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Are You really losing bone?
Dr. Susan E. Brown

Who needs a medical work-up to find the causes of their osteoporosis?

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Here at the Center for Better Bones, we often say that it is difficult to solve a problem you do not fully understand.Osteoporosis does not happen “just because” — there are always underlying causes of osteoporosis. Some of these causes are lifestyle-related, but others can be undetected health problems of which the bone loss is just a symptom.

If you have a bone health problem — or if you or your doctor simply suspect you might have a serious bone concern — an osteoporosis medical work-up of tests is in order to look for the causes of your bone loss.

Step #1: Find out what is happening — are you really losing bone?

When there is any type of bone health concern, an attempt should be made first to understand exactly what is happening with the bones.

Questions we might ask here include:

  • What is your bone density compared to young folks of your same sex?
  • What is your bone density compared to folks of the same sex and same age?
  • Are you underweight with small bones, and thus more likely to have a low bone density reading?
  • Is your bone loss ongoing?
  • If you’re female, is your bone loss related to the transitions of perimenopause and early postmenopause?
  • Do you have multiple osteoporosis risk factors?
  • Have you experienced any fractures?
  • Overall, is there a real problem?

Step #2: Find out why it is happening — what’s the cause of your bone loss?

After these questions have been answered and it has been determined that there is a real concern, then the next step is to undertake medical testing to uncover the underlying causes of any real problems. A good osteoporosis medical work-up can include a variety of tests such as the ones listed below. Background information for these tests and their interpretation is provided in my two articles, The diagnostic tests to find what causes osteoporosis and Understanding your test results.

Tests included in the medical work-up for osteoporosis

The final step in this process should be clear: once you know that you’re losing bone and have found out why you’re losing bone, you can stop the bone loss by addressing the underlying health problem that’s costing you bone! In some cases, it may be something as simple as improving your vitamin D status, either by spending more time in the sun or using vitamin D supplements, or both if needed. Other health concerns might need more complicated solutions, requiring further discussion with your healthcare provider to help you understand what your test results mean.

Better Bones Blog
Dr. Susan E. Brown

Tests included in the medical workup for osteoporosis

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The other day, I had an e-mail from a 70-year-old woman who is following the Better Bones approach. She was obviously very frustrated by what she considered a lack of progress. “I’m doing everything I’m supposed to,” she said, noting that she was eating alkaline and testing her pH, exercising daily with weights, meditating, and taking her vitamin supplements religiously. But she’d just had a DEXA scan and was upset because nothing had changed. Her bone density was no different than it had been the last time she’d had her bone density measured 2 years ago, and she couldn’t understand why it hadn’t improved.

At first, this struck me as a little bit funny. She clearly didn’t understand something very important. For a woman after menopause, keeping bone density stable is a big accomplishment! Keep in mind that the average in her 60’s and 70’s loses 1 or 2% of her bone mass every two years. That means that over the course of 3 years, this particular woman had maintained her bone density instead of losing the 1-2% she might normally have expected to lose just from the average wear-and-tear of aging. Compared to a lot of her peers, she’s doing pretty well! In light of the fact that the average women loses as much as 47% bone of her bone mass by her late 80’s, this client’s stability of bone as she ages is a real sign of success.

Then I reconsidered. I thought, “this woman thinks she’s failing at something when she’s succeeding — that’s a problem!” Here she was, beating the odds and keeping her bones stable year after year, yet she felt like she wasn’t doing enough. I did not want her to walk away feeling defeated when she’d just won a wonderful victory. But how to get that point across to her and others like her?

Well, here’s a small analogy for you. Many personal trainers will tell someone they’re helping to lose weight to pay no attention to what the scale says, but instead gauge their weight loss success by how their clothes fit. It’s somewhat the same with bone health. For many of us, “optimal bone health” might mean results not visible to the naked eye or even to a DEXA scan — a strengthening of bone that leaves it more flexible and less prone to fracture, but that doesn’t increase its overall density. Some might also find their bone density stabilizes, as the woman who wrote me did (even if she didn’t recognize this stability for the achievement it is). Some see small gains in bone density, and a few see significant increases in bone density. But for most, the improvement might not really show up on any measurement made by a DEXA scanner.

What you do often get with a natural bone health program is a visible improvement in overall health — stronger nails, more supple skin, healthier teeth and gums, often better digestive health — that signifies that the body is getting what it needs and therefore doesn’t need to tap the bones for resources. Like a pair of suddenly loose pants on a person whose bathroom scale says she hasn’t lost a pound, sometimes the measuring device should be disbelieved if the body itself says that good changes are happening.

It’s also true that one might have such gains but not see them, since (as I’ve commented in earlier blogs) DEXA machines are notorious for having poor accuracy from one scan to another. A DEXA scan must show a change in density of at least 5-6%, according to noted bone researcher Susan Ott, to indicate a definite change in bone density; anything less than that could just be variation in the scanner or operator skill. The woman who e-mailed me, for example, could very well have had an increase in bone density of 1% from year to year, but the variability in DEXA measurements might have masked the increase.

So there are two points I’d like everyone to take away from this. One is that your success might not be measurable or quantifiable in terms of increased bone density—but that doesn’t mean you should discount it. Having stable bone mass as we age is something to celebrate! The other is that the point of a Better Bones Health Package and the approach I’ve long advocated is not to make sure everyone has bones equivalent in density to a 25-year-old athlete, but to give the bones — and the body, too — the resources they need to obtain optimal health.