Bone Density with the People Inside

Last Thursday I had my much-anticipated DEXA scan, the follow-up from October, 2022, when I learned I was in the very early stages of osteoporosis. For almost two years I’ve been taking a plant-based calcium supplement (believed to be easier to absorb than the rock-based type, and priced to prove it), and consistently following a strength training program. The goal: to improve bone density.

 

You mean your skeleton?

 

Exactly, 9, my “internal framework of bone” as defined in an unattributed online dictionary.

 

 

 

Bones are handy things, good for propping us up and not letting us slide down to our ankles in a puddle of all the other body parts.

 

Must you?

 

I must, Lily, because I’m at that age where it’s a survival skill to treat the threats and actualities of physical decline with humor. Returning to the bare bones of this conversation- –

 

Spare me the puns.

 

Because I am being funny about this, it is probably clear that the follow-up DEXA scan did not show the improvement I had anticipated. Some people do, in fact, improve bone density through strength training. Since January 2023 I’ve been dedicated to my twice a week free weights routine, working both upper and lower body for about an hour each session, at the local YMCA. The increase in muscle strength and tone is easy to see and feel, but my bone density scores. . .

 

Are you in puddle territory?

 

I am happy to report I am not. But my FRAX score (a risk assessment tool used to determine a person’s 10-year risk of major osteoporotic fracture) has increased a little bit, everywhere except my right neck. That lucky spot merrily dances just across the border in osteopenia territory.

 

Where?

 

The place between normal bone density and osteoporosis.

 

I always knew you weren’t normal.

 

I took the news pretty well, no screaming or crying, but there was a disjunction in my mind. Muscular exertion tells the bones to increase in density. My muscle mass had increased. Why were my bones not getting the hint? Then came the Aha moment. Muscle weighs more than fat but my body weight hasn’t changed since I started strength training. I don’t have a lot of fat, so what was going to muscle might not leave enough to build bones. Maybe the bones were even being cannibalized to build the muscles?

 

Ew! That sounds like a horror movie.

 

I’ve discussed bone density issues and possible options with my doctor. She recommends I talk with an endocrinologist to figure out which option(s) would be most effective, given my health history, overall health, and age. Hormones are probably out, considering a 2004 episode of in situ breast cancer. There are other pharmaceutical interventions, and who knows what else.

 

My doc put in the order for an endocrinology consultation last Friday. They haven’t called me back yet to schedule an appointment. The way things are with specialists these days, it could be months before I actually have the consultation. Here’s what I’m doing in the meantime:

 

1. Continuing the strength training routine and the calcium supplement. Better muscle mass is good for my overall health, and it’s possible the work I’ve already done has at least slowed the rate of bone density loss.
2. Pro-actively gaining weight! My current BMI is 16.6, not the only measure of overall health, but well within the Underweight range, and this has negative bone density implications. I’m adding 500 calories a day to what I normally eat- -something I’ve been tracking not only by calories, but by grams of protein and % of daily calcium since this bone density project began. This way, I should be able to maintain my current level of physical activity and gain one pound per week.

 

Ultimately I mean to get my BMI up to 18.5, the lower end of the normal range for women. To stay encouraged I’ve established a preliminary goal of 17, something measurable and attainable in the shorter term (one month or less).

 

 

A word to people who scoff at the idea that gaining weight is difficult. I’ve previously been in the position of seriously needing to lose weight and, honestly, I think that is easier. Why? Because of mind set. Gaining weight is counterintuitive to our cultural norms. In both cases, it’s a matter of getting your mind in the right place to ensure success. I’ve tried a few times this year to gain weight but making the mental adjustment was more than I could sustain. What’s different now? The measurable decline in bone density. Being underweight and following a low fat diet contribute to this issue. As a person who is very numbers oriented, the negative trend inspired me with real motivation, what some might call a “Come to Jesus” moment.

 

Time to let my body show me what it can do when there’s more of it.