By Nancy Alexander, PT
When I teach my exercise classes to adults over 50, I frequently ask how many of them have had a bone density scan done. Thankfully a large majority of them raise their hands – as many as 80% of them. Then I ask how many of them know their numbers. The results change significantly. They stop and think. They look at one another and then lower their hands. Typically, only 20-30% of them say they know. Knowing your numbers can be crucial to your health. I’ll explain why.
According to the National Osteoporosis Foundation (NOF), 10 million Americans have osteoporosis: Another 34 million Americans have low bone density or osteopenia. About nine million Americans over the age of 50 have osteoporosis. One half of women and two in five men will develop osteoporosis during their lifetime. Osteoporosis is the underlying cause of approximately two million fractures every year.
Unfortunately, people with low bone density are more likely to break a bone compared to people with normal bone density. Without a scan and without knowing your numbers, you cannot possibly undergo treatment for this disease. Which, in turn, is risky.
I want you to meet Sam. He is a former patient of mine (name has been changed for privacy). He came to me at an outpatient clinic recovering from breaking his shoulder blade when he fell skiing. As a physical therapist and skier, I was interested in how he fell to cause this. Sam proceeded to tell me. Later that day I was thinking about what he said. I was left with the feeling that I could not see how such a fall could produce a fractured bone. I began wondering about his bone density. He was an active man in his early 50’s. During his next visit I shared with him my concern. A half smile crossed his face and he said, “You know… my wife and I just had this same discussion last night.” I asked him if he had ever had his bone density assessed. He hadn’t. By the end of the visit, he was planning to schedule it. Turns out, Sam had osteopenia or low bone mass. This is often considered the early stage of osteoporosis. Thankfully he was not more seriously injured and healed well. Even more importantly, Sam discovered this disease and was able to begin treatment right away while incorporating some lifestyle changes to help improve it.
As an aside, rates of osteoporosis among men are rising, projected to increase 50% in the next 15 years. That seems quite remarkable but it is also true that with increased awareness now, more men are being scanned.
The DEXA Bone Scan is considered the gold standard for measuring bone density. The World Health Organization (WHO) Classification for bone density is called the T-Score. This is the number you are given as a result of your scan. Lower scores (more negative) mean lower bone density:
Here is the breakdown of key levels:
- -1 to (+) = healthy bone
- -1 to -2.5 = osteopenia
- <-2.5 = osteoporosis
Consider also Kim’s story (again name has been changed for privacy). She said she was last scanned over four years ago and was diagnosed with osteopenia. She started thinking about it again and thought she should get a follow-up scan. She promptly scheduled one. She was screened and now has “severe osteoporosis” at several locations in her body. Her lowest number is -3.6 at her fourth lumbar vertebra. Remember -2.5 is the level at which osteoporosis starts. How could this be? When she inquired about her numbers from four years ago, she found out they were -2.4 – just .1 point from osteoporosis. Knowing that may have brought about treatment options she and her physician didn’t otherwise consider. In the end though this is not about placing blame. This is about learning the importance of getting scanned and knowing your bone density score so you can make the best choices for you at the time.
Here’s another example: Linda (again name has been changed for privacy) had her bone density checked about three years ago and discovered she had osteoporosis. She was given her scores at that time. She immediately began treatment and engaged in multiple exercise classes incorporating strength training and impact exercise. She also began a walking program. Three years later, her numbers revealed only osteopenia, not osteoporosis. Her numbers improved. This is huge! This can mean the difference of not having to take prescription medication for osteoporosis (which is often not appealing) vs opting for more conservative treatment of vitamin supplements and exercise programs as noted above.
Getting scanned and knowing your numbers can lead to better health. True these are only examples and do not in any way illustrate what can happen to you and to others. Always consult with your physician for treatment options and other recommendations and always consult with them prior to starting any new exercise program. Other health concerns may also need to be considered.
It is important to remember that bone remodels throughout our life… it is a continuous process. We can strengthen our bones at any age. Here’s how it works: After the active skeletal growth phase in youth, and after menopause in women (a bit later in men), the remodeling process becomes unbalanced and we begin to lose more bone than we replace. This results in a net decrease in the total amount of bone. Still, osteoporosis doesn’t have to happen if we have enough bone mass. And you can build bone mass at any age with treatments such as prescription medications, vitamin supplements (Calcium and Vitamin D), weight bearing exercise and resistance training. With respect to exercise, bone get stronger with impact and bone gets stronger at muscle/tendon insertion points with resistance strength training.
Exercise is important and fall prevention is especially critical for those with osteoporosis. Research shows that fractures are more common in bones with low bone density vs normal bone. Fall prevention must include movement and exercise to maximize range of motion, strength and function. For those with osteoporosis or osteopenia, seek out safe bone strengthening strategies that integrate alignment and balance techniques. Even if you don’t have osteoporosis or osteopenia, strengthening your bones is important and can and should be done at any age.
In summary, movement and exercise on a regular basis is critical for your overall long-term health, fitness and quality of life. Building strong bones may not be at the top of your wellness list, but perhaps it should be. Get scanned, know your numbers, and act now to improve your health and wellness.
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