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Osteoporosis is a bone disease that causes loss of strength and density, making bones likely to break (or fracture). It is sometimes called a "silent disease" because most people do not know they have it until they have a fracture.
Bone tissue is always involved in a normal process called bone turnover. This process allows old bone tissue to be broken down and new bone tissue to be made. In children, new bone forms faster than old bone is broken down. In adults, the reverse is true, old bone is broken down faster than new bone is formed. After women experience menopause and as men age, the activity of the cells that break down old bone start to exceed the activity of the cells that build new bone. Over time, this imbalance in turnover forms tiny holes in bone tissue, leaving it fragile and easy to break.
Osteopenia is similar to osteoporosis. With osteopenia, some bone strength and density is lost, but not as much as when a person has osteoporosis. Osteopenia is called "bone loss" rather than osteopenia by some clinicians. This is because not everyone agrees about exactly how to treat bone loss that is not at the level of osteoporosis. It is best to keep your bones as strong as possible. Some ways to help prevent bone loss are listed below.
People with bone loss are at high risk for having a fractured bone. Fractured bones can cause pain, depression, isolation (especially if it gets hard to move around), and even death. It is important to know if you have bone loss so that you can change your diet or activity level, as well as take medicine to help increase your bone mass.
A bone density test is often prescribed to measure bone loss. The most common test is called a Dual Energy X-ray Absorptiometry test, or a DXA test. This test is painless and takes about 15 minutes to complete. You lie on a table similar to an X-ray table and the bone density machine moves over your spine and hip areas to read your bone density. A report is sent to your clinician with your bone density levels.
On the day of your test, wear loose, comfortable clothes and avoid clothing with metal zippers or clasps, underwire bra, or metal jewelry. Do not take calcium supplements 24 hours prior to the test. You should not have a DXA test if you are pregnant or have had a contrast dye study in the past 2 weeks. Most DXA machines can only accommodate people who weigh under 250 pounds.
Your clinician will also talk with you and examine you to see if there are any signs of health problems that might cause bone loss. If any are found, they may be able to be treated to reduce effects on your bones.
The National Osteoporosis Foundation recommends you have a bone density test if you:
* are a woman age 65 or over or a man age 70 or over
* are a postmenopausal woman under age 65 or a man age 50 to 69 and have risk factors for bone loss
* are a perimenopausal woman and have specific risks for fracture (weigh under 127 lbs, take medicine that is linked with bone loss, and so on)
* have had a fractured bone at the age 50 or over
* are taking medicine or have health problems that raise your risk for bone loss (for example, asthma, corticosteroid use, and so on)
* are thinking about taking medicine for osteoporosis
* are a postmenopausal woman who is stopping estrogen or hormone therapy
DXA test results include T-scores, which compare your bone density with the bone density of young adults of your same sex, and Z-scores, which compare your bone density with the bone density of others of your same age and sex.
T-scores and Z-scores are reported as having a positive or negative rating, with zero considered normal. The World Health Organization has classified T-scores of -1.0 and above as normal, of -1.0 to -2.5 as osteopenia or bone loss, and of -2.5 and lower as osteoporosis.
There are several things you can do to help improve your bone strength:
* Calcium-eat calcium rich foods (dairy, calcium fortified grains) and use supplements to get at least 1,200 mg/day
* Vitamin D-use supplements to get 800 to 1,000 international units per day
* Exercise-include weight bearing and resistance exercises; walking helps the lower spine, hips, and legs; hand weights help the arms; overhead weights help the shoulders and upper spine)
* Do not smoke
* Limit intake of salt, caffeine, soda, and alcohol; instead drink calcium-rich milk or calcium-fortified juice
* Prevent falls-use nightlights in case you need to get up at night, clear hallways and stairs, remove cords and wires from walking paths, use nonskid mats in showers/tubs, remove scatter and throw rugs, and clear ice and snow from walking paths
* Take medicine to avoid more bone loss exactly as your clinician recommends.
If your T-score is in the osteoporosis range (-2.5 or lower) most clinicians will recommend treatment. If your T-score is in the osteopenia range (-1.0 to -2.5) then using the WHO FRAX Tool might be helpful. This tool was made to help decide when medicine for osteopenia should be started. Information about 11 risk factors and your raw bone density are entered into an online site. The tool calculates your 10-year risk for breaking your hip or having any major fractured bone from osteoporosis. Your clinician can use this information together with your health history, physical exam, and lab test results to decide if medication is good for you.
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