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Do You Really Need to Clean the Gutters…& Other Bone Health Tips!

Posted Oct 17 2010 4:13pm

This past week I was sponsored by Wellsphere to attend the North American Menopause Society (NAMS) 21st  Annual Meeting. NAMS is an organization that covets evidence-based medicine in the treatment of menopause – a lifestage that we women find ourselves in for much longer than our female ancestors.

I’m interested in menopause because with women living well into their 80’s, and with an average age of menopause at 50 – there remains about 30 years of healthy aging during which time many early age habits reveal their havoc…and fruits.

One of the most interesting presentations incorporated information around preventing fractures during this estrogen-deficient time in women’s lives. In fact, by labeling this time in women’s lives as “estrogen-deficient” as opposed to a “disease or medical problem”, I believe there could be a more “whole woman” approach to managing bone health that includes exercise, diet and lifestyle changes.

3 Key Take-Aways

1.  Management of bone health must start earlier in a woman’s life to prolong bone health as long as possible. It’s inevitable that women will loose bone once estrogen levels decline.  Bone density tests will only confirm that, yes – just as science says, women lose bone as they age.  That’s nothing new. How we manage it though requires a mindset shift.

2.  The mindset shift is needed because of the way we’ve treated millions of pre-menopausal and post-menopausal women presenting with “low” bone density scores.  The news is not that more women may need osteoporosis drugs to manage osteoporosis.   In fact, many women could be over-treated with biphosphonates like Actonel, Boniva and Fosamax.   There has also been concern that long-term use of these drugs may result in an accumulation of older bone in the skeleton (because the drugs slow down the activity of scavenger cells, which clear away older bone to make room for new). Right now this is more a theory than a finding, but the thinking is that over time these drugs might make the skeleton more, not less, brittle.

3.  What would make an approach to bone health  more comprehensive and palatable to woman who don’t like Rx drugs added onto their breakfast plate, is more awareness about  an assessment of the 10-year estimate of the risk of fracture.  Called FRAX, the test includes a bone density test and is one that many doctors still under-utilize as a tool to predict risk of fracture.  FRAX was introduced in 1994 – a while ago – but it’s not a drug and requires time to administer and analyze.  For more information on FRAX check out the National Osteoporosis Foundation’s web site.

The tool that requires the healthcare professional to carefully input risk factors like smoking, age, alcohol consumption,  and other risk indicators as well as the bone density test results.  But, it is “spine-less” in that it does not reveal vertebral fracture.

The net result: Over-treatment

A considerable number of younger postmenopausal women whose risk of fracturing a bone in the near future is statistically minuscule are being treated prematurely or unnecessarily. Nelson B. Watts, MD, of the University of Cincinnati Bone Health and Osteoporosis Center, says that if 30-year-old women submitted themselves en masse to the World Health Organization’s measurement criteria, fully 16 percent would be diagnosed with Osteopenia – a condition that, in and of itself, does not require medication but prevention!  It is never too late to prevent progression of Osteopenia!

The Net Result: Under-treatment

The other, perhaps more troubling, side of this story: Under the current parameters, many older people who face immediate grave risk of fracture aren’t getting treatment, simply because their T-scores don’t demand it. At Oregon Health & Science University, a 2005 study of women age 65 and older found that, based on the World Health Organization’s bone density criteria, more than half of the women who suffered hip fractures did not technically have osteoporosis.

Here’s what a Real Woman Can Do:

Let’s work on preventing osteoporosis not treating it before we really have it!  No doubt that many (but not all) women in their 50’s can work with their healthcare professional or nutritionist to achieve the recommended dose of calcium and Vitamin D for prevention of osteoporosis – before women age into their 60′s and 70′s…. where the “real risk” of fracture increases exponentially as estrogen-deficiency takes a greater toll …and environmental factors play a greater role.

Hey, here’s a way to reduce fracture risk:  get off that step ladder and let someone else clean the gutters!

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