My Bone Loss Story
Osteopenia: What you can do for early detection, remediation and prevention
My Story
Last year, at age 53, I was diagnosed with severe osteopenia (bone loss). Osteopenia is a precursor to osteoporosis. Ironically, I had just completed two research projects during my MA in Integrative Health on Bone Health and the Prevention of Osteoporosis in Women! It was that research prompted me to ask my primary care physician for a DEXA-scan — the bone-density test. She said to wait until I’m over 60, ideally 65. Dissatisfied with her reply, I found a few private local clinics in SF where I could get one if I paid out of pocket. But, it was expensive, life got busy,and I delayed.
Eventually (nearly 2 years later), I found a new provider who spent a full hour learning about my history and immediately ordered a DEXA-scan without me even asking for one. She said I was at risk due to a number of factors including early-ish menopause at 47, with no hormone therapy and being small boned. I started smoking cigarettes as a teen in the mid-80s when it was practically encouraged at my high school in Indiana with two smoking lounges right outside the doors of the school! I also did not have the best nutrition growing up, existing on packaged snacks, pizza and fast food mainly.
I changed my lifestyle, diet and habits my early twenties, though it took more than a decade of trying to quit to finally quit cigarettes in my early thirties. I’ve been running somewhat regularly since then, and have done strength training and yoga over the years. But, it’s never been as consistent as I would have liked. So, this is all to say, that while I have lived a pretty healthy lifestyle for 20+ years, I certainly didn’t give my bones the best foundation when I was young.
Even so, I went into my DEXA-scan feeling fairly confident I’d have normal, if not great, bone density. I thought of all the times I got myself out for a run when I could’ve stayed in, and all the other healthy choices I’d made.
However, my results were not good. My scan showed that I had osteopenia and that it was way too close for comfort to full-blown osteoporosis.
Since then, over the last 18 months, I have made several changes to prevent, and hopefully remediate, bone loss including:
strength training 3-5x/week; yoga 2-3x/week; jogging, walking or rucking 3x/week
started some recommended supplements and the estradiol patch plus progesterone (under recommendation and NP/doctor supervision)
improved my diet, stress and sleep habits; reduced alcohol consumption
Fear of falling and breaking bones is very motivating to me! I want to be able to do things I love like hiking and gardening for decades to come. I will have another scan later this year and hope for improvements, or at least no more bone density loss!
What you can do to detect, prevent and remediate bone loss
How’s Your Bone Density?
It’s a good idea to have your bone density tested around menopause, and can be helpful also to test earlier for a baseline number. Osteoporosis is under-diagnosed and often silently progresses until there is a fracture. For this reason, it is recommended that all women over 65 be tested. Women over 50, postmenopausal women and those with risk factors may want to test earlier. I’m thankful that I finally did.
Diagnosis - DEXA Scan
Bone density tests determine bone mineral density (BMD), whether osteopenia or osteoporosis has developed and the risk of bone fracture. It is helpful to know BMD when making lifestyle adjustments, selecting appropriate and effective exercise, supplementation and nutrition to strengthen bones achieve optimal bone health.
The standard and most widely available way to measure bone density is the DEXA or central DXA (dual-energy x-ray absorptiometry). The DXA scan measures BMD of the hips, spine and forearm. The DEXA compares the density of a patient's bones with normal bones at peak bone mass (young adult) as well as with the average BMD for a person's age.
DEXA scores are reported as T-scores and Z-scores.
A T-score is the BMD when compared to an average healthy 30-year old of the same same. If your score is equal to the peak bone mass of the average 30 year old, your T-score would be 0. If your score is +2 your bone mass is 20% above the average 30 year old, and -3 would be 30% than the average 30 year old.
A Z-score reflects how a woman's bone density compares to the average woman of her age.
Bone loss prevention and remediation
Fractures and broken bones can be debilitating, and even deadly to older folks. It’s critical that we take steps to increase and maintain bone density as we age, which we can lose at a rate of 5-10% each decade after 30!
In addition to reducing stress and getting enough sleep, nutrition and movement are key. Below are some tips based on evidence-based studies. Please consult with your doctor, an NP or medical professional to discuss any risk factors and your personal medical history before starting any exercise or nutrition programs or beginning supplements.
