Osteoporosis Part 1: What is it, and who is at risk?

We have all heard of osteoporosis, probably especially as it relates to older people with vulvas.  But what is it exactly, and how gets this disease?  We dig down into the details to help you understand what osteoporosis is, and who is more likely to have it.  Then check out our next article for more information on how to build stronger bones through exercise!

What exactly is osteoporosis?

“Osteoporosis (OP) is a systemic skeletal disease indicated by very low bone mineral density (BMD), which is generally defined as values 2.5 standard deviations or more below the average BMD for young adults.” (Dressendorfer 2021)

That’s a mouthful!  Basically, OP means that you have less density in your bones, and to get a clinical diagnosis of course we had to put a cut-off limit as compared to “normal.”  So the values this definition is referencing are the values that you would get if you had a DEXA screening.

Who does OP affect?

OP mostly affects postmenopausal people with vulvas over the age of 50.  And it affects 54 MILLION adults in the US over the age of 50, and in the E.U. it affects 22 million people with vulvas and 5.5 million people with penises! And, the WHO has identified OP as one of the 10 most important conditions affecting the entire human race.

Plus, “OP is a ‘silent’ risk factor for fragility fractures (i.e., fracture with minimal trauma). Fractures of the hip, spine, or wrist are common in persons with OP, especially postmenopausal women and adults older than 65.” (Dressendorfer 2021).

That’s so many people!  So who is at greater risk for OP?

There are many risk factors that can lead to the development of OP.   Dressendorfer 2021 had a great summary, found below:

• Premenopausal osteopenia (T-score for BMD of –1.0 to –2.5)
• Sex: Females > males
• Race: Whites and Asians are at higher risk
• Older age (≥65 years-old)
• Small frame, very low BMI
• Loss of body height (more than 1.5 inches or 3.81cm)
• Previous fracture: Having one fracture doubles the risk of having another
• Genetics
  • Parental history of hip fracture
  • Cystic fibrosis
  • Hemochromatosis
  • Porphyria
  • Osteogenesis imperfecta
  • Hypophosphatemia
• Activity level: Insufficient weight-bearing (WB) exercise and excessive exercise training without adequate nutrition
  • Sedentary lifestyle
  • Lifestyle associated with emphasis on leanness, as found in women with female athlete triad
    • Triad components: Low BMD, menstrual dysfunction, and inadequate caloric intake
• Medications associated with bone loss
  • Tricyclic antidepressants
  • Medroxyprogesterone (Depo-Provera)
  • Glucocorticoid use (e.g., patients with chronic asthma or Crohn’s disease)
  • Use of drugs to treat malignancy
• Premature menopause (before age 45 years) increases risk
• Poor dietary habits associated with increased risk
  • Excessive caffeine intake
  • Excessive dietary fiber consumption
  • Low intake of calcium and vitamin D
  • High intake of phosphate
  • Excess vitamin A intake
• Medical conditions that promote bone loss
  • Endocrine disorders: hyperparathyroidism, hypogonadism, anorexia nervosa, diabetes mellitus (DM), Cushing syndrome, hyperthyroidism
  • Gastrointestinal disorders: celiac disease, gastric bypass, Crohn’s disease, malabsorption, cirrhosis
  • Hematologic disorders: multiple myeloma, thalassemia, leukemia, lymphoma, mastocytosis
  • CNS disorders: epilepsy, multiple sclerosis, Parkinson disease
  • Rheumatologic and autoimmune disorders: rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematous (SLE)
  • Other medical conditions: HIV infection, amyloidosis, COPD, chronic kidney disease, heart failure, hypercalciuria, alcoholism, renal tubular acidosis
• Modifiable lifestyle factors that increase risk
  • Tobacco use
  • Alcohol use (3 or more drinks a day)
  • Prolonged daily sedentary behavior (e.g., sitting at a desk) not interrupted by frequent breaks

Oh wow.  So if I have some of those risk factors, what can I do about it?

There are many medications of course to help with OP, but that is outside of our scope of practice.  So we will mostly focus on physical activity from here on out.  Namely, it’s important that any exercise interventions for OP are prescribed appropriately, and are completed under the guidance of a physical therapist or personal trainer.  But, we know that there are NO exercises so far that have been shown to be harmful to anyone with OP!  Even high-intensity exercise can be safe for postmenopausal people with vulvas, when it is appropriately recommended.

That’s so cool!  So what types of exercise are best?

This is such a BIG topic that we had to split it up into two articles!  So please check our  next article titled “Osteoporosis Part 2: How to build stronger bones through exercise” for more information!  MommaStrong can absolutely help with building bone density, so if you are interested in our special offer for new members of $5/month for the first 3 months, click here!