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Posted by on May 12, 2013 in The Symptoms |

Osteopenia/Osteoporosis

Osteopenia/Osteoporosis

Have you been diagnosed with either of these conditions? Do you want to share your treatment and compare it with others? What kind of lifestyle changes did you implement as a consequence of OP? For all of these, and more, head to the Osteopenia and Osteoporosis forum.

Why Is Osteopenia/Osteoporosis In ‘The Symptoms’ Section?

Because, like with urticaria pigmentosa, it is a visible sign that something connected to mast cells may be going wrong. If you experience unexplained bone fractures, without any particular force being exerted on your bones, this should prompt your physician to test for mastocytosis.

However, not many physicians know that.

What The Heck Is Osteopenia?

Let's get this one out of the way quickly. Here's the blurb about Osteopenia, straight from WebMD:

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop BMD that is very low compared to normal, known as osteoporosis.

Now, what is peak BMD?

 The amount of bone tissue in the skeleton, known as bone mass, can keep growing until around age 30. At that point, bones have reached their maximum strength and density, known as peak bone mass.

So, let's be clear. If you are over 30, your bone mineral density  WILL be lower that peak BMD. That is because

All people begin losing bone mass after they reach peak BMD at about 30 years of age.

And, even if you are 30 or below …

Some people who have osteopenia may not have bone loss. They may just naturally have a lower bone density.

Uh? So, you have no bone loss and you are still told there's something wrong with you?

One thing everyone agrees on, osteopenia does not require treatment. It's NOT a disease. True, osteopenia is a risk that you may be on the way to osteoporosis. And osteoporosis is, in turn, a heightened risk of bone fractures. So, osteopenia  is a risk of a heightened risk of bone fractures …

My opinion : if you want to take precautions due to osteopenia, check vitamins D, K2, A and calcium. Steer well away from medical drugs.

Did you read the first to words of the previous paragraph? Remember, I am NOT a doctor.

Do your homework. There's a decent amount of medical research that questions what osteopenia  really means.

OK, Got That. What is Osteoporosis, Then?

Watch this short (1:27) clip. It tells you enough to get you going.

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So, in osteoporosis, your calcium balance is off kilter. You remove more calcium from your bones than you put back in.

You see, you need calcium for very important stuff in your body. Bones are the calcium bank, all the calcium ‘money' is stored there. When your body needs calcium, it is shaved off the bones and supplied to the other parts of the body through the blood stream. That “shaving off” thing is called bone resorption. That resorption is performed by bone cells called osteoclasts. But, simultaneously, there are some other bone cells that build new bone, which are called osteoblasts. They both work in tandem, to keep the bone healthy.

However, with mastocytosis, even if your calcium balance was OK, your bones are still being depleted of calcium . If you read the post What Are Mediators, you know that mast cells release lots of mediators (heparin, serotonin, chymase, renin, prostaglandin …)  that interfere with the work of osteoblasts, an interference which causes new bone buildup to slow down while old  bone is still resorbed at the same rate.

You can have osteoporosis even if you do not have mastocytosis. That is called primary osteoporosis, that is, it is not dependent on the existence of another condition. If your osteoporosis is deemed to be caused by mastocytosis, it is called secondary mastocytosis. This distinction will be important later, when we talk about the probability of fracture risk.

Osteo-whats?

Yes, I know, they don't make it easy, do they? And the first clip above did not make it very clear.  Watch this clip, maybe it will become clearer.

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So, there's one guy removing old bone and one guy adding new bone. If both guys work at the same pace, all is well. That is, provided there is enough building material for new bone, in this case, calcium.

If one starts to work faster than the other, or if one starts to slow-down, an imbalance occurs. That imbalance also exists if there are fewer new bone builders than there  are guys breaking down old bone. That distinction will be important when we talk about  prescription drugs for osteoporosis.

Fragility Fractures

If you suffer from osteoporosis, you run an increased risk of experiencing fragility fractures, which are …

… defined as fractures resulting from a fall from a standing height or less, or presenting in the absence of obvious trauma. Fragility fractures affect up to one-half of women and one-third of men over age fifty, and are often associated with low bone density. Such fractures occur most commonly in the hip, spine, and wrist.

