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Osteopenia and Osteoporosis

Osteoporosis is a condition characterized by a decrease in bone quality which increases risk of hip, thigh, and spine fractures with normal activities or accidental falls. Osteoporosis may result due to loss of bone mass or density, or a reduction in the quality of the bone matrix with the bones becoming more fragile. EVND’s Osteoporosis Prevention and Treatment Program is designed for both women and men to optimize bone quality and density. Good bone quality helps prevent fractures of the weight bearing bones, especially the hip and spine.

The conversation about osteoporosis risk often starts in women who are approaching their menopausal years. A leading risk factor of bone loss in aging women is due to the expected menopausal decline of estrogen which is known to stimulate bone growth in younger women. However, variables that impact the health of the bones can start much earlier in life adding to the concern as we age.  As an example, certain medications or medical conditions can predispose a person to bone density loss, including long term steroid use, long term use of proton pump inhibitors, early menopause, a long history of infrequent menstrual cycles, or long term use of prescription Depo Provera for contraceptive purposes. Hyperthyroidism, alcoholism and family genetics are additional risk factors that contribute to premature bone loss.

Other risk factors that are often under valued include gastrointestinal (GI) function. A compromised GI system will negatively influence how well we absorb nutrients from foods leading to mineral and vitamin deficiencies. Patients often benefit from IgG food sensitivity testing to discern if a food they are consuming is unknowingly promoting excessive inflammation in the body. Inflammation in general is a promoter of bone loss with an anti-inflammatory diet providing a key support that reduces bone loss. Another deterrent to healthy bones is a diet high in processed foods, sugar, and soda which depletes important minerals that build and maintain bone.

Patients who are at particular risk include those with a family history of osteoporosis, previous fractures, smokers, post-menopausal women, men with low testosterone, presence of rheumatoid or inflammatory arthritis, poor exercise habits, and calcium and vitamin D deficiencies. Maintenance of optimal health requires being active and also proactive. A qualified physician can ascertain risk and recommend specific protocols to optimize bone health and significantly decrease risk of fractures.

Specific blood tests can help us isolate areas of focus with our patients. The tests we run may be based on symptoms as well as severity of the bone loss. Examples of tests that may be run include:  Vitamin D25OH, inflammation (hsCRP), homocysteine, thyroid stimulating hormone (TSH), Free t4 hormone, Free t3 hormone, N-telopeptide cross links, estradiol, testosterone, as well as stool tests if there are absorption concerns.

Though significant attention is placed towards vitamin and mineral deficiencies related to osteoporosis (ie Vitamin D, K, C and Calcium, magnesium, boron), there are a lot of other variables beyond replacement of these nutrients that effect bone quality and growth. Current and ongoing research supports many herbal therapies for there influence on bone density.  EVND is up to date with the newest information on osteo benefits of these non-prescription alternatives to medications. Some treatment considerations that our doctors may discuss with you are herbal remedies like Epimedium, red clover, black cohosh, black cumin seed, curcumin, Cistanche and quercetin.

Since menopause and andropause are common instigators of advancing bone loss, hormone therapy may be an important tool to utilize for improving bone density and quality. Estrogen therapy specifically in a postmenopausal woman can help slow the rate of bone loss. Risks and benefits with estrogen therapy must always be carefully discussed with your practitioner before starting any hormone replacement therapy.

Maintaining strong and healthy bones is essential for overall well-being, and assessing bone density is a critical aspect of bone health management. A bone mineral density test should be performed on anyone with a high risk. The DEXA (dual energy x-ray absorptiometry) scan is a safe and reliable method for evaluating bone mass of the hip and spine. The typical recommendation is to get a baseline done around menopause, or andropause, as this is the time bone loss can occur more rapidly. DEXA scans (bone density scans) are recommended every 1-2 years after the initial baseline assessment. Traditional methods like Dual-Energy X-ray Absorptiometry (DXA) have been the gold standard for bone density measurement, but measuring bone density alone is not enough. Until recent no tool existed to diagnose the quality of bone, so it was generally ignored. A new and promising tool in bone health assessment has emerged called Bone Score®.

