Osteopenia and osteoporosis are a continuum of a condition that begins as you lose bone mass (also called bone mineral density) which causes your body to break down bone faster than it can rebuild. It is more common in people older than 50. The National Osteoporosis Foundation (NOF) estimates there are 9.1 million women with osteoporosis and an additional 26 million with low bone mass versus the estimated 2.8 million men with osteoporosis and 14.4 million men with low bone mass. Even though women with osteopenia are more likely to have a broken bone, men tend to have worse outcomes after a similar injury. Bone mass peaks for most of us at age 35 then begins to decline.

People often refer to osteoporosis as a “silent” disease. In fact many people are unaware that they have osteoporosis until they break a bone often from a minor fall. Once this occurs, it can significantly affect physical and mental health and contribute to mortality. The risk of death in the first year following a hip fracture is estimated to be 14% to 58%. There are risk factors for bone loss that we cannot control such as family history and menopause. Smoking, steroid medications, and moderate to heavy alcohol use also increase your risk of bone loss. Individuals with celiac disease, an autoimmune condition causing gluten intolerance, are also at risk for osteoporosis. It’s important that these individuals be evaluated for bone loss even if they are under 50.

Diagnosing this condition is done with a bone density scan called a DEXA (dual x-ray absorptiometry) which measures bone thickness and strength by passing a high and low energy x-ray beam through the body, usually in the hip and the spine. Based on the findings, a T-score score is calculated. A T-score is a comparison of the your bone density with healthy, young individuals of the same sex. A negative T-score of -1 – 2.5 indicates osteopenia and a score of -2.5 or less indicates osteoporosis. All women should be screened for osteoporosis at the time of menopause. Men with risk factors should also be screened. If you have bone loss, a urine test called NTX can measure and monitor rate of bone loss.

There are also specialty supplements that you can speak to your provider about taking. People with osteoporosis should also be screened for celiac disease and non-celiac gluten intolerance and if positive, gluten-free diet can help to halt bone loss. Medication interventions such as bio-identical hormone replacement as well as medications like Miacalcin, Evista, Prolia, Boniva and Fosamax can also be used to target bone loss.