"I Don't Get What The Doctor Told Me..." The Vocabulary Of Osteoporosis

PJ Hamel Health Guide
  • Lately, as a new osteopenia patient, I find myself drowning in a sea of unfamiliar words. Osteoporosis I’d heard of. But osteopenia… huh? I realize T-score has nothing to do with little kids hitting baseballs off a tee. And bisphosphates, despite vague memories of my grandma trying to doctor me, have nothing to do with a stomachache (except perhaps to give you one).

    So I figured I’d better compile a top-10 list of common osteoporosis vocabulary words, and study up on ’em.  I did this during breast cancer, when I couldn’t tell radiology from radiation, and didn’t realize adjuvant therapy was a fancy way of saying chemo. It helped. And if you’re an osteo-newbie like me, maybe this will help you, too. Especially since it’s written in plain English, rather than medical-speak.

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    The following words and terms aren’t in alphabetical order. They’re in order of how you might need to access them, from your first hint of trouble right up through active treatment. Even if you’re an osteo-pro, use this list as a refresher course: you never know when a friend might ask you the details of the T-score system, right?!

    Osteopenia: This is a condition that can (but doesn't necessarily) lead to osteoporosis. It’s like those first autumn leaves that drift down, way before the others; they don’t add up to much, but they signal what’s on the horizon. Osteopenia is a thinning of the bones. The calcium and other minerals that make up your bones are packed less densely, which means your bones are more porous, which means they can break more easily. Technically, osteopenia is when your T-score (see below) is between –1 and –2.5.

    Osteoporosis: The big daddy. The reason we’re all here on this site. Either we have it, we’re on the way, or we’re trying to prevent it. Osteoporosis is when your bones are significantly less dense than normal, because they’re less tightly packed with calcium and other minerals. Technically, it’s when your T-score drops below –2.5. This can happen for a number of reasons. The main ones are age; menopause; and the use of steroids, steroidal drugs, or other drugs that promote a loss of bone density.

    So, what’s the big deal? Unfortunately, the thinner and lighter your bones are, the more likely they are to fracture. And that doesn’t mean just a broken wrist. It means hip fractures and spinal fractures. A series of small spinal fractures can compress your spine, leading to poor posture and eventually to that bent-over, crippling stance colloquially called “dowager’s hump” or “widow’s hump.” Osteoporosis can have a huge impact on your health, mobility, and lifestyle; it’s critical to do everything possible to head it off.

    Bone mass/bone density: These terms are interchangeable. And they refer to how thick/heavy/tightly packed with minerals your bones are. The more tightly packed—the denser your bones—the stronger they are, and the less likely to break. Bone density is what your doctor measures and tracks over time, to see if you’re on the way to osteoporosis.

  • Bone mineral density test, a.k.a. bone density test, DEXA-scan, densitometry scan, DXA-scan, bone mass density test: This test uses X-rays to figure out how many grams of calcium and other minerals are packed into a specific quantity of bone. The test doesn’t look at all your bones; it focuses on those most likely to break as your bones thin: your lower spine, hip, and forearm/wrist. It’s non-invasive (i.e., you don’t have to drink anything or be injected with anything beforehand). You lie out in the open; the machine never touches you. And the whole thing takes about 10 minutes. All in all, it’s a really easy test.

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    And once you have the results of your first bone density test, it’s like having your first mammogram results: the doctor will use it as a baseline, to track whether/how fast your bones are thinning. Typically, the baseline test is followed by tests every other year. The tests may be done every year if there’s strong evidence your bones are thinning pretty quickly, and/or if you’re trying different things to stop osteopenia from turning into osteoporosis.

    T-score: This is the number you get from the bone density test. It compares your bones to a healthy young adult of the same sex, and then gives you a score. Zero is the healthy young adult score. Anything above –1 SD (minus 1 standard deviation–don’t worry, you don’t have to understand the statistical math here) is considered normal. From –1.0 to –2.5, you’ve got osteopenia. Below –2.5, you’ve got osteoporosis. And by the way, these figures refer to postmenopausal women. If you fall into another group, figures may vary, as they say.

    Calcium: What IS that stuff that’s supposed to pack your bones? The reason your mom made you drink all that milk? Well, it’s the most abundant mineral in the human body. And 99% of it is stored in your bones, including your teeth. But the tiny little bit that circulates in your bloodstream helps your nerves send messages, your muscles work, your heart beat—calcium literally keeps you alive.

    Your bloodstream will always get the calcium it needs, by drawing it from your bones; the problem is that if there’s not enough calcium in your diet, or your bones are shedding their calcium more quickly than you can replace it, then there’s not enough to go around. Uh-oh… here comes osteoporosis. See why you take those calcium tablets every day?

    Vitamin D: Calcium’s best friend. Vitamin D helps your body absorb and metabolize calcium (in simple terms, put it to use). Without sufficient levels of Vitamin D (and that’s Vitamin D3, specifically), you can stop worrying about your calcium intake; it won’t make any difference. You need Vitamin D just as much as you need calcium.

    Vitamin D can come from your food (usually, eggs and fortified dairy products); in tablet form; or mainly, from exposure to the sun. In many parts of the country, your normal routine will give you sufficient outdoor time for your body to make all the vitamin D it needs. In northern climates (say, anywhere north of Boston in the winter), you simply won’t get enough D from sunlight, and you’ll need to go the supplement route.

  • Weight-bearing exercise: OK, now that you’ve been tested, found yourself heading towards osteoporosis, and have ensured that your calcium and vitamin D intake is sufficient—what next? Lifestyle changes, which can include cutting out smoking, reducing alcohol intake and, most important, the e-word: exercise.

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    And not just any exercise. Weight-bearing exercise, which is any kind of exercise you do that forces your bones to carry your weight, and your muscles to work against gravity, or against resistance. So, is swimming a weight-bearing exercise? Well, not much of one, since the water is holding your body up. Biking? No, ditto. Walking? Yeah, although recent studies have shown normal walking doesn’t do a whole lot for your bone density (though it’s great for your general health).

    So, what are some good weight-bearing exercises? Any kind of running, from a slow jog to a sprint. Hiking. Jumping, which translates to step aerobics (or dancing!) Stair climbing. Pushups. And the most obvious, weight-lifting. Add to that all manner of active sports (soccer, basketball, tennis…) and you get an idea of what types of exercise will help your bones the most.

    Resorption: Heard of absorption? This is the reverse. Resorption is when your bones shed; when they lose their substance. Your bones are always in flux; “remodeling,” it’s called. They break down, and they build back up. When you’re young, there’s more growth than breakdown. In middle age, the processes are about equal. In older age, your bones break down faster than they build back up. If this equation is TOO far out of whack—if your bones are breaking down way too fast, much faster than they can build—then you have osteoporosis.

    You probably won’t hear much about resorption until your doctor starts talking about medication, and refers to anti-resorptive agents. These are simply drugs that slow down the rate at which your bones lose density.

    Drugs used to strengthen your bones. Simple as that. They inhibit your bones from losing density. Typical bisphosphanates used to treat osteoporosis include Boniva, Fosamax, and Actonel. They’re a bit tricky to take; and they come with some uncomfortable side effects. Thus, newer drugs on the horizon may replace bisphosphanates sometime in the near future.

    Wow, I feel smarter already. Next time I go see the bone nurse, I won’t leave the  office wondering what the heck she was talking about… now that I know my basic osteo-vocab words.

Published On: August 28, 2008