Your Healthcare Team

An important part of that is building a capable, trusted team of medical professionals who will be your advocates at different stages of your life. For example:

• General Practitioner (GP): Have this medical professional who is your health quarterback, someone who has an overall perspective on your health, access to key medical information about you, and can guide you on preventative actions appropriate for your age and situation.
• Gynecologist: Your GP may not cover all your feminine-specific needs, so also have a gynecologist, your feminine health quarterback, who can guide you on what female-related actions to take and when in order to stay healthy.
• Dentist: Regular dental care is an important part of your overall healthcare. Make sure that you keep your mouth as healthy as the rest of you. Your dentist can guide you on actions to take to maintain good dental health, including regular cleanings and X-rays.

Even then, you need to be your own healthcare advocate.

Being Your Own Advocate

You will need to be proactive to stay informed about the best health promotion and treatment practices that are recommended for your particular age, gender, or other special health circumstances. You will also need to exercise discernment about what health promotion and treatment actions may be best for you, your health status, and your health goals.

In other words, one size does not fit all when it comes to our medical needs, but you may be the one who needs to take ownership of finding out what size fits you best.

After all, while I hope that you have a trusted team of medical advocates that work together as needed to ensure that your health is cared for holistically, not piece-meal, what I have experienced too often and heard from others’ experiences, too, is that often that is not the case.

As someone who lived abroad for 20 years, living in multiple countries during that time, I sorely missed having a doctor who could be my ongoing healthcare quarterback — someone who knew my history and was providing guidance for me as I moved through different stages in my life and physical health. I thought that my disjointed healthcare situation would be resolved when I moved back to the U.S. and settled down in one place.

Unfortunately, what I found was that it was not so easy a thing to resolve.

Trying to find a general practitioner (GP) who accepted new patients was difficult. When I found one, for the year and a half that I stayed with the practice, I never did see my GP. Instead, I saw a physician’s assistant (PA) (who directed me to take an antibiotic I didn’t need, as was confirmed by test results that were not communicated to me but I tracked down on my own; I did not take the antibiotic, and I did change health care providers).

(By the way, this is not to say anything against PAs. I have seen wonderful PAs and rely on them, as well. However, when I sign up with a new doctor, I would like to meet them. I would also like to know my test results and not be prescribed medication I may not need.)

While I finally found a GP and gynecologist who were accepting new patients, who I actually do see on my annual visits, and who I feel pretty good about, I have also recognized that I still need to be my primary healthcare advocate. What I have found is that my healthcare providers generally do not communicate with each other, and the online communication portals that have, in many cases, taken the place of direct communication between health providers and patients are not infallible.

Furthermore, what is generally recommended may not always be in my best healthcare interest.

Which brings me back to the bone density scan.

The Bone Density Scan

A bone density scan, also known as a DEXA or DXA scan, is a low-dose x-ray that measures calcium and other minerals in your bones.¹ Bones containing more minerals are denser and tend to be stronger and less likely to break, so the measurement shows your bone’s strength and thickness (known as bone density or mass).¹

In the U.S., a bone density scan is typically recommended for women at the age of 65.

Specifically, the CDC guidelines are as follows:¹

Screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, such as having a parent who has broken a hip. However, there are other risk factors for osteoporosis besides age and gender, such as some intestinal disorders, multiple sclerosis, or low body weight. Your healthcare provider may recommend a DEXA scan if you have any of these other risk factors.

However, my own experience is that many women who are at higher risk are not aware that they are or not aware that a bone density scan may be something they should speak to their health provider about and consider. I know women who are 65+ who have never had a bone density scan and were not aware they existed.

Fortunately, although my healthcare as an expat often felt disjointed, one of the preventative care actions that was recommended to me during that time was to have a baseline bone density scan at age 50, which I did. The results were normal. However, when I did my follow-up scan at age 55 (based on my follow-up instructions from my European provider), the results showed that I had osteopenia.

