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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 71 As massage therapists, being conscientious about managing our osteoporosis risks is one way we can demonstrate our commitment to making lifestyle choices that promote health and longevity. bones have outer layers of cortical bone and an inner layer of trabecular bone. We use calcium and other minerals for bone density, but they have other important functions as well, like blood clotting, muscle contractions, and cellular repair. During childhood and into early adulthood, more is added to our bone mass than is taken away, but those processes are constantly in f lux. The minerals we use in daily activities are replaced by what we take in through our diet, and turnover occurs in lengthy, predictable cycles. WHEN BONES GET THIN Somewhere around age 30–35, the balance between increasing and decreasing bone mass shifts and we begin to lose bone faster than we replace it. At that point, we can, through diet and weight- bearing stress, work to maintain bone density, but we can't usually increase it. As we age, losses accelerate. Changes develop faster in trabecular bone than in cortical bone, which is problematic because trabecular, or "spongy," bone is more porous to begin with, so it has less mineral matter to give up. Furthermore, our femoral heads and vertebral bodies are made of trabecular bone. When these structures lose important internal support, they may collapse (Image 1). Patterns in bone loss are often more extreme for females, who are more at risk for osteoporosis for several reasons: • They usually have lower bone density than males in the first place. • They may have had the added demands of childbearing and breastfeeding. • The hormonal changes that begin with perimenopause impact the cells (osteocytes, osteoblasts, and osteoclasts) that sculpt bones throughout life. Genetics, age, lifestyle, and hormonal shifts are not the only factors in osteoporosis. It can also develop as a complication of medications—steroidal anti- inf lammatories, lithium and related drugs, heparin, methotrexate, anti-seizure drugs, and several others can affect bone density. Chemotherapy and radiation treatment for cancer can also cause bone thinning. Autoimmune diseases, gastrointestinal issues, and any condition that involves being sedentary or confined to bed also contribute. When these are combined with age, hormonal changes, and other factors, the risk is even higher. DIAGNOSING OSTEOPOROSIS We have several ways to measure bone density and fracture risk. The most common is dual-energy X-ray absorptiometry (DEXA), which indicates the presence of minerals by how they absorb photons. Two-dimensional DEXA scans give good information about bone health, but the risks related to osteoporosis also depend on bone quality and whether a person is prone to falling, and these factors play into treatment strategies. New tests and analytical models are also in use and becoming more common. It is useful to get this information as early as possible since early intervention may be able to slow—if not reverse—the bone-loss process. Complications Osteopenia and osteoporosis typically have no symptoms until the main complication occurs: a bone fracture. Then symptoms include deep pain, limited movement, and if it occurs at the hip, confinement to bed, where life-threatening thromboembolism, heart failure, or pneumonia may develop. Even when people recover from hip fractures and can walk again, their susceptibility to falls remains high, and that remains a risk for early death. People with osteopenia are more susceptible to fractures than others with many injuries, but those with osteoporosis can sustain a fracture with very minimal force. These are sometimes called fragility fractures, and they can occur with any low- energy trauma, such as a fall from standing height or less. A person who has had one such fracture is at increased risk for others, especially when this is associated with balance and falling. Treatment Options Genetics play a large role in osteoporosis. Experts estimate that 60–80 percent of peak bone mass is determined by genetics, and 20–40 percent is determined by factors that include nutrition, physical activity, tobacco and alcohol use, medications, and so on. 3 This means it's especially important to take control of the things we can inf luence for the best possible outcomes, especially for people with a family history of osteoporosis. Osteoporosis prevention measures ideally begin in childhood and adolescence, when adding to bone density through nutrition and exercise is crucial, and then continue throughout adulthood. Bone- healthy behaviors like weight-bearing physical activity, avoiding tobacco and excessive alcohol use, and getting adequate calcium, vitamin D, and other supportive minerals in absorbable forms are all steps that can reduce the risk of osteoporosis and related complications.