Signed in as:
Signed in as:
Osteoblasts: a type of bone cell that builds-up bone. When bones build up, they undergo both synthesis (formation) and mineralization (elements are combined).
Osteoclasts: a very large bone cell which breaks down bone tissue, also referred to as remodeling. Normal healthy bones are constantly undergoing
Bone resorption: the process where the osteoclasts break down the bone and release the minerals into the blood stream, which results in calcium moving from within the bone to the blood.
Bone Remodeling: the breaking down of mineralized bone by osteoclasts followed by the synthesis of bone matrix by osteoblasts. The bone tissue will subsequently become mineralized.
Bone Matrix: consists of about 33% organic matter (mostly collagen) and 67% inorganic matter (calcium phosphate). The integrity of the bone matrix is critical for bone strength.
Bone Density or Bone Mineral Density (BMD): is the amount of minerals, ie: calcium and phosphorous contained in a certain volume of bone.
Low Bone Mass: is diagnosed when your bone mineral density (BMD) value at either the neck of your femur (hip joint) or in your lumbar spine (low back) or both that is between -1 and -2.5 standard deviations (SDs) below the mean (average) bone density (BMD) of the value of a young, healthy female adult.
DEXA scan (Dual-Energy X-ray Absorptiometry), also called a Bone Scan or a Bone Densitometry is an imaging modality where a very small dose of ionizing radiation (like having an x-ray) will be used to produce a image of your bones, specifically your wrist, femur and spine.
Osteopenia: osteo means "bone" and penia means "decrease or deficiency". Osteopenia is diagnosed when your BMD is low. Your DEXA scan "T-scores" will fall between -1 and -2.5 standard deviations below a young female adult.
Osteoporosis: osteo means "bone" and porosis means “porous bone.” Osteoporosis is diagnosed when your BMD is very low. Your DEXA scan "T-scores" will be less then -2.5 standard deviations below a young female adult.
Osteoporosis is a condition in which the bone mass or your BMD is decreased, which often begins to occur when a woman enters into perimenopause or menopause stage of life. Once she is post-menopausal this process often accelerates, which is attributed to the woman's lack of estrogen and/or a deficiency in calcium or vitamin D.
The lower levels of estrogen occur because the woman stops ovulating. If a woman is still having monthly menstrual cycles, generally her blood estrogen remains at an adequate level to support normal healthy bone remodeling. If you would like to learn more about the menstrual cycle physiology and ovulation see my education page.
If you could view bone under a microscope, you would notice that the spaces become very widened when BMD decreases, which causes bones to become brittle and weak and thus the risk of fractures increases. There are a few types of bone fractures that are hallmarks of osteoporosis:
Well, most often women have absolutely NO symptoms at all, which is why it is so important that you educate yourself about this disease condition.
Osteoporosis is known as a “silent” disease” because oftentimes women will not be diagnosed until they have a bone fracture.
YES, there are many conditions which can perpetuate early osteoporosis. Your bones begin to build themselves up in childhood. By about age 30, you will have built up most of your bone mass. The following are conditions that can put women at risk of developing osteopenia and/or osteoporosis many years prior to menopause.
Many medications can cause early osteoporosis:
Women who have eating disorders, who have dieted excessively, or who have had poor diets are at greater risk of developing osteoporosis. Thus, it is very important all for women to have adequate protein, calcium and Vitamin D throughout their lifespan.
Women who have a BMI < 24 and who are smaller typically have thinner bones to begin with, so they will be at a greater risk to develop osteoporosis.
White and Asian women are at the highest risk.
Genetics plays a role. If your mother, aunts, sisters, or grandmother has had osteoporosis or if they had bone fractures, you are probably at higher risk.
Excessive alcohol is a significant risk factor for osteoporosis.
Nicotine use (vaping, smoking) is a risk factor for osteoporosis.
See list of medications above, "Can Younger Women Get Osteoporosis?"
First, I will meet with you for a visit to discuss your DEXA results, and to help you understand what they mean. We will be focusing on three parameters in your report:
Next we will do a Fracture Risk Assessment using a standardized tool called the American Bone Health Fracture Risk Calculator (see below). The calculator will give us the following information:
DEXA results and FRAX scores along with your Fracture Risk Assessment scores will tell us if you are:
Next we will discuss treatment options that are recommended for you. Please click the "Pharmacological Management of Osteoporosis" button below.
American Bone Health is a national nonprofit organization dedicated to providing educating about bone health and fracture risk and prevention.
Click here to take a quick quiz to learn your personal 10-year fracture risk
Click into the "Health Care Professional" tab to access the the American Bone Health Fracture Risk Calculator™ PRO, which is a validated tool that estimates fracture risk for your patients over age 45. The Endocrine Society Guidelines recommends you assess your patients' risk of fracture in order to move forward with an appropriate management plan. We
It is very important for health care providers to understand that :
we no longer provide medication based solely on the patient's DEXA scores.
Per the 2020, Endocrine Society Guidelines, recommended pharmacological management of osteoporosis in postmenopausal women is as follows:
Per Clinical Practice Guidelines published in 2018, entitled: "Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society, our risk assessment would include:
Very High Risk: