Men, too. For the first time, the National Osteoporosis Foundation guidelines directly advise men, suggesting that all men ages 70 and older have bone mineral density testing. (The same applies to all women ages 65 and older.) Starting at 50, men and postmenopausal women who have other risk factors should be tested. Disagreement about osteopenia doesn't suggest that bone loss is not a serious issue, with aggressive treatment necessary in many cases. But "the big problem is people with true osteoporosis aren't getting treated," says Robert P. Heaney, a Creighton University professor and member of the NOF's Emeritus Board. Someone with osteoporosis can break a bone even without obvious trauma, the NOF treatment guidelines note.
Young, healthy, postmenopausal women whose doctors say they have osteopenia should certainly consider possible side effects before saying yes to drugs. The bisphosphonates (Fosamax, Boniva, Actonel) can cause gastrointestinal illness, and some women taking Evista are at an increased risk of stroke. They might do much better to commit instead to healthful lifestyle changes that include exercising, giving up smoking, choosing a balanced diet, and taking extra calcium and vitamin D. At age 65 or 70, the calculus may shift—so that, as in Goodman's case, medication may seem right.
Updated on 02/27/08: This story has been updated to reflect new guidance from the World Health Organization and the National Osteoporosis Foundation on treating bone loss.