What are osteopenia and osteoporosis?

Osteopenia and osteoporosis are two related conditions characterized by lower than normal bone densities. Anyone can have osteopenia and osteoporosis, although it most commonly afflicts post-menopausal women. Reduced bone density in patients presents a greater risk for bone fracture. Technically speaking, osteopenia and osteoporosis are manifestations of the same condition, but to different degrees. Osteopenia, the lesser condition, is defined as having one standard deviation below normal bone density. A standard deviation is a unit of measurement used in statistics and it represents about the 16th percentile and below. Osteoporosis is defined as having 2.5 standard deviations or more below normal bone density, placing it at the 2nd percentile and below. There has been some controversy regarding osteopenia and its status as a genuine condition. Some doctors and epidemiologists view osteopenia as simply a precursor to osteoporosis and hold that the diagnosis has no real significance other than to identify those who are most at risk for later developing osteoporosis. Other doctors believe that osteopenia is a genuine condition that while less serious than osteoporosis develops in a far greater percentage of patients and still represents a treatable condition. Since diagnoses and treatments of the two conditions are very similar, they are usually grouped together.

Causes

Both osteopenia and osteoporosis are caused by an imbalance in the activities of two different types of bone cells: osteoblasts and osteoclasts. Osteoblasts are bone cells that form bone, while osteoclasts are bone cells that break bone down and absorb its minerals back into the blood steam. Normally, there is a balance between the two. Osteopenia and osteoporosis develop when osteoclast activity is stronger than that of osteoblasts and as a result bone density lowers over time. Different factors can lead to such an imbalance, including lowered estrogen levels and calcium and Vitamin D deficiencies. Over time, however, all adults will lose bone density to some degree as they age, although women will on average lose more than men.

Symptoms

Oddly enough, osteopenia and osteoporosis have no visible symptoms. As such, it’s often referred to as a “silent disease.” Most people who have either condition don’t realize it until they have been diagnosed with it or until they crack or break a bone. The characteristic symptom, then, of either condition is a greater risk for bone fracture. The types of bone fractures that patients with osteopenia and osteoporosis experience are ones that usually would not occur in healthy patients with normal bone densities. Such bone fractures are commonly referred to as osteoporotic fractures or fragility fractures. Because the elderly lose mobility and balance as they age, their greater risk for falling makes lowered bone densities a very serious condition. Broken wrists and hips are very common as a result of minor slips and falls.

Diagnoses

Although there are some bloods tests that can confirm either condition, the most common method to diagnose them is by using dual energy x-ray absorptiometry (DEXA). This form of radiography allows doctors to determine whether a patient has reduced bone density or not. The results of the test are expressed in what are called T-Scores. A normal T-Score is defined as having the bone density of healthy, normal white female at the age of 30. Having a T-Score one standard deviation or below normal leads to a default diagnosis of osteopenia or osteoporosis. In most cases, doctors would perform certain follow-up tests to ensure that the reduced bone density isn’t caused by some other underlying disease or condition. Certain types of bone and plasma cell cancer, among others, can reduce bone density on their own and need to be eliminated as root causes of the condition.

Treatments

Treatments for osteopenia and osteoporosis fall into one of three categories: those that modify lifestyle, those that lower the rate of bone resorption, and those that increase bone production.

Lifestyle changes

Regardless of medication, the most important aspect of treatment will be certain changes to a patient’s lifestyle. This includes, but isn’t limited to:

  • Better nutrition, especially the consumption of calcium and Vitamin D
  • Exercise to maintain or even increase bone densities
  • Elimination of smoking and the reduction of alcohol consumption
  • Reconfiguration of the home to reduce the chance of slips and falls

Bone Resorption

Patients with osteopenia and osteoporosis can take medications that slow down the activity of osteoclasts and thus lower the rate at which bone is broken down and absorbed back into the bloodstream. Examples include bisphosphonates and raloxifene.

Bone production

Patients with either condition can also take medications that increase the activity of osteoblasts and thus speed up the rate at which bone is created. Examples include teriparatide and sodium fluoride.

