What are Osteopenia, Osteoporosis, and Osteoarthritis
This blog post is a long one. I want to establish that I am not a medical professional, you should always consult your medical practitioner for a diagnosis and medical treatment before making any changes to your diet and starting an exercise regime.
Osteopenia occurs when the bone mass thins and becomes porous but isn’t severe enough to be diagnosed as osteoporosis. It increases your risk of an osteoporosis diagnosis. Osteoporosis is diagnosed when the bone density becomes severe according to the measure of bone mineral density (BMD). This is not one of the “witches of menopause” everyone jokes about, but it should be. Most people think of osteoporosis when they see an old woman’s back bent over, but it is happening throughout the body. The hip femur bones can break and leave a woman immobile for the remainder of her life.
BMD peaks in your 30s and reduces after that age. There is more severe loss after menopause. Increased risks beyond your control include sex, age, race, genetics, and body frame size. Your estrogen levels lower in menopause and throughout your remaining years, which weakens your bones. There are medical and lifestyle risk factors: poor diet, sedentary lifestyle, untreated celiac disease, overactive thyroid, chemotherapy, and medications. BMD will be determined by a bone density scan called DEXA (duel-energy x-ray absorptiometry).
Osteoarthritis is often confused with osteoporosis. Osteoarthritis occurs when the protective cartilage cushioning the joints wears down over time. It has the nickname “wear and tear” arthritis. It also has risk factors: age, sex, obesity, joint injuries, repeated stress on the joints, genetics, bone deformities, and metabolic diseases.
Treatments for Osteopenia and Osteoporosis
Once you have a baseline determined by a DEXA scan, your doctor will monitor your bone density over time. If the test determines you have osteopenia or osteoporosis, treatments will be suggested or medicine prescribed. There are medications to treat bone density like bisphosphonates, denosumab, hormone-replacement therapy, and bone-building medications, but there are lifestyle changes you can make as well. The medications have many side effects.
To reduce your risks of osteoporosis and breaking bones, it is recommended you don’t smoke or drink alcohol, reduce caffeine intake, and take precautions to avoid falling. You should increase exercise including weight-bearing types and resistance training. If your doctor allows it, add jumping routines to your exercise. Studies have shown the best way to increase bone density in the hips and legs is to jump 10 to 20 times a day with a pause of 30 seconds between them. However, the women in the study did not have a diagnosis of osteoporosis. Get clearance from your medical practitioner.
Treatments for osteoarthritis include pain medications, physical and occupational therapies, transcutaneous electrical nerve stimulation, injections, and surgery.
My Personal Journey
I’ve been exercising for years—hiked, walked, biked, and ran some. I added light weight lifting over a decade ago. I gardened, dug tree holes, and broke up dirt with a pickaxe. I was a teacher and stood ALL day. A sedentary life has never entered my radar. When I had my first baseline DEXA scan in my 50s, I knew my bone density scan scores would come back great. Imagine the shock I experienced when the scan came back with a diagnosis of osteopenia.
My gynecologist recommended I have a bone density scan (DEXA) due to my size. I’m a petite woman with a height of 5’ 3” and my weight hasn’t fluctuated much over the years. Currently, I weigh 120 pounds, but at the time I weighed about 128 pounds. I have a few risk factors: white, petite frame, thin (but not skinny), and age/menopause. BUT and this is a BIG BUT, I had NO deficiencies in vitamin D or calcium. They have always been at acceptable levels.
I wasn’t convinced. I began researching on my own, trying to find what other factors could have attributed to my diagnosis of osteopenia. Eventually, I found a website that discussed the medications that can contribute to low bone density. Bingo. The first was medicine I took for years, and the other is a problem with the DEXA scan itself.
The Problems with Medicine
I have a history of Complex Partial Seizure Disorder, now called focal onset impaired awareness seizures, a type of epilepsy. I was diagnosed in graduate school and prescribed an antiepileptic drug called Tegretol (Carbamazepine). It can have nasty side effects. Most websites don’t even list the side effects like lowered white cell count and depletion of calcium and vitamin D! I was sick all the time. And of course, doctors didn’t know it had the side effects of decreasing bone density at the time.
After taking Tegretol for years with no seizures, I begged to go off the medicine. My neurologist wouldn’t allow it. Meanwhile, it was depleting my bones! I finally convinced my neurologist to remove me from Tegretol and have been off the medicine for years with no seizures. My gynecologist said to be thankful I did exercise over the years. My condition could have been much worse. Sure, I’ll be thankful the medical and pharmaceutical industries ruined my bones. So, now what?
What to do?
Besides cursing my neurologist and big pharma, I gave up caffeinated coffee. I increased my calcium intake but a woman can’t consume more than 1200mg a day without increasing the risk of a heart attack. I increased bearing exercises. I increased the amount of weight I lifted over time.
