Your Thin Bones

If your doctor says you have thinning bones -- osteopenia or "Even generic brands are fine if they have that information," Diemer advises.
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Many factors affect bone strength. Use of certain medications to treat chronic diseases, for example, is an often-overlooked risk factor for developing osteoporosis. Also, certain medications may cause dizziness , light-headedness, or loss of balance -- which could put you at risk for a fall. Your doctor can explain your own risk -- as well as options for preventing and treating bone loss. A bone mineral density test BMD is the only way to determine the extent of your bone loss. Your doctor will determine how frequently you should have a bone density test. If you're taking osteoporosis medications -- or have certain risk factors -- you may need a test every six months.

Before having the test, check with your insurance company.


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Some will only cover bone density tests every two years. But you may need to be persistent in getting it covered. Bone Health Step 1: Calcium and Vitamin D Calcium builds strong bones, but vitamin D helps the body absorb calcium.

We know that dairy has calcium, but other foods do, too. Low-fat milk or soy milk 8 ounces: Calcium carbonate must be taken with food for the body to absorb it. Many women have side effects from calcium carbonate -- gastrointestinal upset, gassiness, and constipation , Diemer tells WebMD. If you take calcium carbonate with magnesium , however, you won't likely have the constipation. Continued Certain medications can interfere with absorption of calcium carbonate -- including Nexium , Prevacid , Prilosec , and others used to treat acid reflux GERD or peptic ulcers.

Calcium citrate is generally well tolerated, and can be taken without food. You might need to take more than one pill to get the recommended dosage, so take them at separate times -- to help your body absorb the calcium. If you take more than about milligrams of calcium at one time your body will simply pass it as waste.

Bone Health Step 2: Weight-Bearing Exercise Calcium supplements and osteoporosis medications can stop bone loss -- which allows the bone to rebuild itself, Diemer explains. Continued Swimming , however, is not a good bone-booster, says Diemer. Bone Health Step 3: Talk to Your Doctor Many factors affect bone strength.

Osteoporosis: 5 Steps for Better Bone Health

These are questions you might ask your doctor: How can I best improve my bone health? What is the best calcium to take? What medication can help me? Has this medication been proven to lower risk of fractures of spine and hip? What are the side effects? Do I need special instructions for taking my bone medication? Will the medications affect other drugs that I'm taking for other conditions?

How will I know if the treatment is working? How soon will I see a change? How long will I take this medication? Am I taking any medications that put me at risk for a fall? What exercise is safest for me? Are there exercises I should not do? How can I know if I've fractured a bone in my spine? Tricyclic antidepressants, for example, may cause dizziness — which increases the risk of falling and could explain an increase in bone fractures. In the past few years, however, better-designed studies have not only strengthened the case for a biological link between bone and brain, but also suggested something previously unsuspected — that SSRIs may be particularly harmful to bone.

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Researchers began investigating the link between depression and bone loss in the late s. Although multiple factors may contribute to bone loss, growing evidence implicates SSRI use. Clinicians prescribing SSRIs and patients taking these drugs may want to address bone health during office visits. Although typically depicted as something solid, bone is actually a dynamic, living tissue undergoing constant remodeling see illustration. During a stage called resorption, cells known as osteoclasts break bone down into calcium and other constituent components that are returned to the bloodstream for use elsewhere in the body.

During bone formation, other cells known as osteoblasts assemble calcium and other biological materials to rebuild the harvested area. Nutrient intake, exercise, and cigarette smoking all affect this remodeling process, and likely contribute to findings of low bone mineral density in patients with depression. For example, a severely depressed patient who stays indoors for extended periods may not get enough sunlight exposure to produce vitamin D, which helps the body convert calcium into bone. Patients with depression are also less likely to exercise, and more likely to smoke, compared with healthy people.

But researchers have identified several possible biological mechanisms linking brain and bone.

Aging and Bone Loss

For example, studies have reported that depression elevates levels of both the stress hormone cortisol and various immune system cells that promote inflammation — changes that can harm bone. Bone is constantly being demolished and rebuilt. During resorption, osteoclasts gnaw at bone, releasing calcium and other minerals into the bloodstream and leaving troughs behind. If bone-building cells known as osteoblasts cannot keep pace, these tunnels are not completely refilled, and bone becomes weaker and may fracture.

More recently, scientists have discovered that bone cells have receptors for various neurotransmitters and are responsive to changes in the brain. A traumatic brain injury, for example, activates cannabinoid type 1 receptors in osteoblasts, which respond by building new bone at a rapid rate.

What Is Osteopenia?

In the brain, activation of these receptors by smoking marijuana causes euphoria. Other researchers have found that osteoblasts also have receptors for neurotransmitters that are involved in regulation of appetite, such as neuropeptide Y and leptin. An emerging theory is that the hypothalamus, which helps control hunger, thirst, and behaviors related to circadian rhythm, may regulate the bone remodeling system in response to signals about food intake and energy stores that it receives from the gastrointestinal system. Most recently, researchers have focused on the impact of serotonin 5-hydroxytryptamine, or 5-HT on bone health.

Depressed mood results in part from abnormal levels of this neurotransmitter. It's an intriguing theory, but so far the basic research has produced mixed results. One team found that inhibiting 5-HTT in mice slowed bone formation while accelerating bone resorption. But another animal study found just the opposite: Other preliminary research suggests that serotonin affects bone remodeling through targets other than 5-HTT.

Bone Health Step 1: Calcium and Vitamin D

Despite these conflicting laboratory findings, results from four of five epidemiological studies included in the review cited earlier support the theory that SSRI use weakens bone and increases the chance of fracture — even after adjusting for depression or other confounding factors. Participants who took SSRIs daily were also twice as likely as nonusers to suffer a bone fracture. Three other large studies found lower bone mineral density among SSRI users.


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This deficit of bone mineral density was similar to that reported by studies of the impact of known risk factors for osteoporosis, such as smoking or low calcium intake. The large, prospective Women's Health Initiative Observational Study of postmenopausal women ages 50 to 79, however, found no relationship between use of antidepressants SSRIs or others and reductions in bone mineral density over a three-year period in a subset of more than 4, women.