way to build up bone strength is a combination of health-related factors. See your medical provider for clarification if you have any concerns. Being active, and having adequate calcium and vitamin D are essential to developing strength. Some positive habits for exercise include walking, running and weight lifting, or even just being on your feet for three hours a day. Weight lifting specifically strengthens the targeted area, so upper and lower body segments should be exercised. Spinal extension exercises reduce the risk for spinal fractures by strengthening the back muscles and bones. Gardeners tend to have strong bones due to regular walking, lifting items, and their frequent exposure to vitamin D.

An outline of an optimum bone-building program would include activity across the lifespan, such as weight lifting, walking, running, spinal strengthening, and balance exercises. This activity could involve as little as 15 minutes a day, as a minimum essential program. Some key examples would be bicep curls, bench presses, squats, balancing on one leg, and lifting opposite arms and legs while on all fours. Customized exercise programs might include individualized weights, reps, frequencies, and intensities, based on your starting fitness and health profile.

Risk factors should be identified and modified as possible, such as smoking cessation, keeping an optimum level of nutrition, and including regular exercise in your lifestyle. However, even with optimum nutrition and exercise, there will still be some natural bone loss with aging. You can slow the rate and amount of bone loss to prevent the risk of fractures, pain and disability.

Medications for osteoporosis can help reverse bone loss, but only if optimum vitamin D and calcium are present.

Finally, modify your home to prevent the risk of falling or tripping and causing fractures. Risk reduction in the home includes eliminating throw rugs, using adequate lighting and providing railings for stairs and steps. Risk reduction is so important that Medicare now requires all medical screening to assess and counsel on risk factors for falling in homes.

Build bone now to prepare for an active and safe future!

References:

Irion JM, Irion GL, eds. Women's Health in Physical Therapy. Lippincott Williams & Wilkins, 2009.