Women and Bone Health

Dr. Jennifer Neville with BJC Medical Group discusses women and bone health.

At what age do you begin screening women for bone health issues?

Typically as far as bone health, I target 65 and older. Usually we start screening more routinely at age 65. If they have other risk factors like being on chronic steroids or prednisone for asthma, have rheumatoid arthritis, or a family history of osteoporosis, smoke or drink more alcohol, they’re more likely to have osteoporosis earlier, so we may start screening in the 50s. But usually, it’s 65.

How do you test bone health?

We do the bone density scan, so that kind of determines the strength of the bones. There’s normal range and then there’s osteopenia, which is mild bone loss.

How can women treat or help prevent bone loss?

When you have osteopenia, we’re talking about risk factor modification like making sure you’re taking 1200 milligrams of calcium a day either through diet or through supplements. You don’t have to take supplements. A lot of people are lower in vitamin D. With the skin cancer scare, we’re all covering up. We’re wearing sunscreen. We’re not getting out in the sun. Sometimes older adults are not getting in the sun as much either so vitamin D between 400 and 2000 international units a day can help prevent bone loss. Weight-bearing exercise is one of the biggest things to prevent osteoporosis. You can walk. You can do light weights that can help prevent that from worsening. If you have osteopenia, we usually check the bone density scan about every three to four years. It’s not as often we monitor for changes once it’s in the osteoporosis range. That’s more serious. You’re at an elevated risk of fractures. Typically, I start talking to people about lifestyle modification but also medications for bone loss.

What medications do you prescribe for bone loss?

Fosamax is one of the first things that we use. It’s a once-a-week pill that you’re supposed to take on an empty stomach with a full glass of water. You should remain upright after you take it. If you take it and lay down, you’re more likely to have heartburn or other side effects associated with it. What that medication does is it decreases our breakdown of the bone and kind of promotes bone strength so that our body can build stronger bones and prevent them from becoming weaker.

If a woman has osteopenia, will she eventually develop osteoporosis?

Not necessarily. Osteopenia is very common. I would honestly say a majority of women develop osteopenia at some point in their life, but that’s when we start doing the lifestyle modifications. You can really slow that process down. There are some women who have osteopenia that we choose to be a little more aggressive at and treat. They have an elevated fracture risk score. We take into account some other risk factors, and we have a score. If they’re higher risk, then we may opt to treat them earlier because they are headed for that osteoporosis.

Is it possible to strengthen your bones as you age?

Absolutely. A lot of people think that once I have osteoporosis, I will always have it, and I can’t make my bones stronger. It’s just we’re going to try to slow it down. You can make your bones stronger through the lifestyle modifications and the medication so you actually can get improvements.