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Thursday, July 1, 2010

Gwyneth Paltrow and Broken Bones

x-ray

Stockbyte/Thinkstock

Sticks and stones  — and reviews — can break an actress sometimes. But now Gwyneth Paltrow has a new challenge: avoiding broken bones.

Gwyneth revealed on her website GOOP this week that she suffers from osteopenia, focusing her celebrity attention on the incidence of low bone density among younger women.

Gwyneth, a young 37, wrote that her low bone density was detected after a severe lower leg fracture. Let’s look at how having the same diagnosis as Gwyneth might apply to other women under age 40.

The diagnosis of osteopenia, or low bone density, is usually made after receiving a DXA (“Dual Energy X-ray Absorptiometry”) scan. Such scans are rarely done on women younger than age 50. The exception to this rule would be if the woman has a medical condition known to interfere with bone density. Health issues with known bone impacts can include: high thyroid hormone levels, type 1 diabetes, Cushing’s disease, rheumatoid arthritis, excess cortisol and a greater than three-month use of oral (not inhaled) corticosteroids.

Some of us have had low bone density much of our lives, usually the result of genetics. Other contributing factors can include:

  • Being thin with a body mass index (BMI) less than 21 (e.g., 5’6” and 128 pounds).  (Check your own BMI with the WebMD BMI Plus Calculator.)
  • Current smoker
  • Daily alcohol intake of more than 8oz. wine, 2 oz. of liquor or 24 oz. of beer
  • Low vitamin D levels, often coupled with low calcium intake

We don’t know all the facts about Gwyneth Paltrow’s health history but she is very thin (5 ft. 9 inches and 112 lbs. according to Google searches), and she has written that her Vitamin D levels were quite low.

Not everyone with low bone density goes on to develop osteoporosis and bad fractures. Bone density is just one factor involved in fracture risk. Some women with low bone density never have a fracture. This might be attributable to good micro-architecture of the bone, or developing muscular strength to help stabilize bones and thus prevent falls.

The age of the woman with low bone density also matters. Two women with the same degree of osteopenia, one aged 50 and the other 70, will have different risks of hip fracture. If there were no added risk factors, and both women had the same osteopenia DXA score of -1.5, the 50-year-old would have a 10-year risk of hip fracture of 0.4%. The 70-year-old would have a 10-year risk of 1.4%. Alas, there is not as much data about low DXA scores in younger women, but we assume that a 40-year-old would have an even smaller risk. This is why most younger women are not started on prescription medications for osteopenia.

We don’t know Ms. Paltrow’s DXA score. Nor do we know if she was prescribed medication beyond increased vitamin D. Generally, prescription medication to prevent bone loss is reserved for older women and/or those with DXA scores lower than -2.5. Adequate vitamin D intake is something that most of us can improve upon. While the current RDA for Vitamin D is 400 mg/day, most experts believe that the RDA should be at least 800 mg/day for adults.

If you would like to know more about ways to increase vitamin D levels, read my post, Vitamin D and Women’s Health. If you would like to learn more about low bone density (including effects of different types of birth control), consider reading Boning Up: New Guidelines on Low Bone Density.

Are you concerned about your own bone health or Vitamin D levels? Share your comments with the Gynecology Community.

Posted by: Jane Harrison-Hohner, RN, RNP at 7:09 am

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