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Clearing up Some Confusion about Osteoporosis

separator In the past several years, as researchers have learned more about osteoporosis and how to treat it, there’s been some confusion over what constitutes osteoporosis and who should be treated for the disease. Here are some of the facts.

Osteoporosis vs. osteopenia
The word “osteoporosis” used to refer to a condition that caused fractures due to thinning bones. But about 10 years ago, the definition changed. Now it includes the thinning bones, even if there have been no fractures. Which means that more people are said to have osteoporosis itself.

The new definition is based on a number from an x-ray called a “DEXA scan.” People who have a DEXA number of minus 2.5 or lower are considered to have osteoporosis.

Osteopenia, on the other hand, is present if the DEXA number is minus 1 to minus 2.4. This means that the bone density is getting low. But it doesn’t necessarily mean that you’re in danger of have a fracture in the very near future. In fact, if you’re in your 50s and you have osteopenia, you would be considered normal. In other words, osteopenia is not a disease.

When to treat?
You and your doctor need to take a lot of factors into account before deciding it’s time to take one of the osteoporosis medications, which include Fosamax, Actonel, Evista and Forteo. Your age is important. Someone who’s 75 and has a DEXA number of 2.5 is at much higher risk of breaking a bone than someone who is 65, for example. Lifestyle factors can also help you decide whether medication is a good idea. If you smoke, don’t get much exercise, drink a lot of alcohol or have a family history of osteoporosis, it’s more likely that medication will be of benefit to you.

Men get osteoporosis too
It’s true that women make up the majority of osteoporosis cases—80 percent, in fact. But that leaves 20 percent to the men, which translates into about 2 million men in this country.

Risk factors for osteoporosis—for men and women

  • Not getting enough calcium and vitamin D
  • Not doing any weight-bearing exercise, such as walking and strength training
  • Smoking (smoking contributes to bone loss)
  • Heavy alcohol consumption
  • Family history of osteoporosis
  • Light skin
  • Small bones
  • Use of corticosteroids for more than three months
  • Kidney or liver disease
  • Increasing age

Additional risks for men

  • Low testosterone level
  • Having had androgen ablation therapy for prostate cancer

Prevention is the key
For all individuals, doing what you can to prevent osteoporosis is the best way to maintain the health of your bones and put off the need for medication. What are the ways to do this?

  • Do weight-bearing exercise several times per week.
  • Go for brisk walks nearly every day—at least 30 minutes at a time.
  • Limit alcohol
  • Stop smoking
  • Get plenty of calcium

How much calcium should you take?
The National Osteoporosis Foundation has the following recommendations for calcium intake for men and women:

Under age 50:   1,000 milligrams per day
Over age 50:    1,200 milligrams per day

If you’re just deciding to start taking calcium supplements, add them in increments of 500 milligrams at a time.

In addition, you should consume 800 International Units of vitamin D from food or from supplements.


National Osteoporosis Foundation; The New York Times, “Osteoporosis: It’s not Just for Women,” 20 June 2005; Journal of the American Medical Association, 25 May 2005
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