“Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones)”. (National Institute of Arthritis and Musculoskeletal and Skin Diseases: https://www.niams.nih.gov/health-topics/osteoporosis).

Recommendations to prevent osteoporosis: these recommendations may slow, but not do prevent, bone loss:

• Sufficient calcium, magnesium, Vitamin K, and Vitamin D, preferably from food. (There is very little benefit to taking Vitamin D doses greater than 600-800 IU/day).
• Weight-bearing exercise: 150 minutes/week.
• Nutrient rich diet with at least 1.2g protein/kg of body weight, plenty of green leafy vegetables, legumes/beans, fruits, grains, and fermented, low fat, dairy.
• Estrogen and estrogen plus progestin prevented both vertebral and hip fracture in women with an average age of 63-years and did not have osteoporosis in the Women’s Health Initiative study (See reference below).

Risk factors for osteoporosis:

• Personal or family history of fracture.
• Certain medical conditions: Rheumatoid arthritis, Cushing syndrome, chronic renal disease, anorexia nervosa, hyperthyroidism, Type 1 Diabetes mellitus, Hemochromatosis, and chronic liver disease, among others.
• Certain medications: Aromatase inhibitors (used in the treatment of breast cancer), immunosuppressants, excessive thyroxine doses, and phenytoin, among others.
•  
• Caucasian, thin, petite build, advanced age, sedentary lifestyle, excessive alcohol intake, and genetics.

Medications often prescribed to treat or manage osteoporosis: these should be prescribed/managed by a specialist:

• Estrogens (if not otherwise, contraindicated).
• Bisphosphonates (Raloxifene, Risedronate, Alendronate, Etidronate, and Ibandronate orally).
• Estrogen agonists/antagonists (SERMs) (Bazedoxifene/conjugated estrogen combo).
• RANK ligand inhibitor (Denosumab subcutaneously).
• Salmon calcitonin (subcutaneously or nasal).
• PTH-receptor agonists (Teriparatide, Abaloparatide subcutaneously).

What is osteopenia?

Osteopenia is bone density loss. It can progress to osteoporosis if the bone density loss worsens.

References

Cauley, J., Robbins, J., Chen, Z., et al. (2003); Women’s Health Initiative Investigators. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA; 290(13): 1729-1738.

Jackson, R., Wactawski-Wende, J., LaCroix, A., et al; Women’s Health Initiative Investigators. Effects of conjugated equine estrogen on risk of fractures and BMD in postmenopausal women with hysterectomy: results from the Women’s Health Initiative randomized trial. Journal of Bone Miner Res; 21(6): 817-828.