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What if I am told that I have osteopenia but not osteoporosis?

If you have osteopenia, then your T-score is 1 to 2.5 standard deviations below the bone density of the average healthy young adult. Given a score in that range, your bone mass is somewhere between 10% and 30% below normal for a young adult, and your risk of fracture, based on your T-score alone, is as much as 2 to 5 times that of a healthy young adult with normal bone density. Therefore, it's still important to prevent falls.

Although your T-score may indicate that you have osteopenia, it is best to assume that your bone loss will continue if you do not embrace the goals and behaviors intended to improve your bone health. Sometimes clinicians don't use the term osteopenia. Instead, they prefer to tell patients that they have low bone mass. Some clinicians may suggest prescription medications specifically intended to prevent further bone loss or to increase bone density. However, management options for osteopenia have been controversial, and some clinicians think prescription medications for osteopenia are not appropriate. See Question 55 for more about medications for osteoporosis and who should be treated. In either case and whether you have lost bone mass or not, your clinician should always emphasize the importance of calcium, vitamin D, and appropriate exercise.

Finding out that you have osteopenia represents an opportunity. While no one wants to have low bone mass, you have an opportunity to avoid developing osteoporosis. Even if your clinician doesn't prescribe medications for you, you can still make behavioral changes that can make the difference between having osteopenia and going on to develop osteoporosis.

So, now that you have been told you have osteopenia, what can you do to change your lifestyle to make it more bone-friendly? There are several things that you can do now, no matter what your age:

• Calculate your intake of calcium and vitamin D, making sure that you are getting the necessary amount every day (see Questions 47 and 51).

• Get moving. Exercise can help slow the rate of bone loss by increasing the rate of bone formation. Consistent, moderate exercise is associated with a big decrease in hip fractures. Remember that bone strength increases in your body at the location where you exercise. For example, walking benefits the lower spine, hips, and leg bones but not the arms or upper back (see Question 42).

• Stop smoking.

• If, on average, you drink more than one or two alcoholic drinks per day (one serving of alcohol is 5 ounces of wine, 12 ounces of beer, or one cocktail containing 1.5 ounces of hard liquor), cut back or avoid alcohol entirely.

While no one wants to have low bone mass, you have an opportunity to avoid developing osteoporosis.

• Drink water, milk, or calcium-enriched beverages instead of coffee and soda. If you drink coffee, add milk to add some calcium. Large amounts of caffeine can interfere with calcium absorption. However, if you are getting an adequate amount of calcium, moderate caffeine intake (1-2 cups/day) is unlikely to cause a problem. Large amounts of phosphorus can also interfere with calcium, but you would have to consume more than 3 to 4 grams of phosphorus per day for phosphorus to be a problem.

Question 86 discusses dietary changes to lessen or avert the effects of osteoporosis and osteopenia.

I understand that exercise is important for the treatment of osteoporosis. Why?

It doesn't matter how old you are—exercise is important to your overall health. An increase in exercise can decrease your risk of heart disease, high blood pressure, diabetes, breast cancer, and colon cancer. Exercise will give you more energy and better sleep. Regular exercise has also been found to decrease depression in a couple of ways. First, exercise releases endorphins, the "feel-good" substances related to mood. Second, the social interaction of group exercise or sports can reduce depression as well.

We can add bone health to the list of important reasons to exercise because we know that the stress of weight-bearing exercise and strength training helps bone mass. Any significant increases in stress on bone from exercise— that is, weight-bearing and resistance exercises—will actually signal the need to build more bone. Stress on bone literally shifts the bone-building process into high gear. Exercise is known to assist individuals who want to lose weight or who want to maintain a healthy weight, and exercise may also play a role in reducing symptoms of arthritis (see Question 96). Strength training exercises, such as weight lifting, can increase your body's muscle mass, which in turn increases your body's metabolic rate. If you increase your muscle mass by 3 pounds, your metabolic rate increases by 7%, which allows you to add some extra calories to your diet without fearing they will add extra fat.

Exercise is important in preventing and treating osteoporosis for several reasons. First, it improves the integrity of the bone by preserving what you already have. The stress on bone that is exerted by weight-bearing and resistance exercise causes an increase in bone formation. Secondly, exercise can help to reduce falls by improving muscle tone and balance. Lastly, though definitely not least in the order of importance, moderate weight-bearing exercise for 4 hours per week can reduce the risk of hip fracture by up to 40%.

The less you engage in physical activity, the less stress is placed on your bones. This costs you bone mass and muscle mass, a high price to pay for a sedentary lifestyle. Women engage in regular physical activity less than men, and they can ill afford to be less active because they are at higher risk of osteoporosis just by virtue of being women. Inadequate activity can make anyone, but particularly women, become frail, increasing their risk of osteoporosis and fracture.

Marjory's comment:

As a nurse, I've always been aware of when my rheumatologist was examining my hands and feet for bone density

Inadequate activity can make anyone, but particularly women, become frail, increasing their risk of osteoporosis and fracture. and evidence of rheumatoid arthritis, he said my bones looked good and that I didn't have osteoporosis. I had my first bone density test of my hip and spine about 10 years ago, and I've had a couple more since then. After one of the tests, my doctor said that I had the bones of a 27-year-old (but where did the body of the 27-year-old go?!). I try to maintain a healthy diet with lots of fruits and vegetables, but I also know I should lose about 20 pounds. It's just that the one disadvantage to exercising regularly is that it makes me so hungry! In addition to exercising regularly, I take 1000 mg of calcium supplements with vitamin D. And, in part because I was getting lots of foot cramps in the pool and at night, I also take 500 mg a day of magnesium.

There are two types of exercise that can help to improve your bone health: weight-bearing and resistive.

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