Until recently no tool existed to diagnose the quality of bone, so it was generally ignored. A new and promising tool in bone health assessment has emerged called BoneScore®. BoneScore® is NOT another bone density test. It’s a first-of-its-kind, FDA-cleared test for measuring bone quality and without the exposure to radiation. BoneScore® gauges the softness of bone tissue to help physicians better understand the quality of your bone. BoneScore’s® cutting-edge technology determines bone strength on a microscopic scale to offer insights into the quality of your bone tissue. BoneScore® also allows more frequent testing than DEXA or BoneDensity; This allows your physician to monitor the effects of diet, exercise, and supplemental therapeutics to prevent or reverse osteoporosis. Over the last 10 years, BoneScore® has been performed on thousands of patients and has been featured in 60+peer-reviewed clinical studies from to pranking medical institutions like MayoClinic, Columbia, Harvard, Tufts, and Johns Hopkins, among others. Patients find value in BoneScore® especially when the DXA results are unclear.

Understanding Bone Density

Bone density is a measure of the amount of minerals, such as calcium and phosphorus, present in bone tissue. It directly correlates with bone strength and resistance to fractures. Low bone density, often indicative of osteoporosis or osteopenia, increases the risk of fractures and can significantly impact an individual’s quality of life.

Conventional Methods vs. BoneScore®

Traditionally, DXA scans have been the primary method for assessing bone density. DXA uses X-rays to measure the amount of mineral in bone and calculates a T-score, comparing an individual’s bone density to that of a healthy young adult. While DXA is highly effective, it has limitations, including exposure to ionizing radiation, limited accessibility, and potential overestimation of bone density in individuals with degenerative joint diseases.

Bone Score®, on the other hand, is a newer and advanced imaging technology that provides a more comprehensive assessment of bone density. It utilizes data from a DXA scan but incorporates additional information about the trabecular microstructure of bone, providing a more accurate and nuanced evaluation of bone health.

How BoneScore® Works

  1. Trabecular Bone Score (TBS): Bone Score focuses on the trabecular microstructure of bone, which represents the inner, spongy part of the bone. TBS measures the quality and connectivity of trabecular bone, offering insights beyond the conventional measurement of bone mineral density (BMD). By analyzing the texture of the bone on DXA images, Bone Score provides a TBS value that reflects the microarchitectural integrity of bone. By gauging the softness of bone tissue on a microscopic scale BoneScore® offer new insights into the quality of bone with results available immediately after the test and displayed as a simple numerical number ranging from 40-100 (referred to as BMSi in published literature).
  2. Integration with DXA Results: Bone Score is often integrated into DXA reports, enhancing the interpretability of bone density assessments. TBS values complement BMD measurements, providing a more comprehensive understanding of bone health. A higher TBS indicates better trabecular bone quality and is associated with a lower risk of fractures, even in cases where BMD may appear normal.

Benefits of BoneScore®

  1. Improved Fracture Risk Prediction: Determining bone strength requires more than just density. BoneScore physically tests the bone on a microscopic scale to offer insights into the quality of your bone tissue. With this additional data point, your physician may assemble a more comprehensive understanding of your bone health, which is particularly valuable in identifying individuals at risk for fractures who may not be accurately classified by BMD alone.
  2. Enhanced Patient Management: By providing a more detailed analysis of bone health, Bone Score aids your Naturopathic physician in tailoring interventions and treatment plans. It enables a more personalized approach to your bone health management, ensuring that you receive appropriate care based on their specific risk factor.
  3. No Additional Radiation Exposure: Since BoneScore® physically gauges the bone tissue without the use of radiation. This makes it a safe and practical tool for routine bone health assessments.
  4. Applicability to Various Populations: Bone Score is applicable to a wide range of populations, including postmenopausal women, men, and individuals with various health conditions that may promote bone loss.

