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THREE. Lifestyle Changes and Treatments

It is very difficult to fully reverse osteoporosis once it is present.

After I'm diagnosed with osteoporosis or told that I have osteopenia, what happens next?

Once you have been sent for BMD testing, it's a good idea to investigate management options for osteopenia and osteoporosis. If your results are abnormal, you and your clinician can select the regimen that you both feel is best suited for your individual case. If your testing results come back in the normal range, you will still need to discuss prevention of osteoporosis to keep your bones healthy. If your T-score shows that you have osteopenia or osteoporosis, secondary causes of osteoporosis should be ruled out before treatments are suggested.

You might think that after you are told you have osteopenia or are diagnosed with osteoporosis, your only goal should be to get rid of it. That is not the case. It is very difficult to fully reverse osteoporosis once it is present, but there are several important goals that you will want to work with your clinician to achieve:

• Reduce the risk of fracture. Although the bones in your spine can fracture without warning or trauma, fractures are most often associated with falls. It is important to change your environment and lifestyle to prevent falls so that the risk of fracture is minimized (see Question 79). You will also need to adjust your exercise routine to avoid bending your spine too far forward (see Question 44).

• Relieve symptoms of fractures and/or skeletal deformity. This may require pain medications and a change in your exercise routine. Question 84 discusses exercises that may help minimize the deformity from kyphosis.

• Improve mobility, activity level, and ability to function despite fractures or the potential for fractures. An in-home assessment by staff from a home health agency may be helpful in evaluating your risk for fractures. They can also explain how you can change your environment so that you can maintain or improve your mobility and avoid falls. If you have fractured a bone, you will need to maintain your body strength by continuing to exercise. If you have fractured your spine (vertebral bones) or your hip, the tendency may be to isolate yourself from others and become home bound. It is an important goal of treatment to maintain social connections, despite bone loss or the presence of fractures.

• Prevent further bone loss. You don't want to lose any more bone than you already have. Make lifestyle changes that will aid in reducing further bone loss.

• Maintain the integrity of bone. You will want to be especially thoughtful about having a healthy diet. Consider carefully the amount of calcium, vitamin D, and other nutrients you are taking in to make strong bones. You will also need to do appropriate exercises.

• Regulate bone turnover. The goal is for bone formation to stay equal to or ahead of bone breakdown. Although this goal might be accomplished with lifestyle changes, regulating bone turnover may require prescription medication.

It is important to remember that your goals toward improving or maintaining good bone health will require lifelong effort. You won't feel medications working. You won't know if your bones are responding until you have follow-up testing. So, after you've been

Sometimes clinicians don't use the term osteopenia. Instead, they prefer to tell patients they have low bone mass.

told you have osteopenia or have been diagnosed with osteoporosis, remember to:

• Maintain a positive attitude about your diagnosis.

• Read as much as you can about osteopenia and osteoporosis.

• Develop a management regimen with your clinician— one that you can live with.

• Use the suggestions in this book and the resources in Appendix B to develop a healthy lifestyle.

• Think of this as a beginning—not an end—to good bones and an active life. It is never too late to improve your bone health!

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