Boning Up on Osteoporosis
Robert Heaney, M.D., an internationally recognized calcium and bone health expert and professor of medicine at Creighton University in Omaha, Neb., says that you can take steps to prevent osteoporosis. Although the disease is most prevalent among postmenopausal women, following these actions throughout life can help prevent it:
Get an adequate amount of calcium and vitamin D.
Lead a vigorous lifestyle.
Maintain an recommended weight.
Avoid smoking and excessive alcohol.
Osteoporosis progress can be slowed. The disease thins and weakens a person's bones, making them more porous (less dense) and fragile, and thus more likely to break. Although a fracture is often the first outward sign of the disease, a bone mineral density test can help diagnose it before that happens.
Who's at risk?
In the United States today, 10 million Americans have osteoporosis, and nearly 34 million more have low bone mass, placing them at increased risk for this disease and fractures. Of the 10 million who have osteoporosis, 8 million are women, 2 million are men.
One out of every two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. The rate of hip fractures is two to three times higher in women than men, but the one-year mortality following a hip fracture is nearly twice as high for men as for women.
Osteoporosis can strike at any age.
Gender. Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause. Women can lose up to 20 percent of their bone mass in the five to seven years following menopause.
Age. The older you are, the greater your risk of osteoporosis. Your bones become less dense and weaker as you age.
Body size. Small, thin-boned women are at greater risk.
Ethnicity. Caucasian and Asian women are at highest risk. African American and Latino women have a lower but significant risk.
Family history. Your likelihood of fracturing a bone may be, in part, hereditary. People whose parents have a history of fractures also seem to have reduced bone mass and may also be at risk for fractures.
"If your mother broke her hip, it doubles your risk, regardless of your own bone density," says Dr. Heaney, a member of the National Osteoporosis Foundation.
Risk factors you can change:
Lack of exercise. Weight bearing exercises that put tension on muscles and bones help maintain and build bone density. This means getting 30 to 60 minutes of brisk walking, gentle weight training, or exercises to strengthen back muscles on most days of the week.
Abnormal absence of menstrual periods (amenorrhea), low estrogen level (menopause) and low testosterone level in men. Hormone therapy (HT) may relieve menopausal symptoms and may have benefit in the prevention of osteoporosis, but this therapy increases other health risks. Discuss the issue carefully with your health care provider to decide what is best for you.
Anorexia. Eating disorders can lead to nutritional deficits. They can be treated. Talk to your doctor about the right treatment for you.
A lifetime diet low in calcium and vitamin D. Change your diet to include more of these essential nutrients.
Use of certain medications such as glucocorticoids and some anticonvulsants. Discuss these medications with your doctor.
Cigarette smoking. Smoking limits calcium absorption. Get help to quit this habit.
Excessive use of alcohol. Talk to your doctor about how to cut down on your drinking.
Calcium and vitamin D
Bones are basically made of collagen and calcium, which make bones strong, hard and slightly flexible. Calcium is also needed for a number of bodily functions. Calcium is not produced by the body and must be absorbed from the diet to maintain healthy levels. "You lose calcium every day, and if you don't replace it, the body pulls calcium from your skeleton to get it," Dr. Heaney explains.
The best way to get enough calcium and other important nutrients is through a healthy diet. The NOF recommends that adults get 1,000 to 1,200 mg of calcium and 2 cups of fruits and 2 cups of vegetables a day. Dr. Heaney observes that although that's not difficult – for example, three daily servings of vitamin D fortified dairy products will provide sufficient calcium and vitamin D -- most Americans fall far short of that goal.
The body's demand for calcium is greater during childhood and adolescence, when the skeleton is growing rapidly, and during pregnancy and breast-feeding. By about age 20, the average woman has built nearly all (98 percent) of the bone mass she will have in her lifetime.
Postmenopausal women and older men also need to consume more calcium. This may be because of inadequate amounts of vitamin D, which is necessary for the body to absorb calcium. Also, as you age, your body becomes less efficient at absorbing calcium and other nutrients. Older adults also are more likely to have chronic medical problems and to use medications that may impair calcium absorption.
Vitamin D plays an important role in calcium absorption, metabolism and therefore in bone health. It is synthesized in the skin through exposure to sunlight. Although many people are able to obtain enough vitamin D naturally, studies show that vitamin D production decreases in the elderly, in people who are housebound and during the winter. These people may require vitamin D supplements. Daily intake of vitamin D should be between 400 and 800 IU. Massive doses of this vitamin are not recommended.
Foods that can help boost your calcium intake and get other important nutrients include dark green, leafy vegetables, sardines and salmon with bones, calcium-set tofu, almonds and foods fortified with calcium, such as orange juice, cereals and soy milk. "Milk is not just for children," Dr. Heaney says.
Work those bones
Your bones are like your muscles -- if you don't use them, you lose them. But not just any activity will do. For bone strength, it's important to do weight-bearing exercise, such as walking, dancing, jogging, stair climbing, racquet sports and hiking. Weight lifting can provide the “impact” or flexion stress required to maintain strength of bone in the arms and upper body.
A sensible weight
Although no one recommends getting fat to protect your bones, Dr. Heaney notes that being overweight can reduce your risk of an osteoporotic fracture by perhaps 70 to 80 percent. "We don't have to be obese to protect our skeletons, but we shouldn't be too thin, either," he says. "Despite the old saying, you can be too thin."
Smoking is bad for your bones, as well as your heart and lungs. Women who smoke have lower levels of estrogen compared with nonsmokers, and they frequently go through menopause earlier. Postmenopausal women who smoke may require higher doses of HT and may have more side effects. Smokers also may absorb less calcium from their diets.
What about calcium supplements?
Many people find it difficult to get enough calcium through their diet, so they turn to calcium supplements. The NOF offers the following tips for choosing one:
The body absorbs calcium more efficiently in small amounts, so it is better to take several small dosages each day rather than one large one.
The body needs Vitamin D to absorb calcium. Experts recommend a daily intake of between 400 and 800 IU per day. If you don't get that through your diet or from direct sunlight, take a multi-vitamin or other supplement.
Look for calcium products that are "purified" or that display the U.S. Pharmacopeia symbol.
If you are taking any over-the-counter or prescription medications, check with your doctor or pharmacist about possible interactions. The long-term use of glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn's disease, lupus and conditions of the lungs, kidneys and liver) can lead to a loss of bone density and fractures. Other forms of drug therapy that can cause bone loss include long-term treatment with certain antiseizure drugs such as phenytoin; barbiturates; gonadotropin-releasing hormone (GnRH) analogs used to treat endometriosis; excessive use of aluminum-containing antacids; certain cancer treatments; and excessive thyroid hormone. It is important to discuss the use of these drugs with your doctor and not to stop or alter your medication dose on your own.
What about other treatments?
Although there is no cure for osteoporosis, the Food and Drug Administration has approved medications to prevent and/or treat osteoporosis. A health care provider may recommend any of the following classes of medications: