I have a medical question for you following up on your “Basic Guide to Osteoporosis” article. In the article you say:
“Lots of people are told that osteoporosis means that their bones are “brittle” or “fragile” – and this can cause a lot of fear and anxiety over their risk of breaking a bone.”
This is my mom’s experience exactly. For at least ten years, she has wondered what she did “wrong” to result in her having “brittle” bones. She is under the impression that her hip or femur may spontaneously break while walking or standing in the absence of any blunt force. Of course, I would be worried about that too, but I question whether it is likely.
When I have gone over her DEXA results I see the following:
It seems Osteoporosis is a statistical diagnosis only - anyone having a bone mineral density in the bottom 5% of the human population is osteoporotic (less than 2.5 standard deviations from the mean).
When comparing my 68 year old mom to women of her age and race, her bone mineral density places her in roughly the 50th percentile of her age/race/gender cohort
NEW INFO FROM BBM: When I plug her data into the FRAX calculator, her chance of a fracture in the next ten years is 10-12% and her chance of a hip fracture is ~2%. This seems like great news!
I am not a medical professional and I don’t want to be seen as contradicting her doctor. However, bullets 2 and 3 seem to paint a very normal picture, and I’d like to alleviate my mom’s anxiety.
Umbrella question: is it possible that people correctly diagnosed with Osteoporosis by WHO standards really are so “normal”?
Osteoporosis can be diagnosed in men/women over 50 years of age using any one of the following criteria:
having a fragility fracture (typically of the spine, hip, wrist, humerus, rib, or pelvis), OR
a T-score < 2.5 standard deviations at any site by DXA, OR
a 10-year risk of major osteoporotic fracture > 20% or hip fracture > 3%.
The T-score is typically used for diagnosis (2.5 SD below the young adult mean bone mineral density).
You may be referencing the Z-score, which compares the patient’s BMD to an age-matched population. A Z-score of -2 or less would be considered below the expected range for age and would merit further evaluation to identify potential underlying causes for decreased bone mineral density.
I don’t really know how to best answer your final question – but it would be best to work on alleviating your mother’s anxiety and getting her moving/exercising regularly regardless.
Ok, the three criteria make a lot of sense to me. My mom seems to meet criteria #2. Her spine has a T-Score <2.5 SDs below the mean. She does not meet criteria 1 or 3.
You’re correct that I was referencing the Z-Score for the age matched population. Does it seem possible to you that the mean BMD for 68 year old white females is <2.5 SDs below the mean BMD for all adults? Perhaps I am mucking up the stats by comparing T and Z Scores but it just struck me as odd that a whole sub populations average would be so low compared to other humans. Unless it just “do be like that sometimes”.
On the last point, the FRAX score really lowered my moms’ anxiety. She was very thankful to have that information, so kudo to you all for bring it to our attention.
No problem. After listening to the recent podcast on Osteoporosis I think its clear I am still too focused on the DEXA measurements.
I have one more question about suggesting an efficacious resistance training program to my barbell skeptical mom.
Right now she see a trainer in a standard globo gym 2x a week, and does a circuit training routine on machines. She is interested in modifying her training, but she likes her trainer and I think switching her to say, a BBM novice template for senior is unlikely be complied with.
So in the realm of slightly suboptimal resistance training, I’m thinking of suggesting that she start each session with some leg, chest and shoulders presses at increasing intensities prior to doing her standard circuit. If we assume machines are the most likely training modality to be complied with, is there any machine that somewhat approximates a deadlift?
I see the Liftmore trial used 5x5 at 85% of 1rm. I was thinking of just suggesting using 3x10 on everything to start to see if she can stick with in.