Osteoporosis
Definitions:
Osteoporosis: decline in bone mass often related to increased age and decrease in hormone levels.
Osteopenia: decline in bone mass that is less severe than osteoporosis.
T-Score: This is the score used to determine if you have osteoporosis/osteopenia. The score represents the number of standard deviations above or below average for a typical young caucasian woman. In other words, this is how your bone density compares to that of young healthy caucasian females and may not represent the standard for various races.
Osteoporosis is defined as femoral neck, total hip, or lumbar spine bone mineral density ≥ 2.5 standard deviations below mean level for young-adult reference population which translates to a T score of -2.5 or lower.
Osteopenia is defined as femoral neck, total hip, or lumbar spine bone mineral density between 1 and 2.5 standard deviations below mean level for young-adult reference population which translates to a T score of -1 to -2.5.
Z-Score: compares your bone density to the average bone density of people your own age and gender.
FRAX score: fracture risk assessment score used to estimate 10-year probability of hip fracture and 10 year probability of major osteoporosis fracture. Calculate your score here: https://www.sheffield.ac.uk/FRAX/
Risk factors:
Female gender 65 years and older
Women with low BMI - less than 19
Lifestyle factors such as smoking, inadequate physical activity, low calcium intake.
Medical conditions such as genetic diseases that affect connective tissue and bones, endocrine or metabolic disorders, nutritional and gastrointestinal disorders, blood disorders, long term use of steroid medications or proton pump inhibitors
Signs and symptoms:
Patients are typically asymptomatic until fractures occur which is why we perform the dexa scan.
The patient may notice a loss of height or a change in corporate or to the spine
Supplement recommendations:
Calcium
Vitamin D3
Vitamin K2 - specifically MK4 and MK7
Omega-3s: EPA, DHA
Magnesium glycinate
Melatonin
Things that add to bone loss:
Salt
Excess animal protein
Refined sugars
Phosphate additives - sodas, cured meats, processed foods
Pro-inflammatory fats - too much omega-6, transfats
Pesticides
Wheat
Heavy metals - lead, cadmium, mercury
Fluoride
Alcohol - limit to less than 2 drinks per day
Smoking
Lack of weight bearing exercise
At least 3x/wk for 1 hour - Dynamic not static, involves impact, exceeds threshold intensity (at least 70% max capacity)
Monitoring:
Repeat a DEXA scan every 1 to 2 years after starting medication for osteoporosis until findings are stable
Dietary recommendations:
Adequate calcium, vitamin k2 magnesium, and vitamin D intake
Protein intake should be 0.8 - 1.2 grams of dietary protein per kilogram of body weight
Physical activity recommendations for adults with osteoporosis:
Aerobic exercise ≥ 5 times/week for ≥ 30 minutes at moderate-to-vigorous intensity
Resistance exercise ≥ 2 times/week (8-12 repetitions per exercise)
Balance exercise (such as yoga, dancing, barre, or Tai Chi) ≥ 15-20 minutes/day
Use caution when lifting heavy weights or performing exercises that bend or rotate the spine.
Regular physical activity is one of the best ways to support bone health and help prevent falls.
Medication:
Pharmacologic medications are recommended in postmenopausal women if they have a history of fragility fracture, T score less than 2.5 in the spine/ femoral neck/total hip. T score between -1 and -2.5 if the FRAX 10-year probability for major osteoporosis factor is greater or equal to 20% or if the 10-year probability of hip fracture is greater or equal to 3%
Options for pharmacologic therapy
Antiresorptive medications include
Bisphosphonates such as alendronate, ibandronate, Rizal, the LED Roenick acid.
Denosumab - these are the first line treatments for women with high fracture risk.
select estrogen receptor modulators such as raloxifene or bazedoxifene
Other: Hormone replacement therapy