Osteopenia: Do You REALLY Need the Drugs?

Patient Expert

So, you've been diagnosed with osteopenia. Your doctor recommends a bisphosphonate - say, Fosamax. But you've read some pretty awful things about it.

From the rigid schedule for taking a bisphosphonate, to the heartburn, diarrhea, and nausea that may accompany it, to the awful possibility that it may dissolve your jaw" right about now, your inner self is probably screaming, "Don't go there"

But what's a woman to do? You've been through menopause, and tests tell you your bones are thinning. Why is this happening?

Maybe you have a family history: your grandma was bent over nearly double by the time she passed; your mom broke her hip in her 80s.

Or maybe you have some lifestyle issues; you smoke, you drink, you're out of shape.

Are you taking an aromatase inhibitor for breast cancer? Steroids for asthma or rheumatoid arthritis? Your bones are at risk.

But" do you REALLY have to go the drug route?

Maybe not. If you were deep into osteporosis, with T-scores WAY below -2.5, then yeah, you definitely have to take some kind of drug. But if you've had a bone density test, and your T-score shows you in osteopenia - what then? Take drugs?

Or take action?

Take a look at these 10 things to know about avoiding osteoporosis drugs. You may just be able to bypass the expense and irritation of a bisphosphonate.

  1. Calcium. This is job #1: make absolutely sure you're getting enough calcium in your daily diet, via food, or supplements. For women over age 50, that's a minimum of 1200mg daily, with some doctors recommending 1500mg.

And, did you know there's a wrong way to take calcium, and a right way? And that what you eat along with calcium affects how well it works? Familiarize yourself with this critical mineral, and make sure you're getting what you need, when and how you need it.

  1. Exercise. Yes, exercise makes a HUGE difference. But, while all exercise is good for you, certain types of exercise are much better than others for building bone. Weight-bearing exercise - anything that stresses your bones, like weight-lifting, jogging, sports that involve jumping or running - is much better for you than, say, swimming or cycling or walking, where your bones aren't really undergoing any stress. Exercise regularly - and concentrate on the types of exercise that'll really help your bones.
  1. Vitamin D. This vitamin is to calcium what gas is to your car: without vitamin D, calcium just can't get going. Vitamin D helps in the formation of a hormone, calcitriol, which in turn allows your body to absorb calcium. So insufficient amounts of vitamin D in your body prevent the most effective absorption of calcium.

While the current government recommendation for vitamin D is 400IU daily, it's an accepted fact that new guidelines, to be released next year, will advise a much higher daily dose. A recent study disclosed that fully 70% of Americans are vitamin D deficient; we've got some catching up to do.

So, how do you get vitamin D? Through your skin, via about 10 minutes a day (or 15-20 minutes several times a week) of natural sunlight, no sunscreen. Through your diet: eggs, saltwater fish, and vitamin D-fortified milk are all good sources. And via vitamin D supplements, which are often paired with calcium supplements. Caltrate 600-D (and its generic knockoffs) offers 600mg calcium paired with 400IU vitamin D, both in tablet and chewable form.

  1. Cut back on alcohol consumption. The more alcohol you consume, the more bone you lose. Alcohol disrupts the bone remodeling process by slowing down or even preventing new bone growth. So old bone cells are dying and being flushed away, but no new ones are taking their place. The result? Brittle bones.

How much alcohol is too much? Current research indicates that MORE than 1 drink per day - a shot of liquor, 12-ounce glass of beer, or 4-ounce glass of wine - will encourage bone loss.

On the other hand -

  1. Researchers at the Jean Mayer Human Nutrition Research Center on Aging (JMHNRCA) at Tufts University in Massachusetts say a moderate amount of wine is GOOD for you. For women, one glass of wine per day actually increases bone density. A study detailed in the April 2009 edition of the American Journal of Clinical Nutrition reports that post-menopausal women who drink moderately (a daily glass of wine) show an increase in bone mineral density (BMD) of 5% to 8% over non-drinkers.  Interested? Read more.
  1. Cut back on diet soda. First, drinking any diet soft drink probably means you're replacing a healthier drink - notably, milk, or calcium-fortified water or juice - with a nutritionally empty one. You're only going to consume so much liquid in a day; if you drink five cans of soda, you're probably not also going to drink the liquid equivalent of milk or juice - just shy of half a gallon. There goes a prime source of calcium, key for keeping bones strong.

Second, the phosphoric acid present in most sodas (not just diet sodas) leads to excessive calcium excretion - i.e., the calcium in your bloodstream is excreted via your urine at a faster rate. And, since your body maintains the calcium level in your bloodstream at all costs, your bones shed some of their calcium to bring the level in your blood back up. Leading to thinner bones.

I know, diet soda is SO handy for keeping calories in check. But try to move to water, if you can; the 0-calorie flavored waters are VERY tasty. Or, even better - skim milk. Chocolate chip cookie optional!

  1. Stop smoking. Period. End of story. Aside from being bad for your heart and lungs, smoking is disastrous for your bones. If you don't smoke - great, don't start. If you do smoke - PLEASE do everything you can to quit. Your bones will thank you.

  2. Ready for a bit of controversial advice? Consider hormone replacement therapy (HRT). Replacing the estrogen lost to menopause definitely increases bone density. But it also raises the risk of heart disease and breast cancer. How high is your risk for osteoporosis? How about breast cancer? Cardiac problems? Assessing your risk for all of these conditions may lead you to the surprising conclusion that the lowest possible dose of an HRT, taken for the shortest possible time (e.g., the first couple of years after menopause), may be worth the risk.

  3. Here's a key factor in avoiding osteoporosis drugs: awareness. Know your risk factors: ALL your risk factors. Get your bone density tested regularly after age 60; or before, if you know you're at risk. Simply knowing whether you're at high risk for osteoporosis is the first step towards prevention.

  1. This final bit of advice won't build bone. But it may convince you that even with T-scores that put you in osteopenia, you can avoid taking bone-loss drugs. Doctors and scientists are beginning to think that osteopenia may be a "phantom" condition - a natural part of aging, and not worth treating.

Interested? Read our post, Osteopenia Treatment - Not Worth the Risk and Expense?