I had a new DEXA scan completed two years ago. My numbers were slightly worse in some areas but my lumbar score was stable. Unfortunately, it showed my left hip femur at -2.5, giving me a new diagnosis of osteoporosis despite it being borderline and only in that hip bone. My doctor approved adding jumping to my exercise routine thankfully.
The Problem with Big Pharma
I am curious what the next DEXA scan will show, but I’m taking the results with a grain a salt. There have been studies showing DEXA results aren’t consistent. Check out this post by a Certified Clinical Densitometrist and bone health expert. READ this article from the National Women’s Health Network that states “DEXA scans over-estimate how many women are at risk of fracture.”
The article further discusses the problem with how the pharmaceutical company Merck pushed prescriptions of their drug Fosomax, a biphosphonates drug, using the DEXA scans to show the need for the drug. They subsidized the production of the DEXA scans! No bisphosphonates for this woman. Look at the side effects and concerns.
Many characteristics determine weakened bones not only one inconsistent medical scan. This article is long but explains why other characteristics must be used to determine the true risk of fracture. Balance may be a better determining factor.
Weightlifting: Building Bone and Muscle
Weightlifting is a win-win for older women. It builds bones and muscle. As we age, we lose muscle mass. Due to menopause, we lose estrogen and collagen production reduction, causing laxity in the skin as well. If you increase your muscle, you reduce the amount of loose skin. That’s a huge win-win in my book!
I initially began lifting small weights to tone my body and to build strength. After receiving the low bone density scores, I increased the amount of weight I lifted. I mostly use weight machines, which are safer for us old farts. I also do bodyweight exercises and use dumbbells when I’m not able to get to the fitness center. That was all I had in the lockdown during the Covid pandemic.
Many women worry about bulking up as a woman. It’s not going to happen unless you consume a lot of protein and lift heavy weights. When I was bulking up, I drank protein shake supplements. I stopped drinking those during the pandemic, because I lacked the heavy weights to keep my larger muscle mass. I deflated quickly. My loss of weight from 128 lbs. to 120 lbs. was mostly due to a bit of muscle loss. I prefer to have more muscle. It fills out the little loose skin I have and makes me strong!
There are a couple of women who are my heroes. Ernestine Shepherd didn’t begin her fitness journey until she was 56 years old, and at 85, she’s still weightlifting. The other woman is 74-year-old Joan McDonald. An Instagram influencer with an account called Train With Joan, she began her journey, weighing 200 pounds with medical issues. If these amazing women can do it, what are you waiting for? You are just as amazing!
Osteoarthritis: Wear and Tear
I also have osteoarthritis (OA). I keep telling people I’m slowly disintegrating. Ha! I joke about it, but this is very real for a lot of people. You don’t have to be very old to develop OA. Forty years of playing instruments was hard on my hands, and many instrumentalists develop OA and other issues like trigger finger in their hands. I started having pain in two of my right-hand DIP joints (the joints nearest the tip of your fingers) in my early 50s. That wasn’t what a professional musician wants to hear. I had many X-rays of my right hand like this picture over the next few years.
I went to a hand specialist in Delaware, and he gave me injections for the pain. After a year, it had worsened. I was developing bone spurs that made them look knobby (the beginnings of “witchy” hands), and the pain made it difficult to play instruments. I had some bone spurs on my left-hand DIP joints, but they weren’t nearly as bad and still aren’t.
Around this time, I became a vegetarian (with occasional salmon) and started researching which foods cause inflammation. Wheat gluten and dairy are the worst culprits for many people. I eliminated all wheat gluten from my diet and reduced my dairy intake. Lo and behold, the inflammation disappeared. I also added turmeric with pepper to my eggs each morning. I eliminated 100% of the pain and never need acetaminophen or ibuprofen. Arthritis hand creams? Nope. I don’t use anything.
DIP Joint Arthroplasty
Unfortunately, the three center DIP joints on my right hand had deteriorated to the point that two were frozen and my index finger was leaning in the wrong direction. My hand specialist in Delaware told me he would have to fuse all three joints. I asked him how I was supposed to play instruments with straight DIP joints? He didn’t see why it would be a problem. FACE SLAP! I left his office crying, wondering how I was going to continue my career.
I did my research and found that some hand surgeons performed DIP joint arthroplasty, just not my doctor in Delaware. As you can imagine, I had some evil thoughts about this doctor saying “joint fusion was my only option.” No, he just didn’t perform arthroplasty. I found my brilliant surgeon in Philadelphia.
I had so much anxiety and fear going to that intake appointment. At the time, my hand surgeon told me they only perform DIP joint arthroplasty on 1% of the patients who come in. When he told me he would perform arthroplasty on my three joints, I felt like I’d won the lottery. DIP joint arthroplasty involved replacing the deteriorated cartilage with inserts and removal of the bone spurs. The surgery was successful, and I regained full motion and strength in my hand after four months of occupational therapy. We don’t know how long the arthroplasty on the three fingers will last. Fingers crossed and pun intended!