In the realm of bone health assessment, BoneScore® emerges as a powerful and innovative tool that goes beyond traditional methods. By integrating trabecular bone quality into the evaluation of bone density, Bone Score provides a more nuanced understanding of a patient’s fracture risk. With its benefits of improved fracture risk prediction, enhanced medical management, and no additional radiation exposure, BoneScore®  is poised to become a valuable asset in the pursuit of optimal bone health. As research and technology continue to advance, BoneScore® stands at the forefront, revolutionizing the way we assess and manage bone density. If you are considering a bone health assessment, discussing the potential inclusion of BoneScore®  with your physician may offer valuable insights into the state of your bone health and guide preventive measures to maintain strong and resilient bones. View a video of a procedure here:

Exercise Prescriptions

Maintaining optimal bone quality is essential for overall health and longevity. The importance of exercise as it pertains to osteoporosis is extremely important.  Engaging in weight-bearing activities has been proven to be a key factor in enhancing bone density and reducing the risk of bone-related issues such as osteoporosis. Here we will explore various proven weight-bearing activities that contribute to improved bone quality.

Understanding Weight-Bearing Activities

Weight-bearing activities involve working against gravity, requiring bones and muscles to support the body’s weight. These exercises stimulate bone growth and enhance bone density by putting stress on the skeletal system. As bones respond to this stress, they become stronger and more resistant to fractures.


Walking is one of the simplest yet most effective weight-bearing activities. It is low-impact, making it accessible to people of all fitness levels. Regular brisk walking encourages bone remodeling and helps maintain bone mass and quality. Aim for at least 150 minutes of moderate-intensity walking per week, incorporating it into your daily routine.

Running and Jogging

For those seeking higher-impact activities, running and jogging are excellent choices. These weight-bearing exercises engage multiple muscle groups and impose significant stress on bones, promoting bone density. However, it’s important to start gradually, especially for beginners, to minimize the risk of injury.


Dancing is a fun and versatile weight-bearing activity that can be tailored to various fitness levels. Whether it’s ballroom, hip-hop, or salsa, dancing involves movements that challenge bones and muscles, contributing to improved bone quality. Joining a dance class or dancing at home can be an enjoyable way to incorporate this activity into your routine.


Hiking combines cardiovascular exercise with weight-bearing benefits. The uneven terrain and elevation changes during a hike engage different muscle groups, making it an effective way to strengthen bones. Additionally, spending time outdoors provides the added benefits of fresh air and exposure to sunlight, promoting vitamin D synthesis, which is crucial for bone health.


Resistance or strength training is a powerful way to improve bone quality. Weightlifting, whether using free weights or machines, places stress on bones, triggering the bone remodeling process. Focus on compound exercises like squats, deadlifts, and bench presses, gradually increasing the resistance as your strength improves.

Jumping Rope

Jumping rope is a simple yet highly effective weight-bearing exercise that can be done almost anywhere. The repetitive impact on bones during jumping stimulates bone growth and improves bone density. It also provides cardiovascular benefits, making it a time-efficient and versatile exercise option.

Aerobic Classes

Participating in aerobic classes, such as step aerobics or Zumba, combines cardiovascular exercise with weight-bearing elements. The dynamic movements challenge bones and muscles, contributing to improved bone quality. Joining a group class can add a social component, making it more enjoyable.

Leg Jumps

In one study, 20 healthy inactive postmenopausal women was asked to perform an exercise program of daily one legged jumps from 3 x 10 to 4 x 20 jumps a day. The study was looking to determine whether mechanical loading through jumping on one leg repetitively can improve the bone microstructure in the exercised leg. Results were impressive. Just after 3 months there was a 7% increase in the leg that got the exercise intervention showing the impact it had on what is known as the cortical geometry, which increased the strength. This change was evaluated by using the bone material strength index (BMSi) , a more innovative way to study bone microstructure changes. The initial and repeat bone density at 3 months didn’t show changes which is likely due to the time it takes to show changes on the scans.

Whole Body Vibration Therapy

Whole-body vibration (WBV) is another form of non-invasive, passively induced mechanical stimulation that increases the mechanical load on bone tissues through the production of strain and modulating muscular force contractions. WBV has been demonstrated to improve bone density,  muscle architecture, and function.

Incorporating proven weight-bearing activities into your fitness routine is a proactive step toward maintaining and improving bone quality. Whether you prefer low-impact options like walking and dancing or higher-impact activities like running and weightlifting, the key is to choose activities that you enjoy and can sustain over the long term. Prioritize consistency, gradually increase intensity, and complement your efforts with a balanced diet rich in calcium and vitamin D for comprehensive bone health. Remember, consulting with a healthcare professional or fitness expert before starting a new exercise routine is always advisable for personalized guidance.