Osteopenia

Osteopenia is the medical definition of bone density loss.¹ It is where bone mineral density is low, so bones are weaker and can have a higher risk of fractures.¹ Some people with osteopenia go on to develop osteoporosis, which is where bones become weak and brittle — “so brittle that a fall or even mild stresses such as bending over or coughing can cause a break.”¹

Most of us lose some bone density as we get older.¹ Postmenopausal women are more susceptible to bone loss. Other risk factors for osteopenia include the following:¹

• Adults older than 50.
• People assigned female at birth (AFAB). People AFAB are four times more likely to have osteopenia than people assigned male at birth (AMAB).
• People who are in postmenopause.
• People who smoke or use tobacco products.
• People who regularly drink alcohol (more than two drinks per day).
• Certain health conditions, such as hyperthyroidism, diabetes, chronic kidney disease (CKD), malnutrition, a calcium or vitamin D deficiency, hormonal imbalances (like Cushing syndrome), anorexia and other eating disorders, and autoimmune diseases that affect your bones (like rheumatoid arthritis or collagen defects).
• Certain medications that can increase your osteopenia risk, such as diuretics, corticosteroids, medications used to treat seizures, hormone therapy for cancer (including to treat breast cancer or prostate cancer), anticoagulants, and proton pump inhibitors (PPIs, like those that treat acid reflux, which can affect your calcium absorption).

At age 55, my T-score indicated that I was about 65% along the osteopenia range.

With only five years between my normal scan and my non-normal scan, I was a bit alarmed. After all, I have witnessed how osteoporosis — also known as the “silent” disease because there are typically no symptoms until a bone is broken¹ — can hijack a person’s life.

Osteoporosis

A friend of ours, an active retiree who was just hitting her stride in terms of enjoying retirement and finally having time to do the things she’d always wanted to do, fell and broke a hip. Unknown to her, she had osteoporosis. She went from traveling overseas to being unable to travel across her living room without assistance. Her world has become not only smaller but also more painful. It is a tragedy for her and her loved ones.

Women are more susceptible to osteoporosis.¹

Of the approximate 1.5 MM fractures that happen each year from osteoporosis, most are sustained by women.¹ Of hip fractures sustained by women with osteoporosis, 20 to 30 percent die within a year.¹ Of those remaining, many will not heal back to full function or even be able to live independently again.¹

This happens because, as mentioned, we lose bone density as we age, especially after menopause.¹ Unfortunately, the loss may not be noticeable until it’s too late. The erosion of our bones happens silently, without symptoms. And then we fall, and it is anything but unnoticeable or silent.

So, as a white, postmenopausal woman with a small body frame, I know that I am at greater risk of developing osteoporosis. Risk factors include:¹

• Gender: Women are much more likely to develop osteoporosis than are men.
• Age: The older you get, the greater your risk of osteoporosis.
• Race: You’re at greatest risk of osteoporosis if you’re white or of Asian descent.
• Family history: Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.
• Body frame size: Men and women who have small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.
• Hormone levels: Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies; for example, the fall in estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis and treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss.
• Thyroid problems: Too much thyroid hormone can cause bone loss, such as caused by an overactive thyroid, or taking too much thyroid hormone medicine to treat an underactive thyroid.
• Dietary factors, such as low calcium intake, eating disorders, and gastrointestinal surgery to reduce the size of your stomach or to remove part of the intestine because it limits the amount of surface area available to absorb nutrients, including calcium.
• Steroids and other medicines, such as long-term use of oral or injected corticosteroid medicines, such as prednisone and cortisone and medications used to combat or prevent seizures, gastric reflux, cancer, and transplant rejection.
• Medical problems, such as celiac disease, inflammatory bowel disease, kidney or liver disease, cancer, multiple myeloma, and rheumatoid arthritis.
• Lifestyle choices, such as a sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are good for your bones, but walking, running, jumping, dancing, and weightlifting seem particularly helpful.
• Excessive alcohol consumption, such as regular consumption of more than two alcoholic drinks a day, increases the risk of osteoporosis.
• Tobacco use

Finding What Fits You

Of my healthcare providers, my gynecologist was more engaged when it came to reviewing my bone density scan results and discussing ways to address it. I initiated the conversation, and we discussed options. There are always risks with any medication, so that is why we need to make sure that we ask questions and get as much information as we can to make an informed decision with our trusted medical providers as to what will most support our health.

