Bone Health and Conditions

Healthy bones are an important part of your overall well-being. Your bones are not just your body’s frame. They also protect your organs, support your muscles, store calcium and help you move. When they aren’t at their best, your health may be at risk.

Certain diseases or problems can weaken or damage your bones. Here’s what to know about some of the most common ones.

Osteopenia and osteoporosis

Osteopenia (low bone mass) and osteoporosis (bone thinning) are two related conditions where your bones become weak and develop tiny holes on the inside.

Your bone tissue is constantly breaking down and being replaced. During childhood, new bone growth outpaces old bone breakdown, and your bones get bigger and stronger. After about age 20, this process starts to even out for both men and women. By age 40, your bones can start to lose their strength. Low bone density increases your risk of wrist, spine and hip fractures. Other bones can also be affected.

Osteopenia is a condition that can lead to the bone disease known as osteoporosis. With osteopenia, your bone density is lower than average but not low enough to be classified as osteoporosis. At this stage, there are still steps you can take to lower your chances of developing osteoporosis.

Symptoms of osteoporosis

Most people don’t notice osteoporosis symptoms until it is advanced. At that point, you could have:

• Broken bones that happen after a minor injury, such as a fall from standing height or even from coughing or simply lifting an object.
• Loss of height and a stooped or curved back.
• Back pain and/or bone pain.
• Compression fractures in the spine.

Risk factors for osteopenia and osteoporosis

There are risk factors for developing osteopenia and osteoporosis that you can’t control. Your risk is higher if you:

• Are female – women are four times more likely than men to develop osteoporosis.
• Are over age 50 (for women) or age 70 (for men), since your bone slowly thins and breaks down as you age.
  • In rare cases, children can develop juvenile osteoporosis.
• Are white or Asian.
• Have a body mass index (BMI) of 19 or less.
• Have smaller bones.
• Have a family history of osteoporosis.
• Have broken a bone after age 50.
• Have low estrogen levels (in women) or low testosterone levels (in men).
• Had your ovaries removed before menopause (in women).Take certain medications such as: glucocorticoids, corticosteroids, thyroid medications, antiepileptic medicines, heparin, methotrexate, diuretics, lithium, depo-progesterone, proton pump inhibitors, selective serotonin reuptake inhibitors (SSRIs) or medicines that reduce levels of sex hormones, which might be prescribed to treat breast or prostate cancers.
• Have medical conditions such as: certain hormonal disorders, celiac and other digestive diseases, autoimmune disorders (particularly rheumatoid arthritis), neurological disorders, inflammatory bowel disease, kidney or liver disease, overactive parathyroid glands, HIV/AIDS, eating disorders, previous weight loss surgery, organ transplants or certain types of cancer (particularly multiple myeloma).

How to keep your bones healthy

The good news is that there are steps you can take to lower your risk of developing osteoporosis.

Good bone health starts early, so if you have children encourage them to be physically active and to choose a calcium-rich diet. From birth until about age 20, children can continue to build bone strength. After that, you can take easy steps to keep your bones strong.

With the right choices, you can maintain the strength of your bones so they support you for life. Here are some tips:

• Choose a balanced, nutrient-rich diet with adequate calcium and vitamin D. Adults need 1,000 milligrams of calcium a day. After age 50 (for women) and age 70 (for men), you need 1,200 milligrams a day. In order for your body to absorb the calcium, you also need 600 IU (international units) of vitamin D per day until age 70, then 800 IU per day after age 70.
• Engage in regular weight-bearing exercise such as jogging, dancing, aerobics classes and resistance training.
• Avoid smoking.
• Limit alcohol and caffeine consumption.

Early detection of osteopenia and osteoporosis

Because most people don’t have symptoms of osteopenia or osteoporosis, it’s very important to ask about bone density screening as early as age 50 if you are at risk. When these conditions are detected early, you can consider treatment options to help keep them from progressing.

Talk to your doctor if you think you may be at risk, especially if you went through menopause early, have taken steroids for several months at a time or have a parent or sibling who had osteopenia, osteoporosis or a hip fracture.

Your doctor may test your blood and urine to look for conditions that can cause loss of bone mass. They will also probably recommend a Dual-Energy X-ray Absorptiometry (DEXA or DXA) scan,  also called a bone mineral density scan. This test is a common and reliable way to measure bone density and assess bone health. It’s recommended for anyone at high risk, all women over age 65 and all men over age 70.

DXA scans are painless, non-invasive and take less than 30 minutes. For the test, you lie on a table and have low-dose X-rays taken of your hip or spine.