Complete Assessment

A complete assessment of bone health is made with the use of past and current DEXA scans, BoneScore®, comprehensive blood tests including thyroid function, Vitamin D, high sensitivity C-Reactive Protein, Homocysteine, and possibly,  IgG Food Intolerance Testing. The information from the combined labs will help your Naturopathic physician determine risk of fracture and also design an individualized program to prevent further bone loss and build bone density as well as quality.

Your individual program for bone health will include nutritional and exercise guidelines, including a discussion and recommendation of the best nutritional supplements for bone health. Quality bone health and maintenance requires consistent therapy over many years and your doctor will give you recommendations for further evaluation as you make positive changes for the future


1. Licata, A., Cleveland Clinic Journal of Medicine, 2009. 76(6): p. 331-36.
2. Unnanuntana, A., et al., Clin Orthop Relat Res, 2011. 469(8): p. 2194-206.
3. Felsenberg, D. and S. Boonen, Clin Ther, 2005. 27(1): p. 1-11.
4. Mellibovsky, L., et al., Journal of Bone and Mineral Research, 2015. 30(9): p. 1651-1656.
5. Guerri-Fernandez, R., et al., J Acquir Immune Defic Syndr, 2017. 75(3): p. 322-327.
6. Pérez-Sáez, M.J., et al.,. Transplantation, 2017. 101(6): p. 1290-1294.
7. Pérez-Sáez, M.J., et al. Bone, 2018. 116: p. 290-294.
8. Sundh, D., et al., J Bone Miner Res, 2018. 33(7): p. 1242-1251.
9. Lerma-Chippirraz, E., et alJ Antimicrob Chemother, 2019.
10. Blom-Hogestol, I.K., et al., Bone, 2020. 130: p. 115069.
11. Schoeb, M., et al., Osteoporos Int, 2020. 31(9): p. 1683-1690.
12. Malgo, F., et al J Clin Endocrinol Metab, 2015. 100(5): p. 2039-45.
13. Duarte Sosa, D. and E. Fink Eriksen, Acta Orthopaedica, 2016. 87(6): p. 626-631.
14. Malgo, F., et al., Osteoporos Int, 2017. 28(8): p. 2433-2437.
15. Nogues, X., et al., Bone, 2017. 103: p. 64-69.
16. Sosa, D.D. and E.F. Eriksen, Calcif Tissue Int, 2017. 101(1): p. 34-42.
17. Rozental, T.D., et al., J Bone Miner Res, 2018. 33(4): p. 621-626.
18. Rufus-Membere, P., et al., Endocrinology, 2019. 160(9): p. 2143-2150.
19. Holloway-Kew, K.L., et al., Bone, 2020. 133: p. 115241.
20. Farr, J.N., et al Journal of Bone and Mineral Research, 2014. 29(4): p. 787-795.
21. Furst, J.R., et al., The Journal of Clinical Endocrinology & Metabolism, 2016. 101(6): p. 2502-10.
22. Nilsson, A.G., et al., J Bone Miner Res, 2017. 32(5): p. 1062-1071.
23. Holloway-Kew, K.L., et al., Bone, 2021. 142: p. 115685.
24. Starr, J.R., et al.,. Osteoporos Int, 2020. 31(2): p. 327-333.
25. Herrera, S., et al.,. Journal of Bone and Mineral Research, 2017. 32(7): p. 1575-1581.
26. Herrera, S., et al., Osteoporos Int, 2017. 28(12): p. 3489-3493.
27. Pérez-Sáez, M.J., et al., Osteoporosis International, 2017. 28(9): p. 2723-2727.
28. Ballesta, S., et al., Osteoporos Int, 2020. 31(1): p. 175-180.
29. Orduna, G., et al., J Bone Miner Metab, 2020. 38(4): p. 563-569.
30. Malgo, F., et al., Eur J Endocrinol, 2017. 176(3): p. 339-347.
31. Schoeb, M., et al., J Clin Endocrinol Metab, 2021. 106(7): p. e2527-e2534.
32. Rufus-Membere et al., Calcif Tissue Int, 2023. 112: p. 338–349.