Overview of Osteoporosis and Osteopenia
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) [ACE-AHFS, 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 [National Osteoporosis Foundation 2008]:
- 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. > 5 mg 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 anti-acid medication use, especially H2-blockers and proton-pump inhibitors.
- Low vitamin D intake and living far from the equator.
Complimentary and alternative treatments for osteoporosis that are considered below include:
- Neurotransmitter Balancing