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Doc says I have osteopenia/osteoporosis! Now what?

Osteoporosis is a condition where the bones become weak and brittle, and it’s usually associated with aging. One in 2 women over the age of 50 and one in four men will experience osteoporsis. But whether you are diagnosed with osteoporosis or osteopenia all depends on your "T-score" on the DEXA scan, but lets back up and do a deep dive in to the definition of both. Are they reversible? What increases your risk? What are the testing methods and treatments, both conventional and functional?

OSTEOPENIA This condition happens when there is low bone mineral desity without the fracture risk. This is great information for you, so do not panic because now you can make the appropriate lifestyle changes and avoid the diagnosis of its big sister, osteoporosis.

OSTEOPOROSIS is diagnosed when you have a T score of -2.5 or higher (-2.6, -2.7 etc). This score is on your DEXA bone scan. This diagnosis is a sign you have weak and porous bones. It’s a disease that involves low bone mineral density combined with compromised bone integrity, making the bones more susceptible to fracture. In the elderly, fractures are often followed by complications and decreased life span.

Both conditions are reversible, depending on age, severity, and underlying conditions. Mild or borderline osteoporosis can often be reversed to simple osteopenia. Most importantly, with either condition, you can take steps to decrease fracture risk.


Modifiable - Top 3 risk factors

  1. Lack of exercise. Get a combination of cardio with impact (walking, running) and strength training (weights, kettlebell, Pilates, yoga) a few times each week.

  2. Poor nutrition. The higher the quality of your food the more your bones will love you. Remember, we lay down our bone reserves by the age of 30! Nutrition matters. Avoid all processed food, refined sugar and unstable vegetable oils.

  3. Chronic inflammation. While its easy to see external inflammation (swelling, tenderness etc) we cannot "see" internal inflammation caused from many things such as over the counter meds, prescription meds, PPIs (Zantac etc), stress, diet etc. All these things rob our bones of nutrients and lead to nutritional deficiencies.

Non Modifiable

  1. Age - peak bone mass reached at age 30 and then decreases

  2. Gender - women more then men

  3. Genetics - Caucasions and Asians at higher risk

  4. Small frame - less bone reserve


DEXA Scan - insurance will pay if over 65 years old, otherwise usually not. It is the #1 test performed. You will receive two scores a T and Z score. The T score is a comparison to the bone desity of a thirty year old, the Z score is related to someone your age. The T score is the most important score and anything higher than -2.5 is considered

osteoporosis (as shown on graph). Anything higher than -1.5 is considered osteopenia. The blue image is your lower spine. An image of the lower spine and hip is taken. This scan measures bone density, but it doesn’t measure the quality, strength, or resilience of the bone. Talk to your doctor if he wants to prescribe medication based on one scan result. There may be lifestyle factors you could adopt to avoid medications.

The FRAX test is used in conjuction with the DEXA. This is a fracture risk assessment tool that looks at common risk factors.


Conventional Medical Treatment for Osteoprosis

  1. Anti-resorptive medications (like Fosamax) work by inhibiting bone destruction. They’re a treatment – not a cure, and their benefits often go away after stopping the medication. The problem is that serious rare side effects limit their use. Even conventional MD’s don’t prescribe them for more than 5 years, some doctors say 2 years is enough. In some cases when bone loss is above -4.0 the benefits of these drugs may outweigh the limitations. Too have your questions ready, it would be wise to do a little research before consulting with your doctor.

  2. Calcium supplementation. Isolated high-dose calcium supplementation comes with risks also. Not only is there uncertainty whether it even reduces the risk of fracture, it also increases the risk of heart disease. Excess calcium in the bloodstream can be deposited on the artery walls.

My Recommendations

  1. Look at all the nutrients involved in bone health. Sure Calcium is one of them but its not the ONLY nutrient needed, its just the one getting most publicity.

Try get your calcium from food first. A useful free app for tracking macro nutrients is Cronometer Foods high in calcium are dairy, greens, nuts, wild caught salmon, oranges, and white beans. Supplement for bone support goes beyond calcium. Bones are not only made up of calcium, they also have selenium, potassium, boron, magnesium, manganese, to name just a few.

If you are supplementing make sure your calcium/bone health supplement contains K2 and D3 which are key factors also. Two doses daily of calcium appoximately 500 mg each time from a reputable manufacturer like Thorne or Pure Encapsulation

A great comprehensive, easily available supplement in New Chapter's Bone Health

Magnesium - Adequate amounts of magnesium are needed for bones to be able to metabolize calcium normally. Sources of magnesium are dark leafy vegs, nuts, seeds, beans, lentils, fish, shrimp, avocado, banana, figs, dates and dark (85%) chocolate. Magnesium glycinate is a very each to absorb form of calcium.

Vitamin D deserves its own accolades. You cannot have calcium metabolism without Vitamin D so you can supplement all you want with Calcium but if your D reserves are low that Calcium supplement is useless. Make sure your bone supplement has Vitamin D3 and ask for this super important vitamin/hormone be checked by your doctor during your annual physical. I prefer sublingual Vit D. Under the tongue supplements can bypass the intestinal tract and travel easier into the blood stream.

If your Vit D level is low (below 50) add 5,000 iu daily. If your level is 50-80 (ideal) stick with 2,000 iu daily. It is a fat soluble vitamin so take with food.

Food sources of D are fatty fish, eggs, mushrooms and of course, the sun.

2. Daily exercise, including 30 mins of movement and some form of strength training.

3. Eat a high nutrient diet, including all the colors of the rainbow, and all the veggies you can handle.

4. And in no particular order (besides the top 3 listed above) don't smoke, drink sodas, drink alcohol excessively (more than 3 drinks a week) , more than one cup of caffeine a day, exercise too much or too little, and finally do not over restrict your diet.

This specific article was inspired by any extremely informative interview conducted by Phoenix Helix with Dr. Amy Nett. The interview is an hour long and worth the listen.

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