Q: I have been diagnosed with osteopenia of the spine. I believe it’s like pre-osteoporosis; is that true? Also, what treatment options do I have besides synthetic estrogen? I have recently started eating tofu and drinking soy milk. What else should I do to ensure that this doesn’t progress?
A: Osteopenia is a potentially pre-osteoporotic condition that indicates you have lost some bone but are not yet in a severe state of bone loss. You are absolutely right to take action to help prevent further bone loss and to rebuild bone. For many years, we thought that once bone was lost, there was no chance of rebuilding it. We now realize we can help replace what has been lost.
First of all, let’s look at the easiest things to do. If you are smoking, stop immediately. Smoking significantly contributes to bone loss. If you aren’t exercising, start doing some weight-bearing exercise regularly. Walking or using a stationary bike can be helpful.
If you aren’t getting enough calcium, start now (presuming you don’t suffer from kidney stones or other rare conditions that would contraindicate the use of extra calcium.) A post-menopausal woman who is not on estrogen replacement therapy should take 1,500 mg of calcium daily; if she is on estrogen, she should take 1,000 mg. Pre-menopausal women should take 1,000 mg a day, and it’s never too early to start. You also want to get in 400 units of vitamin D each day. Remember, one dairy helping – an eight-ounce glass of milk or cup of yogurt – contains about 300 mg of calcium. Many women do not do so well on the dairy front, so extra supplements are often in order. Your best calcium vegetable is broccoli.
Next, we need to consider medications. Presuming you are post-menopausal, estrogen replacement therapy can be helpful. Natural sources of estrogen are available commercially. The Climara patch and Estratabs are derived from soy; Estrace comes from yams. If you don’t want to take estrogen, a family of medications called selective estrogen receptor modulators (Evista is the leading example) can help prevent osteoporosis. Evista also acts at the level of the breast and blocks estrogen activity there; it actually seems to reduce the risk of breast cancer. The drug Fosamax can be used to treat and to prevent osteoporosis and has nothing to do with estrogen at all.
If you prefer a non-medical approach, soy is a reasonable option. Soy contains phyto (plant) estrogens called isoflavones, which many investigators believe are helpful in maintaining bone. The only problem is that there are really no large controlled trials to tell you exactly how much to take or what degree of protection you might receive. However, drinking soy milk, eating tofu or taking one of the new soy extract capsules can be helpful. Many choices are available. And with reliable bone-density measurements, follow-up is easy, so you can make sure your interventions are helping.