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What are osteopenia and osteoporosis?

Osteopenia and osteoporosis are bone diseases caused by a reduction of bone mass. These conditions refer to the degree of loss of bone mineral density (thickness) of the bone. This reduction in bone mass increases your risk of fractures.

  • Osteopenia is a mild loss of bone density.
  • Osteoporosis is a moderate to severe loss of bone density.

This condition most often occurs in post-menopausal women as well as in people with low sex hormone levels (male and female hypogonadism), overactive thyroid hormone levels, chronic high-dose steroids, and malabsorption syndromes. Dr. Thomas will evaluate you clinically and screen you with appropriate biochemistry to determine the condition’s etiology. Bone density scans and X-rays will help quantify the bone loss, monitor treatment efficacy, and identify any fractures. This will help optimize the appropriate therapy to prevent further bone loss and fractures.

The progression of osteoporosis may be reduced with treatments, including dietary changes, nutrition supplements, exercise, and medications.

All your bones line up and connect to form the human skeleton.  In addition to creating your body structure, the bones produce blood cells, form joints with muscles for movement, and protect your internal organs. They change and grow like the other parts of your body.

Until about age 30, our body forms enough new bone to replace the bone naturally broken down by the body (a process called bone turnover). The highest bone mass (size and thickness) is reached between the ages of 20 and 25 and declines after that. Women tend to lose bone even faster after menopause.

Although the exact cause of osteoporosis is unknown, several factors may contribute to the condition.

  1. Hypogonadism – both male and female
  2. Menopause
  3. Thin or small body frame
  4. Diet – low in calcium/and or Vitamin D
  5. Decrease physical activity.
  6. Smoking tobacco
  7. Increased alcohol intake
  8. Endocrine conditions – diabetes mellitus, hyperparathyroidism, hyperthyroidism, Cushing syndrome, and hyperprolactinemia. ( insert the hyperlinks for all the conditions)
  9. Rheumatological conditions – rheumatoid arthritis
  10. Medications – Steroids, anti-epileptic medications, aromatase inhibitors, chemotherapy

Osteoporosis does not cause symptoms in the early stages of the disease. As the disease progresses, you may experience bone tenderness or pain, particularly in your neck or low back. You may also develop stooped posture and a loss of height. For many, bone fractures are the first sign of osteoporosis.

Osteopenia/Osteoporosis is a silent disease. The progression of this condition is preventable.

All women aged 65 years or older, men aged 70 years or older, or those who have had a broken bone since the age of 50 years should get a bone density scan (DXA) to screen for osteoporosis.

Dr Reena Thomas will help diagnose this condition by performing a comprehensive medical evaluation. This will include a detailed medical history, physical exam, blood tests, and urine studies needed to diagnose osteoporosis and estimate the risk of breaking a bone. This is important to assess your risk for fracture and need for treatment. She may also arrange for you to have additional X-rays if you have a fracture.

Getting the appropriate tests is important to determine why you have this condition and guide the appropriate treatment.

Lost bone cannot be replaced, but further bone loss can be prevented. Dr Reena Thomas will review and discuss the results of the blood tests, urine studies, and imaging studies with you. She will address any treatable causes of osteoporosis. She will formulate an individualized treatment plan and discuss the benefits and side effects of the different treatment options.

The potential treatments include:

  1. Lifestyle modifications – healthy diet and weight-bearing exercises.
  2. Supplements –   Calcium and Vitamin D supplements are commonly advised.
  3. Addressing factors that may worsen osteoporosis – smoking, medications.
  4. Medications—several different types of medications are used to treat osteoporosis. Bisphosphonates, Raloxifene, Teriparatide, Abaloparatide, Romosozumab, hormone replacement therapy, and calcitonin are medications currently used to treat osteoporosis in postmenopausal women.
At a Glance

Dr. Reena Thomas, MD

  • Dual American board-certified endocrinologist
  • Author of numerous academic and clinic research
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