Slideshow: Bone-Building Exercises
Additional Bone Health Resources
References
Guthrie, C. (2011). Good to the bone. Yoga Journal, (237), 49-50. Retrieved from https://ciis.on.worldcat.org/oclc/8168503131
Lambert, C., Beck, B. R., Watson, S. L., Harding, A. T., & Weeks, B. K. (2020). Enjoyment and acceptability of different exercise modalities to improve bone health in young adult women. Health Promotion Journal of Australia, 31(3), 369-380. doi:10.1002/hpja.321
Lívia Santos, Kirsty Jayne Elliott-Sale, & Craig Sale. (2017). Exercise and bone health across the lifespan. Biogerontology, , 1-16. doi:10.1007/s10522-017-9732-6
Loeffler, A. G., & Hart, M. N. (2018). Introduction to human disease. Burlington: Jones & Bartlett Learning, LLC. Retrieved from https://ebookcentral.proquest.com/lib/[SITE_ID]/detail.action?docID=5488858
Lu, Y., Rosner, B., Chang, G., & Fishman, L. M. (2016). Twelve-minute daily yoga regimen reverses osteoporotic bone loss. Topics in Geriatric Rehabilitation, 32(2), 81-87. doi:10.1097/TGR.0000000000000085
MacGill, E. A., & Montel, I. N. (2017). NASM essentials of personal fitness training (fifth edition ed.). Burlington, MA: Jones and Bartlett Learning.
McKinley, M. (2020). Anatomy & physiology: An integrative approach with connect by michael McKinley PDF Zenodo. doi:10.5281/zenodo.3748850 Retrieved from https://search.datacite.org/works/10.5281/zenodo.3748850
Mishra, N., Mishra, V. N., & Devanshi. (2011). Exercise beyond menopause: Dos and don'ts. Journal of Mid-Life Health, 2(2), 51-6. doi:10.4103/0976-7800.92524
Moreira, L. D. F., Fronza, Fernanda Cerveira A. O., dos Santos, R. N., Zach, P. L., Kunii, I. S., Hayashi, L. F., . . . Castro, M. L. (2014). The benefits of a high-intensity aquatic exercise program (HydrOS) for bone metabolism and bone mass of postmenopausal women. Journal of Bone and Mineral Metabolism, 32(4), 411-419. doi:10.1007/s00774-013-0509-y
Osteoporosis : Two-volume set (2013). In Marcus R., Cauley J. A., Dempster D. W., Feldman D. and Luckey M. (Eds.), . San Diego: Elsevier Science & Technology. Retrieved from http://ebookcentral.proquest.com/lib/ciis-ebooks/detail.action?docID=1215501
Smith, E. N., & Boser, A. (2013). Yoga, vertebral fractures, and osteoporosis: Research and recommendations. International Journal of Yoga Therapy, 23(1), 17-23. Retrieved from https://ciis.on.worldcat.org/oclc/5533966528
SoJung Kim, Michael G. Bemben, Allen W. Knehans,Debra A.Bemben. (2015). Effects of an 8-month ashtanga-based yoga intervention on bone metabolism in middle-aged premenopausal women: A randomized controlled study. Journal of Sports Science and Medicine, 14(4), 756-768. Retrieved from https://ciis.on.worldcat.org/oclc/7180361555
Wen, H. J., Huang, T. H., Li, T. L., Chong, P. N., & Ang, B. S. (2017). Effects of short-term step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass. Osteoporosis International, 28(2), 539-547. doi:10.1007/s00198-016-3759-4
Yoga: Another way to prevent osteoporosis? (2016). Harvard Health Publications.Harvard Women's Health Watch, , n/a. Retrieved from https://ciis.on.worldcat.org/oclc/6329005105
Yu, P. A., Hsu, W. H., Hsu, W. B., Kuo, L. T., Lin, Z. R., Shen, W. J., & Hsu, R. W. (2019). The effects of high impact exercise intervention on bone mineral density, physical fitness, and quality of life in postmenopausal women with osteopenia: A retrospective cohort study. Medicine, 98(11), e14898. doi:10.1097/MD.0000000000014898