Bone Mineral Density …

… Or BMD, as it is affectionately known, is a measure of … ? Bone Density!

Is bone density a measure of bone strength? The jury is still out. You will find medical research insisting that it is and medical research arguing that it isn't.

There's a story that comes to mind, though, about a twig and a tree …

DEXA Scan

The way BMD is measured is through a non-invasive, low radiation scan called a DEXA scan. The aim of the scan is to estimate bone strength by measuring a proxy called bone density.

You can learn a bit about the DEXA scan here.

What’s The Score?

When you get your DEXA scan result, simple minds like mine become perplexed.

The result talks about Z-scores, T-scores, standard deviations …  Oh, my!

Let's look at the basic definitions:

The scores are expressed as standard deviations, which is a measure of variability based on an average or expected value. Don't worry if you did not understand that,  just look at what constitutes a normal range T-score.

Z-score: A comparison between your BMD and the bone density of someone who is of the same age and sex as you.
T-score: It is the bone mineral density at the site (hip, wrist …) when compared to the young normal reference mean. It is a comparison of a patient's BMD to that of a healthy thirty-year-old of the same sex and ethnicity.

A positive T-score number means your Bone Mineral Density is  above average, a negative number means it is below average.

Now, about the ranges: a T-score of

  • above -1 is normal
  • between -1 and -2.5 is classed as osteopenia (where bone density is lower than average but not low enough to be classed as osteoporosis)
  • below -2.5 is classed as osteoporosis

A bone density scan can help diagnose osteoporosis, but your BMD result is not the only factor that determines your risk of fracturing a bone.

I’ve Got A Below-Normal T-score, What Does It Mean?

It means that you may have a higher probability than normal to have a bone fracture. But the T-score will not tell you what that increased probability is. There are several additional criteria that need to be considered, in addition to the T-score to find out that probability increase.

So how do you find out how what your increased risk is? Well, if your physician has not told you already and you know your T-score, you can find out yourself by using the WHO FRAX tool.

Here's a video that tells you how to do just that.

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A couple of more things:

  • When the FRAX tool gives you your increased probability of fracture, in the UK version of the FRAX tool, you will have a link to The National Osteoporosis Guideline Group (NOGG). This is a second tool which, based n the results of the FRAX tool, will give you (and your physician) an indication as to whether you should be treated or not treated and be given lifestyle guidance or not treated and just keep an eye on the condition. If the NOGG tool is not available in your country, you can still access it and enter your data manually here. But be aware I don't know whether the results will be correct for your particular situation, as they are possibly related to geographical location and ethnicity.
  • The FRAX tool does not take into account your Vitamin D / Calcium status. Quite surprising, as these 2 supplements go a long way to providing additional building blocks for the osteoblasts to improve bone health.

The Treatment

The treatment of choice is alendronic acid. And here, I will leave you to your own devices. Do your home work and learn about the efficacy and the side effects of this drug. Spend some time thinking about the estimated additional level of fracture risk you are incurring at your level of affliction. And then decide whether alendronic acid is for you.

Please, do yourself a favour. Do not blindly accept treatment by alendronic acid WITHOUT doing your own due diligence. If you do your research, you may want to know that alendronic acid is also called a bisphosphonate.

An alternative choice of treatment may be Vitamin C and calcium supplements. However, you then need to do your own research into balancing Vitamin D3 with Vitamin K2 and complementing Vitamin K2 with Vitamin A.

Quite convoluted.

Maybe you should come around to our Nutrition section of this site, once it is completed. Oh, and if you want to know stuff about bisphosphonates, head for the forum. We can have a good ‘ole chat about that.

So Many Quotes In This Post ….

… And not a single reference.

I know … Dreadful!

On purpose, though. All of the above are my opinions only. I did do my own research on the topic, but I encourage you to do the same.  Hey, go and get your own references!