Osteoporosis

Osteoporosis is low bone density which increases your risk for fracture of any bone in your body. A DEXA scan measures your bone density and compares you against a group of women in their 30’s at peak bone mass and against a group of women who are your age. The World Health Organization defines osteopenia, or low bone density, when 85% of women have a higher bone density than you and osteoporosis when 95% of women have a higher bone density than you.

Osteoporosis is when your bones have become weak and brittle and you are at increased risk of falling and breaking a bone such as your wrist or hip or having a compression fracture of one of the vertebral bones in your spine. We screen for osteoporosis with a DEXA scan which is like getting an X-ray of your hip and spine in all women at age 65 or earlier if you are at increased risk of osteoporosis.

Women are at increases risk of osteoporosis if they have a family history of osteoporosis, are petite framed, smoke cigarettes, are heavy alcohol drinkers, don’t consume enough calcium in their diet from low fat dairy products or green leafy vegetables, or have low vitamin D levels from not enough sun exposure. People have a lower risk of osteoporosis if they get lots of weight bearing exercise and do a lot of exercise with their upper bodies like raking, mowing, and carrying heavy objects. We used to recommend calcium supplements and vitamin D supplements to all women to help prevent osteoporosis but now the data is less clear of the benefits.

There are medicines you can take to increase your bone density or at least stop the normal yearly 2-3% decline in bone density. Alendronate (Fosamax) has the best data for increasing hip and spine bone density and decreasing fracture risk. Not all women can tolerate these medications because of gastrointestinal side effects. When you take these medications you need to take them in the morning on an empty stomach with a full glass of water with nothing else to eat or drink for an hour before having other medications or food. The pills are very poorly absorbed if there is anything else in your stomach.

There are also some newer injectable medications like Prolia but they don’t work any better than the pills and have a greater risk of side effects.