Dear Doctors: What is the best or most effective way to treat osteoporosis and osteopenia? I have tried several medications. One had too many side effects, so I had to stop. I took another one for two years, but you have to keep taking it and I prefer not to.
Dear Reader: For those who are not familiar, osteopenia and osteoporosis are two conditions that affect bone strength. The root of both words, osteo-, comes from the ancient Greek word osteon, which means bone.
The suffixes tell you what is occurring to the bone. In medical terminology, -penia indicates a deficiency or a decrease, so osteopenia refers to a loss of bone density. The suffix -porosis means becoming porous. Osteoporosis describes bones in which the loss of density has progressed to the point that they become thin, weak and fragile.
Osteopenia is the earlier stage of bone loss. It means bone density is lower than the normal range for an adult but is not yet severe enough to be diagnosed as osteoporosis. It is possible for osteopenia to be stabilized and, in some people, partially reversed.
Perhaps most importantly, it is possible to prevent osteopenia from progressing to osteoporosis. Doing so can reduce the risk of fractures later in life and may delay or even eliminate the need for medication. This stage of bone loss is treated primarily through lifestyle changes -- for example, weight-bearing and resistance exercises stimulate the formation of new bone.
Eating a bone-healthy diet is also important. Dietary advice tends to focus on calcium. But that's not the whole story: The series of metabolic processes that build new bone also involve vitamin D, vitamin K, magnesium and zinc. Since many of us don't get enough of some or all of these, it is important to craft a diet that supplies them. Dietary supplements can be helpful, but supplement dosages vary, sometimes widely. We think it's wise to get guidance from your healthcare provider or a registered dietitian before using them.
When bone loss progresses to osteoporosis, treatment goals change. At this point, bone has become so thin and fragile that reducing the risk of fracture becomes the primary objective.
Bone density is measured with a test known as a DXA scan. The results help determine whether someone has normal bone density, osteopenia or osteoporosis. The results of the DXA scan, along with age, medical history and estimated fracture risk, are used to determine whether medication is the best course. The decision also considers factors such as a previous fracture, family history of osteoporosis, long-term steroid use and other medical conditions that affect bone health.
There are several classes of medications available, each with benefits, risks and potential side effects. Your healthcare provider, and in some cases an endocrinologist, can help you choose the approach best suited to your specific situation.
Whichever treatment plan you decide on, exercise remains a crucial part of ongoing care. This should include weight-bearing activity; progressive resistance training with weights, bands or body weight; and exercises that improve balance and coordination. In addition to supporting bone health, these activities build strength and help prevent falls and fractures.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
