The great bamboozle of osteoporosis.
It not just for octogenarians.
I have been digging deep into the world of menopause over the past couple of years. It has lead me down many related paths — aging, women and aging, social norms around aging (go, Glenn Close!), digital health, dearth of medical research on women’s health issues, how we understand menopause (not very well), how to deal with menopause symptoms (it’s a mess), even what is changing in the world of menstruation (period underwear — great for unpredictable periods in perimenopause, too). The labyrinth is alluring, complex and replete with misinformation.
One of the things I have been increasingly sensitive to is how we represent age and the ailments arising from aging. One glaring example was a piece I read describing the challenges of being 50 years old in the work place. The header image was something similar to the header image above. Woah. That’s a bit much, no? I am 51 and don’t look nor feel anything like an octogenarian.
I have the similar rant (can I call it a rant?) regarding osteoporosis. I know. It’s not that sexy or interesting but it’s important (now I *sound* like an octogenarian!). All the imagery and the health advice is focused on white-haired octogenarians, frail and hunched over.
It’s a tough sell — bone health. Because, we humans tend to fall into “out of sight, out of mind” patterns when it comes to health. When we are having skin problems, our bellies start to bulge over our belts or are coughing up blood, we see it and are motivated to do something about it. For the inside stuff — blood quality, liver function, bone density — we tend to be less educated and, frankly, less motivated.
But, I have to just call it out! Because ….
The biggest delta in bone density for a woman happens in perimenopause — in a her 40s. You read that right. FORTIES. Not in her 80s or 90s.
Let’s take a step back.
First a small primer on the multi-year arc of menopause. First, menopause is is a point in time (12 consecutive months without a menstrual cycle) and that there are phases before and after. The before phase is referred to as perimenopause (peri is the prefix meaning around, like in perimeter and, in this case, used in the sense of before menopause). And it’s been in use (according to Google Ngram) only since the 1970s.
That’s easy to understand since women have increasingly only been living beyond menopause (the average age is 51) since the 1950s. And women are now living 50% of their adults lives post-menopause.
So that’s perimenopause. It is a relatively new thing. Using it in language is a new thing. Understanding the health issues during perimenopause (and menopause) is a new thing. It often gets lumped in with the term menopause but it is a distinct phase with different hormonal profiles and fluctuations.
Let’s get back to perimenopause and the great bamboozle.
The perception of osteoporosis, the related literature and awareness campaigns categorize it as something to deal with when you are an octogenarian.
However …
A meta-study evaluating perimenopause health demonstrates that a women’s bone density changes (i.e., decreases) THE MOST during perimenopause — in a woman’s 40s. The bone loss per year in perimenopause is 1.8% and 1.2% in early post-menopause. That’s 50% more rapid bone loss! The biggest delta happens at this stage.
Therefore it is the most important time to increase habits to keep bones strong. Not when we are 80 or 90 years old when they’ve already weakened. In my opinion, it’s way too late to do anything meaningful about it at that age.
And that is the great bamboozle. Bone loss is not a grandmother’s problem. It’s a hip, cool, active 40-year old woman’s problem.
What I did about it.
As soon as I read that I did a search to figure out how I could test my bone density. And I got a scan within two days.
Turns out there are two levels of testing. Let’s call one of them direct-to-consumer “informative” testing and clinical diagnostic testing. The latter is performed by a doctor or technician in a clinical setting using technology to determine with a high level specificity the porosity of your bone. They test a certain sites like your wrist or iliac crest. This is use to determine if you need medical intervention, e.g., when you are already frail and at heightened risk of bone fracture.
The direct-to-consumer test is a DXA scanner. It’s a full body x-ray that can differentiate between different types of tissues based on unique densities. What I learned from the technician is that the scanner can distinguish between soft tissues, bone and two kinds of fat — white fat and brown fat. The caveat is that the results are not diagnostic, i.e., they will not inform you enough to know if you need intervention. What it does is give you a sense of where you stand for other people in your demo. I am a 51 year old Asian woman and they have a set of data against which results can be compared. Turns out I am off-the-charts high bone density. Phew.
What you leave with is an understanding of whether you are in the norm, below the norm or above the norm. For most this is enough. For most, we are normal (that’s how the math works). If it turns out you were well below the norm, it could be a motivator to get a diagnostic test done. If not, you can rest assured that you’re ok.
Most importantly, this test is easy — you just lay on a table as a scanner moves toe to head and it gives you a baseline to know where you are now, today. So when you do check in the future, you can understand the change. And that’s the important part.
So, if you’re a woman in your 40s, go get a DXA scan test. It’s really affordable. It’s empowering to know. You’ll feel better. And, I’ll feel better, too.