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Nutrition is an extremely important factor in the life of a senior. Nutrition can be beneficial in keeping the body healthy and functioning well. A well balanced diet packed full of nutrient rich foods can keep many health issues at bay. Worn muscles and tissues in the body can get fatigued easily and can result in limited mobility for many seniors. There are many foods that can improve function, increase bowel movement activity, provide energy, and boost overall well being. The food pyramid is a great resource to use as a guide to maintaining a balanced diet. Vitamins and liquid nutrition should not be a primary source of nutrition but rather a supplement. Seniors should eat primarily whole foods to receive the full benefit of the nutrition packed in this source. Many seniors don’t realize they are deficient in nutrients. Below are some warning signs that one can use to determine if they may need better nutrition.

Determine Your Nutritional Warning Signs:

  • Increased Fatigue: Fatigue can be a warning sign that your body is not receiving adequate nutrition. Proper nutrition can elevate emotional well being as well as increase energy levels. Eating enough fruits and vegetables as well as proper protein and grains can improve energy. Increased calcium can help muscle activity as well as bone health.
  • Constipation or Irritable Bowel Syndrome: Eating a diet high in fiber and drinking plenty of liquids can help alleviate this issue. Many times a sedentary lifestyle can also cause constipation. Taking a short walk and increasing movement each day may help relieve some of the constipation as well.
  • Dry and Brittle Hair: Aging can cause hair to be dry and change in texture but signs that a senior is lacking in nutritional needs can make the hair increasingly dry and brittle as well. Eating a proper diet as well as drinking plenty of fluids can improve the balance of the body. Many different nutrients losses can be the cause of dry and brittle hair such as protein, iron and essential fatty acids. Hair loss can also be an indicator that there is a nutritional deficit.
  • Rigid or curved nails: Iron deficiency is a common problem among seniors. An indicator that the body is lacking in iron is a person’s nails. They become brittle, rigid and curved at the ends. Some people have white marks that can also show some type of nutritional deficit. Including foods that are rich in iron such as shell fish, clams and other meats may improve this condition as well as taking supplements.
  • Dry and Cracked Mouth: If the mouth is dry and cracked, especially in the corners of the mouth, this can be early warning signs that the diet needs to be evaluated. A tongue that is pale or swollen can many times mean there is an iron or vitamin B deficiency. Doctors can perform a blood test to check for nutritional loss and may prescribe vitamins in addition to a healthy diet.
  • Irritability and Crankiness: Early signs that the body is not maintaining proper nutrition levels are irritability and crankiness. Increasing the levels of nutrition per serving in a meal can be a great way to increase overall nutrition in addition to adding a multivitamin to a daily regiment. Low salt and cholesterol is important as well to keeping the body healthy.
  • Morning Nausea and Shakiness: Malnutrition can mimic other conditions. It is important to have a doctor determine what the cause of the nausea and shakes are from. Many times this can be a sign that a senior needs to improve their nutrition. The body does not react well when it is not given adequate amounts of daily nutrients necessary for a healthy life.
  • Lack of Appetite: This can be a confusing symptom of malnutrition because a lack of appetite may deter the person from wanting to eat. It is important to identify this sign early because not eating can make malnutrition worse. Iron and protein rich foods can bring back a level of energy and then a nutritional plan can be assessed.
  • Medicines: A PDF that discusses taking many medications can leech nutrients from the body. It is important to discuss any changes with your doctor to determine if this is causing malnutrition. Many times adjusting the medication doses combined with increasing dietary nutrition can combat this issue.
  • Anemia: This is a common sign that the body is lacking in iron. Eating iron rich foods and plenty of protein along with taking iron supplements that are time released to avoid constipation can help with anemia. Anemia induced by malnutrition can cause other symptoms such as fatigue and many others.

Foods to Eat:

Eating foods rich in nutrients is the best defense against malnutrition in seniors. Eating meals with whole grains, protein and essential fats, along with snacks that have a high concentration of vitamins and minerals is a good way to include more nutrition in the day. Meals and snacks should be from all the food groups, as each group provides the body with different and vital nutrients. Staying away from empty calories such as potatoes chips or candy is important. These types of foods can do more damage to a person suffering from malnutrition. Eating at least 2 to 3 servings of fish with fatty acids throughout the week will ensure adequate amounts of essential fatty acids. Overall, nutrition is an important aspect of senior life; paying close attention to what’s put into the body can lead to a healthy and happy lifestyle for people of all ages.

Additional Resources:

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