Tips & Advice

From Dr. Liz Herself

August 25, 2021
It’s Scary to Lose Your Bone Health!
Midlife healthy woman exercising

As Halloween approaches next month, there’s a women’s health problem that really scares me.

We rightfully worry about breast cancer and heart disease.

But guess what? Besides these major causes of death in women, there is another much less talked about killer: osteoporosis.

Scary, right?

Women reach peak bone density at about age thirty. And we only reach a good peak bone density if we’ve had all the best opportunities to develop good bone density, such as good nutrition, exercise, and good genes.

One out of two Americans over the age of 50 either has or is at risk of developing osteoporosis. Men are also affected, but women are diagnosed with osteoporosis four times as often as men. In total, ten million Americans are diagnosed with osteoporosis and 33 million people in the US over the age of 50 are already diagnosed with osteopenia.

Diagnosing Low Bone Density

What’s the difference between osteopenia and osteoporosis?

The gold standard for measuring bone density is the DEXA scan. DEXA stands for dual X ray absorptiometry. This scan measures the calcium in bones to calculate the score.

When you have a DEXA scan, your report will include what’s called a T score. This score compares your bone density to that of a 30 year old (woman or man, as the case may be).

The numbers of the T score represent the standard deviations above or below the average. If your T score is between minus 2.0 and minus 2.5 you will get the diagnosis of osteopenia. If your T score is lower than minus 2.5 you will get the diagnosis of osteoporosis.

Many insurance companies will not pay for a bone density scan for women until they are 60 or 65, years old.

As a woman’s midlife health expert I do not agree with this.

I encourage women to ask their doctors, either a primary care doctor or gynecologist, to ask for a baseline bone density anytime after age fifty. I recommend this at younger ages if she has had a history of unusual bone fractures.

Treating Low Bone Density

There are quite a number of medications to treat osteoporosis. However, I am not a big fan of any of them so far. Many of them do not actually build up new bone. Instead, they block the reabsorption (clean up) of dead bone cells. This makes the bone density appear to be higher, but the bone quality is not great.

Many of these medicines also have a variety of side effects. For example, One class of osteoporosis drugs is called the bisphosphonates. It must be taken standing up so it does not sit in the esophagus and cause irritation. In my OB/GYN residency, I took care of a woman who got irritation of her esophagus from taking this drug. She felt the pain as chest pain, and the cardiac evaluation led to complications which led to her death.

This year, my mom who is now in her 80s has dealt with two different bone fractures. Because of this, I am brushing up on the different types of medications that are used to treat osteoporosis. They range from oral medications to daily injection that the patient has to give herself, to an intravenous infusion at the doctor’s office once a month or once a year.

Natural Ways to Improve Your Bone Health

While calcium supplementation in general is somewhat controversial, a calcium supplement that contains vitamin D is most likely going to support your bone health. Another way is to do this is weight bearing exercise. I love to swim. However, although this benefits my cardiovascular system, it is not weight bearing exercise and won’t be helpful to my bone density. Examples of weight-bearing exercise include walking and Zumba dancing.

Pro Bono | Recommended SupplementsThere are supplements besides calcium with Vitamin D that also contain additional minerals shown to improve bone strength, including boron and strontium. These can actually reverse bone loss (osteopenia or osteoporosis). Also, phytoestrogen supplements may help bone health.

The consequences of a hip fracture are devastating. Although cardiovascular disease still kills more women overall, the mortality rate (risk of dying) in the first year after a heart attack is 26%. Compare this to the mortality after hip fracture, which can be as high as 58% within one year.

We have a modern challenge – we now live a long time! Two hundred years ago, only 5% of women reached age 50. Now, half of us can expect to live into our 80s. In addition to replenishing our hormones as those levels decline, I encourage you to use the above suggestions to keep your bones healthy and strong as long as possible. You need your bones to last as long as you do.

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