Bone Health

by Henri J. Roca, MD, and Beatriz Olson, MD
As you grow older, benchmarking your bone health becomes increasingly important. Your bones reach maximum density in your twenties and then begin to slowly decline. This decline markedly increases once menopause or andropause occur, during times of increased stress or infection, during times of significant nutritional challenge, and during times of deconditioning or lack of exercise.

Those at greatest risk tend to be Caucasian, tall, thin women who have smoked. Those with hormone imbalances and with a family history are also at greater risk. Other potential risk factors include anorexia, loss of one’s cycle during adolescence, diets low in protein and rich in carbohydrates. Men who have low testosterone, who are inactive, or who have been ill are also at risk. The risk for osteoporosis in women far exceeds that in men.

The following tests should be done whenever you notice a decrease in your height or at the beginning of menopause or andropause. The follow-up frequency may be every 1 to 2 years depending on the degree of bone density loss detected, or on the therapy on which you and your provider decide:

  • Bone Mineral Density (DEXA) scan, which measures bone density, not bone strength – Normally the spine, the hip and the wrist bones are measured.
  • NTX, which measures bone turnover rate – This is useful before and after starting therapy.
  • Female reproductive hormones in women including progesterone – These hormones stimulate bone formation.
  • Testosterone in both males and females – This hormone stimulates bone formation.
  • Thyroid stimulating hormone as well as free T3 and free T4 – Excess or high levels contribute to bone loss, and can exacerbate bone loss in menopause.
  • Red Blood Cell Magnesium – a key cofactor
  • Vitamin D3 level – key hormone needed to absorb calcium from food and
    for muscle strength; Vitamin D and Parathyroid Hormone work together
    to regulate calcium levels in the blood.
  • Calcium level– the primary mineral in bone
  • Parathyroid levels are useful if your calcium is high.
  • Vitamin K level – also a co-factor
  • Lead level – Lead can replace calcium in bone.
  • Urine pH – A more acidic system can contribute to bone dissolution.
  • 24-hour urine calcium collection can tell us about how your body is
    processing calcium. If levels are low we learn that you are not getting enough calcium in your diet; if levels are too high, it can give us a clue about the cause of your bone density loss to help guide our therapy.