The osteoporosis diagnosis problem
I’ve been talking about osteoporosis, and I was thrilled that Marie Berry told our group meeting about her fantastic weight vests. Please visit her website and buy one!
Like many entrepreneurs, Marie started her company to fix a problem she had: she was diagnosed with osteoporosis in her late 30s. There are only two ways people get diagnosed today: either from a fracture or from a DEXA scan, or both. I explained during the event that DEXA scans are unnecessary, that they are how drug companies put patients on track to eventually take their drugs, and the whole industry relies on DEXA as a marketing tool.
Marie, rightly, said that was my “opinion,” because for her, the DEXA scan gave her an early warning and helped her get on the right track before she broke a bone.
The data that forms my opinion
A DEXA scan compares your bones to a healthy young adult’s and reports the difference as a T-score.
Ages 20 to 30: Bones keep adding mass until about age 30, when they reach their peak.
Ages 30 to 50: Men and women both lose bone inside the spine every year, but DEXA barely shows it, because the outer shell holds and the bones grow wider. So for many people, the T-score is not negative, but that doesn’t mean their bones are healthy. They have lost resilience.
Menopause: Over the decade around menopause, women lose about 10 percent of the bone density in their spine, most of it in the three years around perimenopause.
Over 50: Half of American women over 50 have low bone mass, which doctors call osteopenia, and a third of men do. One woman in five over 50 has osteoporosis. This is when drug companies use DEXA scans to scare you into getting onto their products.
Over 65: Eighteen percent of adults over 65 have osteoporosis, more than twice the rate for ages 50 to 64.
The real diagnosis
So here’s the real way to diagnose yourself without a DEXA scan:
1. Are you a competitive rower? Are you rowing during the week and competing on the weekends? Or are you a dockworker or a competitive powerlifter or bodybuilder?
2a. If yes, you do not have osteopenia or osteoporosis, at least until around age 50. Keep doing what you’re doing.
2b. If no, then look at your age. Your age will tell you more or less how much bone you’ve lost since your late 20s. After age 40, you can assume your body is busy losing more bone than it gains each year. For many people, like Marie, that will start earlier, and for some people a bit later. Why not just start now? If you’re 35 or older, what good reason can you give to not start building muscle and bone regularly?
3a. If you want to keep losing bone, don’t change anything.
3b. If you want to start building bone, make the lifestyle changes I talk about in all my writing and lectures:
A. Get on HRT if you’re nearing your last period or past it.
B. Get enough protein.
C. Get enough calcium in your diet. Whey protein is an excellent source.
D. Get outside and get sunlight. Have a reasonable amount of vitamin D in your bloodstream (but not too much). A daily multivitamin will be a good solution for many.
E. Start and maintain an active bone-building program as I describe in my lectures and videos. Stay on it for the rest of your life.
That’s it. If you are diagnosed with osteopenia at age 40, you’re like everyone else, except you got the scan and they didn’t. You’re not special. Osteopenia is extremely underdiagnosed. It would be almost impossible to be age 40 and have the same amount of active, spongy bone as you did at age 30 (unless you’ve been competing in heavy sports that whole time).
Summary
Osteoporosis is not a disease. It does not mysteriously attack certain people and not others.
A DEXA scan does not measure bone resilience. It doesn’t measure anything that helps us reduce fracture risk. You can have bone density that is like glass: dense but fragile. Increasing your bone density on a scan does not reduce your risk of fracture.
If you’re over 35, you should be working on building bone, and you should do that for the rest of your life.
There is never a reason to get a DEXA scan. This is not my opinion. This is the result of looking at the data and understanding what’s really going on.
Dr. Doug Lucas mostly agrees with me. He uses DEXA and REMS scans to help patients feel better, but in reality they don’t need the data. They need to be exercising hard enough to build bone. In a few cases, especially with cancers or rare conditions, there may be a need to take more supplements, but most people don’t need supplements. They need enough protein, and they need to exercise harder. I’m willing to say that perhaps 5 percent of all cases might benefit from more thorough testing and treatment modification, like Dr. Doug does, but not more.