Your DXA scan will result in a T-score  , which compares your bone density to a healthy 30-year-old. A score of -1 or above is normal. A score between -1 to -2.5 means you have osteopenia. A score equal to or lower than -2.5 means you have osteoporosis. If you have osteoporosis, your doctor will probably want you to have DXA scans every two years to monitor your bone loss.

For pre-menopausal women, men under age 50 and children, a race and ethnicity adjusted Z-score is used. Z-scores at or below -2.0 are considered low bone mineral density for their chronological age.

Treating osteopenia and osteoporosis

Treatment of osteopenia and osteoporosis is very important because when your bones get weaker, you’re at higher risk of a dangerous bone fracture. It can also take you longer to heal from a fracture, which may also limit your mobility for the rest of your life.

Your health care provider may recommend treating osteopenia with exercise, nutrition and vitamin or mineral supplements, which may help slow or stop the loss of bone density.

If you develop osteoporosis – and in some cases if you have osteopenia – prescription medication may be recommended. There are various options to consider for treating osteoporosis, including:

• Bisphosphonates such as alendronate (Binosto or Fosamax), ibandronate (Boniva), risedronate (Actonel or Atelvia) or zoledronic acid (Reclast or Zometa). These drugs can cause side effects such as heartburn, nausea and abdominal pain.
• Denosumab (Prolia or Xgeva), which you take as an injection every six months.
• Hormone therapy, including estrogen replacement therapy in post-menopausal women and, in some cases, testosterone replacement therapy in men.
• Selective estrogen receptor modulators (Evista).

Your provider will work with you to develop a treatment plan and will want to monitor your bone density regularly to watch for changes. If treatments aren’t working or your osteoporosis is severe, your doctor might recommend a biologic called Denosumab (Prolia) or bone-strengthening medications such as teriparatide (Bonsity or Forteo), abaloparatide (Tymlos) or romosozumab (Evenity). However, aside from Prolia, you can only take these drugs for one to two years. 

Some people try supplements like soy, black cohosh or red clover to treat osteoporosis, but there’s no evidence that they work. If you choose to try supplements, be sure to let your doctor know since they can interact with other medicines.

Preventing falls

Because it’s so easy to break a bone when you have osteoporosis, it’s very important to prevent falls. But don’t let the fear of falling keep you away from activities you enjoy

To stay safe, older adults should make sure their homes and pathways are well-lit, keep clutter off floors, use non-skid rugs, use handrails whenever they are available (such going up or down stairs, using the toilet or during bathing), and wear shoes that fit well and have non-slip soles.

Other bone conditions

Health care providers at Banner Health are also skilled in diagnosing and treating other bone conditions, including:

• Paget’s disease of bone: a chronic condition where the usual way your bones break down and regrow is disrupted. Your bones grow too quickly, so they are bigger and softer than they should be, become weak and deformed and can fracture easily. It usually occurs after age 50 and affects one bone or a small number of bones. Medications such as bisphosphonates and surgery can help treat it.
• Osteomalacia: a condition where the outside of your bones becomes soft because of a lack of mineral deposits. It’s usually caused by not getting enough vitamin D, so taking vitamin D supplements can help treat it.
• Rickets: a condition where children have weak or malformed bones because they don’t get enough vitamin D, calcium or phosphate. It’s usually treated by increasing the amount of vitamin D or calcium in the child’s diet.
• Osteogenesis imperfecta (OI – also known as brittle bone disease): a genetic disorder where you have problems with collagen that cause fragile, easily broken bones. Sometimes, bones can break for no apparent reason. People with OI may also have brittle teeth, weak muscles, spine curvature and hearing loss. It’s not treatable, but surgery, physical therapy, braces and other mobility aids can help.
• Fibrous dysplasia: a bone disorder where fibrous tissue replaces normal bone, causing weak and deformed bones. Usually caused by a genetic mutation, fibrous dysplasia tends to happen in the skull, upper arm, ribs, pelvis, thigh or shin of children and young adults. It’s usually treated with surgery, medication and physical therapy.
• Bone cancers: Including osteosarcoma, Ewing sarcoma and chondrosarcoma, bone cancers can cause various problems. Sometimes, other cancers spread to the bones from other parts of the body. Treatment can include surgery, chemotherapy or radiation therapy.

Diagnostic tests for bone health

Along with DXA scans for bone density, other tests can evaluate your bone health. Depending on your symptoms, your doctor may recommend:

• Blood tests to check calcium, vitamin D, hormone levels, and secondary causes of bone disease.
• Imaging tests (such as X-rays and CT scans) to identify fractures or structural problems in your bones.