Overview
Osteoporosis and osteopenia are bone disorders in which the bone is weakened by demineralization. Osteopenia is a milder form of the disorder, and may progress to osteoporosis if not treated.
Diagnosis is made by a dual-energy X-ray absorptiometry (DEXA) scan (which is a highly correlated surrogate measure of bone strength). Osteopenia is defined as a bone mineral density T-score between -1.0 and -2.5, while osteoporosis is defined as a bone mineral density T-score below -2.5. (A T-score of -1.0 represents one standard deviation below the bone density of an average 30-year-old white woman). Although there is some radiation exposure during a DEXA scan, it has been estimated to only be equivalent to the amount received flying across the country (cosmic radiation exposure at cruising altitudes of about 5 miles up is somewhat higher than at Earth's surface).
Postmenopausal women and patients on long-term high doses of corticosteroids are most at risk of developing osteoporosis.
Osteoporosis presents a significant risk for bone fractures, most commonly in the proximal femur (hip), vertebrae (spine), and distal forearm (wrist) [ACE2009, pg 395]. While most hip fractures are due to falls, most vertebral fractures result in increased kyphosis ("dowager's hump") and are due to routine activities such as bending or lifting light objects [Cooper1992].
Although good lifestyle and therapy can reduce the rate of progression, age related loss of bone mineral density is a natural part of aging. This loss occurs at a rate of approximately 5 to 10% per decade beginning in the third decade of life. If untreated, bone loss in women is especially rapid during the first five years following menopause [Snow-Harter1991].
Risk factors for developing osteoporosis include [NOF2008]:
- Patients has a small, thin frame.
- Patient is Caucasian or Asian.
- Patient or first-degree relative has had a broken a bone as an adult.
- Patient is a postmenopausal woman.
- Patient has had an early or surgically induced menopause.
- Patient has taken high doses of thyroid medication or used high doses of glucocorticoids (e.g. > 5mg a day prednisone) for three or more months.
- Patient has taken immunosuppressive medications or chemotherapy to treat cancer.
- Patient's diet is low in dairy products and other sources of calcium.
- Patient is physically inactive.
- Patient smokes cigarettes.
- Patient drinks alcohol in excess.
- Long-term antacid medication use, especially H2-blockers and proton-pump inhibitors.
- Hypochlorhydria.
- Low vitamin D intake and living far from the equator.
Please see conventional, complementary, and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complementary, and Alternative treatments that may be considered include: