All-round prevention of osteoporosis

Bone density test: Understanding your bone health
48-year-old Xiuru entered menopause and her doctor advised her to pay attention to osteoporosis. A neighbor told her that a nearby pharmacy provided freebone densityTests, but how does she choose and interpret the test results?

Bone density increases rapidly during puberty, reaching its peak around age 30-35, and then slowly declines at a rate of 0.1-0.3% per year. After menopause, due to estrogen deficiency, bone loss accelerates to 3-5% per year, continuing for 5-8 years before slowing down. Dr. Yang Zaixing, Director of the Reproductive Medicine Center at Zhongshan Hospital, points out that effectively reducing bone loss within 10 years of menopause can preserve 30% more bone mass than other women. Bone loss in men typically occurs later, becoming noticeable around age 65-70. In addition to age, endocrine disorders, gastrointestinal disorders that impair calcium absorption, and the use of medications such as steroids can all contribute to osteoporosis. Therefore, it is recommended that women between the ages of 45 and 50 undergo bone density testing if they experience menopausal symptoms.

Currently, the medical community recommends that "once-in-lifetime bone density screening" be covered by National Health Insurance, but this has not yet been implemented. Dr. Yang Zai-hsing suggests that people can pay for bone density testing at their own expense (approximately NT$600-800). Dr. Tsai Ying-mei, director of the Department of Obstetrics and Gynecology at Kaohsiung Medical University Hospital, further recommends that postmenopausal women, if financially able, undergo annual testing to track bone loss.

There are various bone density testing devices available on the market, but dual-energy X-ray absorptiometry (DXA) is the gold standard, accurately measuring bone density in areas prone to fractures, such as the lumbar spine and hip. A DXA test takes only five minutes to obtain a bone density reading. Smaller devices, while convenient, can be less accurate and prone to misdiagnosis.

In the DXA test report, the T value is an important indicator for diagnosing osteoporosis, representing the difference in individual bone density compared to healthy young people:

T value > -1: normal bone quality
-1≧T value＞-2.5: Osteopenia
T value ≤ -2.5: osteoporosis

Menopausal women and men over 65 can use T-scores to determine osteoporosis, while young men and women should refer to Z-scores. Z-scores are compared with people of the same age. If the Z-score is lower than -1.5, further examination is required.
Treatment of osteoporosis: Drug options
Xiuru's test results showed low bone density, and her doctor recommended hormone therapy. Besides hormone therapy, what other medications can treat osteoporosis?

Hormone therapy is currently the only osteoporosis prevention medication covered by health insurance. It is the preferred choice for women experiencing menopausal symptoms and without contraindications. However, it is important to use low doses within ten years of postmenopause to reduce the risk of cardiovascular disease.

Other osteoporosis treatments include bisphosphonates, selective estrogen receptor modulators (SERMs), calcitonin, parathyroid hormone, and strontium salts. New targeted drugs are also under development, which will provide more treatment options in the future.

Prevention of osteoporosis: balanced diet and regular exercise
In addition to taking medication, Xiuru also takes calcium tablets every day. Is that enough?

Calcium supplements alone are not enough to prevent osteoporosis. The National Osteoporosis Foundation recommends supplementing with vitamins D, K, B6, B12, phosphorus, and protein. Vitamin D promotes calcium absorption and can be obtained from foods such as dark green vegetables, fish, and eggs, as well as sunlight. Vitamin K promotes bone formation and can be obtained from dark green vegetables and vegetable oils. Vitamins B6 and B12 support the functioning of osteoblasts and can be obtained from meat, fish, eggs, and milk. Protein provides bone strength and elasticity and can be obtained from meat, seafood, legumes, and grains. Daily intake of 400-800 mg of calcium during adolescence can reduce the risk of osteoporosis during menopause.

Fracture risk assessment and prevention
Xiuru's friend, Fenfen, suffered a spinal compression fracture even though her bone density test was normal. Why did this happen? How can it be prevented?

The risk of fracture in patients with osteoporosis is five times that of the general population.Fracture riskThe FRAX assessment report can estimate the probability of osteoporotic fractures in the next ten years. Patients with a high probability should receive active interventional treatment.
Exercise and bone health
Xiuru is worried that exercise will causefracture, how to exercise?

Weight-bearing exercise, such as walking, running, and dancing, helps maintain bone health. However, those with osteoporosis should opt for low-impact exercises, such as walking or water exercise. When stretching, be careful to avoid excessive strain. Improving muscle strength strengthens bones, improves balance, speeds up reaction times, and reduces the risk of fractures. High-frequency vibration therapy is currently considered an adjunct therapy and should not replace exercise.