What's Happening

Understanding Osteoporosis and Osteopenia

by Patti Koehler, PT, WCS

Osteoporosis is a musculoskeletal disorder that causes thinning of the bones with a reduction in bone mass and bone strength which predisposes one to increased risk of fracture.

Osteoporosis affects one in two women and one in four men over the age of 60. Osteoporosis is more prevalent than coronary heart disease, heart attack, and diabetes combined. It is also more prevalent than breast, uterine, and ovarian cancer combined.

Osteopenia is a condition in which bone is less dense than normal but not to the degree of bone loss as in osteoporosis. It is considered by many to be a precursor to osteoporosis.

Our peak bone mass generally occurs by age 30–35 with 90-98% accumulated by the age of 18–20. Osteoporosis is said to be a pediatric condition that manifests itself in adulthood. Good bone health begins with a healthy diet, weight-bearing exercise, and good posture and body mechanics. Risk factors for osteoporosis include: heredity (up to 75%), nutrition (particularly inadequate calcium and vitamin D intake), lack of physical activity, ethnicity (increased risk for Caucasians), and lifestyle factors (cigarette smoking and excessive alcohol intake).

Most common fractures occur in the wrist, hip, and spine. Wrist fractures may be an early warning sign for increased bone loss.

Hip fractures may be the most disabling or life-threatening. Half of women with hip fractures die within one year. While women have a 2–3 times increased incidence of hip fracture, men have a mortality rate two times that of women. Nearly half of all people who suffer hip fractures never regain the previous quality of life.

Bones of the spine are usually the first to show signs of osteoporosis. The body of the vertebra is composed of trabecular bone which is less dense and weaker than other bones in our skeleton. The most common vertebral fracture seen with osteoporosis is a compression fracture which occurs when more downward pressure occurs on the bone than it can stand. For most people that downward force occurs with the simple movement of trunk flexion (forward bending) of the low or mid back which exerts force into the body of the vertebra. Compression fractures can be not only painful but also deadly. The risk of death in those who have had a vertebral fracture is 2.7 times higher than the average population.

Diagnostic examination for osteoporosis is done via a DXA Scan. The DXA (dual-energy x-ray absorptiometry) Scan is the current gold standard for measuring bone mineral density.

The DXA provides a T-score which indicates the hip and spine density.

• 0 to 1 indicates normal bone.
• -1 to -2.4 indicates osteopenia.
• -2.5 and below indicates osteoporosis.

The DXA Scan will help you determine any problem areas you may have. Your physical therapist can then create a therapy plan that is unique to your needs.