What Are Osteoporosis, Osteopenia and Osteoarthritis?

“No one can avoid aging, but aging productively is something else,” Katharine Graham once said. What does that mean, “aging productively”? And as I talked with OrthoCarolina’s former nurse turned Orthopedic Surgeon, Michael Bates, MD, it couldn’t be more apparent that aging productively is knowing one’s body and risks, especially post-menopause.

After our bodies decrease estrogen production, our bones no longer grow stronger – like atrophying muscles, they weaken. We’re often told to take calcium supplements and exercise, but as Dr. Bates made me aware, some women actually get enough calcium in their diets; nevertheless, Osteoporosis often takes us by surprise. Many women are unaware they even have osteoporosis until they stumble and fall, fragility fractures the only proof of porous bones. What can you do? And what about Osteopenia? The lesser of the two evils, indicating that a woman’s bone density is 1 to 2.5 less standard deviations less than the average young woman’s bone strength. And Osteoarthritis? Knowledge can help with prevention, so Dr. Bates shared some information we all need to know:

What are the biggest misconceptions about osteoarthritis and osteoporosis?
People hear these terms and often mix them up.
Osteoporosis and osteopenia (less severe) – are conditions of decreasing bone density. We grade a woman’s bone mineral density by comparing it to the average bone mineral density of young women. You should be within 2.5 standard deviations of that. If your t score is -2.5 or lower….you are defined as having osteoporosis and if it is less severe, with -1 to -2.5 standard deviations, you are defined as having osteopenia.

Osteoarthritis, sometimes called degenerative joint disease or degenerative arthritis, is the most common chronic condition of the joints, caused by mechanical wear and tear on joints.

What are the differences between osteoarthritis and osteoporosis?
Osteoporosis does not have any symptoms. Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both.   Osteoporosis is simply talking about the strength of the bones – how strong is the bone? Can it withstand the pressure we put on our bodies everyday?
Osteoarthritis is where two bones come together at a joint and the cartilage breaks down, causing pain, swelling and problems moving the joint. In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. When you lose the cartilage on the end of a bone, that’s when joints become very stiff and painful to move.

How can someone tell if they are predisposed to osteoarthritis or osteoporosis?
If your mom or dad have/had arthritis, or if you’re overweight,  then you’re more likely to develop osteoarthritis, especially in the knee. One of the biggest modifiable risks to osteoarthritis is weight loss. Some patients don’t like to make the connection that this can be weight-related, but more pressure on your knee joints can cause the cartilage to wear away at your joint. Unfortunately, women are more predisposed to osteoarthritis than men are.

When patients describe certain behaviors like having pain when they cross their legs to tie their shoes or when they walk, they have pain in their groin – before I see x-rays, I can predict what we’re going to see. Unlike osteoporosis, with osteoarthritis, you’re going to know about problems as it typically causes symptoms.

Osteoporosis may be either genetic or non-genetic. People with a family history of osteoporosis, especially those with a small and frail body structure, are at the greatest risk of suffering from decreased bone density even at an early age. And after menopause when the body stops making estrogen, a woman’s risk skyrockets. The bones start reabsorbing, breaking down and becoming weaker.

The formation of bone ~ yours, mine, or a postmenopausal woman’s bone ~ is a combination of bone formation and bone breakdown. After a woman goes through menopause and her estrogen decreases sharply, there can be too much bone breakdown which leads to demineralization of the bone. If you look at a slice of the bone under a microscope, you can clearly see the normal pores of the bone and how dense it is. After your bone loses minerals, it becomes more porous and, therefore, weaker.


Any suggestions for prevention?
Plenty of studies show that weight-bearing exercises improve bone density. Exercise in general is quite helpful. Smoking will cause a 5-10% increase of bone loss; that’s one of the things you can modify to instantly decrease your risk.

In general, my recommendation for prevention follows the basic science principles: If you use the bones, they become stronger to support the weight you’re lifting.  It’s the body’s way of responding to increased stress. The exact opposite remains true. Bones start to lose minerals and will weaken if you don’t use them.

Dietary intake of calcium and Vitamin D. Some women get through diet the recommended 1200 mg of calcium per day.  Appropriate Vitamin D levels are often lower than recommended. You have to get sunlight to get Vitamin D, and, instead, many are under fluorescent lights all day. That’s something you do have to have supplemented, especially when you get around the menopausal ages. The good news is Vitamin D is easily replenishable and your primary care physician will help you address this.

There are no convincing studies that show you can eat certain diets to help.  A lot of people swear by Glucosamine for osteoarthritis, but there’s not a lot of scientific evidence. It’s not going to hurt you, but it’s hard to recommend without empirical evidence.


During an annual, are there certain symptoms or signs patients should discuss with their provider?
With osteoporosis, patients have to be aware of it because there are no symptoms. Often, the first time you are told you have osteoporosis, you tripped and fell in your living room and fractured your wrist or hip. If you don’t want to find out you have osteoporosis via a fragility fracture, you have to be aware of your higher risk, especially if you’ve experienced menopause.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman with no additional risk factors. The most commonly used methods for measuring bone density are dual-energy X-ray absorptiometry, or DEXA, scans of the hip and spine, and ultrasound of the heel.

With osteoarthritis, the symptoms usually prompt us to do the appropriate testing and we do not usually screen for it. My treatment principle is that we treat the person and not the x-ray…if they have pain symptoms we treat them. When I review x-rays with patients, there are times I point out severe osteoarthritis on the x-ray, and they respond, “I wouldn’t have known that if you hadn’t told me.”  Osteoarthritis is not preventable except for cases of obesity, which places more stress on your joints, causing cartilage to break down, resulting in pain.


What you can do if you have osteoporosis – a class of medications, the bisphosphinates ( ie Boniva) are very effective and available in multiple forms and dosing regimens. And we do recommend you supplement with Calcium and/or Vitamin D at the direction of your doctor.
Osteoarthritis is usually initially treated with physical therapy and oral medication. Osteoarthritis that causes you pretty disabling pain is a consideration for joint replacement surgery.


If you’d like to learn more about weight bearing exercises to help prevent osteoporosis, check out OrthoCarolina’s online resources here.


For more information, contact a professional at OrthoCarolina.


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