Being diagnosed with osteopenia, meaning thinning of the bones, may sound scary and leave you feeling hopeless. The good news is that with some changes in your lifestyle and, potentially, with medications, you can slow the problem and help prevent the worsening of your condition and even potentially prevent osteoporosis.
You may be worried about taking medications for osteopenia. This may be because you’ve heard that they can cause some pretty nasty side effects including heartburn, diarrhea, and nausea. In fact, these are some of the most common reasons patients cite for discontinuing medical treatment for this condition. If you have tried the first line of defense for treatment, which is simply lifestyle changes, and nothing has worked, you may consider bisphosphanates. However, note that this medication is generally limited to five years, at which point a break is needed, so you don't want to start using them too soon, especially when lifestyle changes can help in the meantime.
Medications for osteopenia and potential side effects
The good news is that when you follow the instructions from your practitioner, like sitting upright for 30 to 60 minutes after taking bisphosphonates and taking them with a full glass of water, these gastric side effects seem to be the same among multiple medications and the placebo. However, they are so commonly cited that you might even see some practitioners just assuming it really is the medication itself causing these issues.
However, there are some serious side effects possible with bisphosphonates use. Whether you experience them can depend on how you take the medication, how long you take the medication, and certain other risk factors. These side effects can include musculoskeletal pain, atrial fibrillation, suppressed bone turnover, and others. Therefore, taking these medications is not a decision to be taken lightly.
To make that decision, you may consider several factors, including your family medical history, your diet, how much you exercise, and other medications that you may be taking. A good conversation with your practitioner about your particular risks and your T-scores (measures of your bone density) can go a long way to deciding if medication is the right choice for you. You may also decide to try alternative steps to slow or reverse the process and hopefully avoid osteoporosis.
Lifestyle changes to boost bone health
Beyond medications, there are other ways you can help shape your bone health, too. Here are nine specific steps you can take right now, even if you do opt for medication:
1. Get enough calcium. This is job No. 1: Make absolutely sure you're getting enough calcium in your daily diet, via food, or over-the-counter or prescription supplements. For women over age 50, that's a minimum of 1200 milligrams daily, and for women under 50, 1000 milligrams daily. The best way to get calcium is the way that you can keep up with regularly and that fits your budget and lifestyle.
2. Get enough 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.
The current government recommendation for vitamin D is 400-800 international units daily for those under 50 and 800-1,000 international units daily for those over 50. Some studies say that there is a global health crisis in respects to vitamin D deficiency.
So, how do you get vitamin D? Through your skin, without sunscreen, via about 10 minutes a day (or 15-20 minutes several times a week) of natural sunlight. You can also get it through your diet: eggs, saltwater fish, and vitamin D-fortified milk are all good sources. Vitamin D supplements, which are often paired with calcium supplements, are also available. Be mindful of how much of each you are getting through all of your sources.
3. Get exercise. Yes, exercise makes a difference in mitigating bone loss related to aging and menopause and strengthen cortical bone. This is actually something that provides the most benefit if done before you hit puberty, but still has some benefits potentially after. 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 your bones 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. You should select a program in conjunction with your practitioner and possibly a physical therapist.
4. Limit alcohol. As with all things related to alcohol, you can find studies that say light drinking can be beneficial and heavy drinking can be detrimental to the protection of your bones. So you will want to look to other risk factors in your life and include this in a conversation with your practitioner. When in doubt, side with little to no alcohol, as it’s an unnecessary item in your diet.
“Wait, I just read that red wine can help prevent osteoporosis!” Yes, you did, but the truth of the matter is that there are a lot of poorly designed studies with small numbers, wide ranges of doses, and a variety of populations in terms of the age, sex, and other factors. For example, one of the studies found that resveratrol, the substance being studied in red wine, actually can negates the effects of exercise on the body.
5. Cut back on colas. There are two ways in which colas may hinder your goal of having healthy bones. One way might be that you are swapping otherwise calcium dense drinks like milk for colas and the other is the intake of caffeine which has been shown to be detrimental to bone density. The National Osteoporosis Foundation recommends that you have no more than five colas a week. Even something as switching to clear sodas, like Sprite, can be less harmful. However, cutting soda completely from your diet is ideal.
6. Stop smoking. Period. End of story. Aside from being bad for your heart and lungs, smoking is disastrous for your bones. The good news is that if you quit smoking, after 10 years, your risk of certain fractures goes down.
7. 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.
8. Sleep. Sleep is so important to many aspects of your health. Now we know that getting poor quality sleep and having a later bedtime can increase your risk of osteopenia and related illnesses. According to the Centers for Disease Control and Prevention, someone between the ages of 18-60 needs over 7 hours of sleep a night.
9. Know your risk factors. Here's a key factor in avoiding osteoporosis drugs: awareness. According to the National Institutes of Health, you should get your bone density tested regularly after age 65, or before, if you know you're at high risk. Simply knowing whether you're at high risk for osteoporosis is the first step toward prevention.
See more helpful articles:
Top 12 Osteoporosis Terms to Know
Osteoporosis Risk Factors: What Young Women Can Do Now to Reduce the Risk
Osteoporosis-Friendly Exercises to Strengthen Your Bones