Given that I had already adopted many of the lifestyle habits that support stronger bones — such as high-impact aerobic activity, strength training, and a good diet — after reviewing the different options and doing research of my own, I opted to start hormone replacement therapy. I will have a follow-up bone density scan in the coming year. Depending on the results, if more aggressive action is required — such as taking bone-building medication — then I will take it.

I feel fortunate because, given what my bone density was at 55, I wouldn’t have wanted to wait until age 65 to find out. I have another friend who was similarly fortunate. She discovered her bone loss at age 45 by accident. She is a retired obstetrician-gynecologist, but when she was working, she tested out a new type of bone density test for her office and discovered in the course of the testing that she had osteopenia. She was about 75% along the T-score range.

What is right for your situation is something that you need to determine. However, the key takeaway is the importance of advocating for your health. You are your best advocate because, frankly, you care the most about your health.

So, speak with your healthcare provider about when and how often you should start monitoring your bone density and what you can do to support your bone health. Get regular physical exams, including any special tests or screenings appropriate for your age, gender, and other circumstances. Collaborate with your trusted medical team to determine the best actions to take and when to care for your overall health. Be proactive and educate yourself on what may be best for you, given your gender, age, stage of life, other health circumstances unique to you, and health goals.

But one thing NOT to do is to delegate your healthcare to someone else because it is something you need to own.

That includes your mental health.

Keep Your Brain Healthy, Too

In addition to doing what protects your physical health, do the same for your brain and overall mental health because it impacts every facet of your life and is a key to living and aging well.

As Katy Butler states in her book, The Art of Dying Well: A Practical Guide to a Good End of Life:

“Above all, guard your brain. It is the keystone of continued independence and freedom.”²

Who would you be, and what could you do without your brain? So, take care of it because its well-being determines yours. Some things that support your brain and mental health include:

• Sleep.³ Getting enough quality sleep is critical to your functioning, including your brain’s.
• Exercise.⁴ Physical activity supports cognitive functioning, so get enough physical activity as it fits your unique health circumstances.
• Good nutrition. A diet rich in plant-based foods, whole grains, fish, and healthy fats, such as a Mediterranean diet, has been shown to support brain health.¹
• Engagement. Keep your brain active and working, such as through reading, puzzles, learning new skills, and other activities that challenge your brain. Stay socially engaged.
• Stress management. Manage stress in healthy ways.
• Mental Wellness. We may engage a therapist or similar mental health professional when we’re facing challenging times, but we can also engage a mental health professional or support group to practice ongoing mental health care. Learning more about what supports your mental health and engaging in what helps you maintain good mental health is worth your investment because how well you feel mentally impacts every facet of your life.

Final Thoughts

Many of us do not like going to the doctor, so we only go when we absolutely need to. However, if there is one area of your life where you want to be proactive, it is your health, even if it’s often inconvenient and even sometimes uncomfortable. Your health — including your mental health — is worth the inconvenience and potential discomfort.

The fact is that it’s easier and more effective to maintain what’s working and address any issues that arise early on to prevent them from becoming big ones that are harder to manage. So, if you are like many of us who may have gotten into a bad habit of tending to our illnesses but not our good health, now is the time to stop tending to your sicknesses and make sure you are doing all you can to tend to your good health.

Don’t just go to the doctor when you have a medical issue. Support and maintain your ongoing good health and well-being:

1. Create a trusted team of medical professionals who can be your healthcare advocates.
2. Be your own healthcare advocate. Do not delegate your well-being to someone else. Be proactive, engaging in preventive care and getting informed about what supports your physical and mental well-being at every stage of your life.
3. If you think you may need a bone density scan, follow up. If you don’t need one now but will later, make a note on your calendar to follow up at a future date, along with any other preventive care that may be appropriate for you.