I'm BACK...The DoctorDiva talks about Osteoporosis

The Doctor Diva has been on a writing hiatus.  She has been very busy working on her “Practice Improvement Module”  (PIM) for the American Board of Internal Medicine in order to complete her Board certification.  In fact, she is not done...and she likes to refer to herself in the third person!  She keeps WRITING DOWN EVERYTHING SHE EATS IN THE WEIGHT WATCHERS POINTS TRACKER!  It really helps her.  Occasionally she thinks about lying.  Is that stupid or what?  Who is she lying to? 

Okay, I’ll stop referring to myself in the third person.  It’s just too hard, anyway.

I have made some progress on both the diet/weight loss and the PIM.  I’m down to 193.3 lbs.  Or at least I was yesterday.  I had a couple of Snickers minis yesterday so all bets might be off today.  I’m not checking though.  I earned those Snickers. 

SO, I thought I’d share with you some of the stuff I’ve learned about osteoporosis. 

Your bones are like a bank account for calcium.  You make deposits and withdrawals at different times of your life and for different reasons.  As a child and teenager, you need to build up your account and add calcium.  Most women reach peak bone mass at 18 and men by 20.  You can add bone density up to about age 30, and then, for women, you stay about the same until menopause.  Then you start to lose bone density pretty quickly for a couple of years after menopause. 

Girls who don’t get their periods until late, who are anorexic, who over-exercise or are underweight or don’t have regular periods, may never reach peak bone density.  Also, girls tend to stop drinking enough milk in their teen years and may not reach peak bone density.  African American children tend to have higher bone density for reasons unknown. Oral contraceptive use seems to improve bone density.

SMOKING.  Don’t do it.  It causes you to get osteoporosis, amongst other things. Same with alcoholism.

Calcium is key.  You need a lot more than you think.  You would need to drink 4 glasses of milk a day to get enough.  SO:  Premenopausal women should take Calcium 500 mg twice a day and postmenopausal women should take 600 mg twice a day plus.  You have to split dose it because your body can’t absorb it all at once.  And make sure you drink enough water to prevent kidney stones.

Vitamin D.  You need it, especially if you live in Chicago, where I do.  I have found that almost ALL of my African American patients are profoundly Vitamin D deficient.  I have found through trial and error, that to get to a level of 30, which seems, (despite the controversy) to be the number to get to to prevent secondary hyperparathyroidism, you  need about 2000 IU of Vitamin D3 a day in Chicago.

Other risk factors include: family history, taking certain medications  like steroids, dilantin or phenobarbital, breast cancer anti-hormone drugs, cancer chemotherapeutic drugs (a certain friend needs to consider this carefully), Lithium, heparin, drugs for ulcers like omeprazole, thyroid hormones in excess.  Remember, though, that calcium can decrease absorption of other medications, so take it separately from other medications! 
Also, don’t stop the  medications you are taking!  You SHOULD talk to and remind your doctor (including me) that you are at risk for osteoporosis and that we should CHECK! 

How does one find out?  Well, I’m glad you asked.  There are a bunch of tests you can get done to check.  At the malls or health fairs you’ll sometimes see a heel ultrasound set up to tell you if you are osteoporotic or osteopenic or normal. 
These are okay, but the gold standard is a test called a DEXA or “Dual Energy X-ray Absorptiometry”.  (Yeah, that’s why we call it a DEXA).  It is a quick, low dose X-ray that measures the bone mass in your lumbar spine and your hips. 

Osteopenia means that your bone density isn’t normal (T-score of -1 to -2.5), but it isn’t severely decreased (osteoporosis T-score -2.5 or less), yet.  You can’t do a DEXA in a child or very young adult because it will overestimate osteopenia because they haven’t reached peak bone mass yet.  It is recommended mostly for women over 65 and men over 70, but we do it after 50 if you have certain of the risk factors above, including a low impact fracture (broken bone).  If you have osteopenia with a T-score of -1.5, you may have a 16% chance of fracturing a hip and a 27%-33%  chance if you have at a T-score between -2.0 and -2.5.  Scary, huh?

Prevention:  EXERCISE!  Walk, bike, hike, play tennis, run!  Do weight bearing exercises!
Take Calcium and Vitamin D every day!  (I need to remember to do this too!)
Make sure your daughters and sons drink milk and get their Vitamin D!  (check with your pediatrician for dosing!)

Treatment--another whole topic!

I have also learned a bunch about fall prevention too...but I’ll save that for another day.

So AGAIN with the Damned Exercise.  I hate exercise.  I need to find a way to make it fun.  I’m thinking, maybe Zumba?  I tried it on my Wii, but my coordination is the pits and the kids kept making fun of me. 
I like to walk, but I live in Chicago and it isn’t always safe for a woman alone to go walking. 
I’m working on it.  I want Michelle Obama’s guns!  She is so cool.  That’s MY goal.