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Osteoporosis: What your Doctor may be too busy to tell you

I get a lot of questions about Osteoporosis, everything from diagnosis, testing, and disease progression. Let's dive into your bone health information that your doctor may be too busy to tell you. Osteoporosis is called the "silent disease" because most people do not know that they have it until a fracture occurs. Women are primarily diagnosed with Osteoporosis, however, men are not excluded from the risk. Osteoporosis is defined as a medical condition in which the bones become brittle and fragile from tissue loss. Osteopenia is a lesser advanced version of Osteoporosis.


Women over the age of 65 are encouraged to have a bone density scan. This is completed via a DEXA scan. A DEXA scan will report to you a score that will interpret your bone density. There are two scores given, a T-score and a Z-score. The T-score takes your results and compares the bone density of young adults of the same sex. A Z-score compares your BMD to people your age. The Osteoporosis diagnosis typically goes on your T-score. A T-score of -1 - -2.5 places you with an Osteopenia diagnosis. A T-score of -2.5 or greater will give you an Osteoporosis diagnosis.

Early symptoms:

Early symptoms of Osteoporosis include spine pain, fracture, decreased height, or hyperkyphosis. Hyperkyphosis is also known as a dowagers hump or forward posture. The most common sign of Osteoporosis is a fracture. Fractures occur most commonly in the spine, wrist, and hip. Studies show that fracture risk in osteopenia is more significant than those with Osteoporosis. The primary thought is that those with Osteoporosis are more cautious with their day to day activities, decreasing the fracture rate.


While genetics play a role in the Osteoporosis diagnosis, lifestyle habits can significantly influence your bone health. Multiple lifestyle factors play a part in your bone health. Smoking, alcohol use, chronic high stress, and excessive steroid use play a large role in the osteoporosis diagnosis. Untreated celiac disease and digestive ailments can also play a role in bone health. Your digestion is essential in the absorption usage of the nutrients needed to promote healthy bone.


Medications and lifestyle changes will be the best approach to treating and reversing your diagnosis. While medications are an essential part of reversing Osteoporosis, lifestyle habits can also improve your bone density without the harmful side effects. It is essential to talk with your doctor about medications and what is the right choice for you. Some common medications are:

  • Synthetic or Horse-derived Estrogen: It is suggested that Estrogen only therapy can have significant health risks. However, Estrogen plus progestin/progesterone therapy has shown to decrease your risk of fracture.

  • Selective Estrogen Receptor Modulators (e.g., Tamoxifen, Evista, Nolvadex): These drugs are meant to stimulate and balance bone-building and clearing cells (Osteoblast and Osteoclast). This can preserve your bone density. Again, these drugs do not come without high-risk factors for uterine thickening and certain types of cancer. They can be appropriate for short-term use for women with advanced Osteoporosis.

  • Bisphosphonates (e.g., Fosamax, Actonel, Boniva, Reclast): These drugs dramatically reduce bone loss. These drugs are meant to retain old bone tissue. Unfortunately, they do not support the production of new bone tissue. Long-term use of this drug can cause your bones to become brittle because there is not new bone growth. Long term use of these medications are associated with brittle bone and increased fracture risk.

  • Monoclonal Antibody (Prolia): This drug is becoming more popular due to its 1 or 2 times a year injections. It does present a wide array of immuno-suppressive risks. These drugs mimic bisphosphonate medications by preserving your bone tissue.

**Adapted from "What Your Doctor May Not Tell You About Osteoporosis" by Dr. Felicia Cosman, Warner Books, 2003.

I can not stress enough that drug use is appropriate in many situations. Drug therapy may be the best choice for you dependant on your bone density levels. The important thing is to not jump into drug treatment without doing self-research and talking with your doctor about different options. Supporting your bones with lifestyle modifications is the best route to take when dealing with your bone health. Next week we will be discussing essential changes you can make to support your bone health.

Wellness 360 offers an Osteoporosis Online Wellness Program designed for individuals looking to improve their bone health through exercise. Each class is designed and led by physical therapists to ensure the appropriate modifications to support your bone health and prevent exercise risk factors. We work to strengthen your muscles, improve your posture, and improve your balance. Each class is modified using evidence-based exercise to allow you to gain strength safely and effectively. Get your 2-week free trial today!


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