The silent crippler, as osteoporosis is often called, sneaks up on its victims and, without any pain, gradually causes bones to become more porous and fragile. Then one day you grab your coat and your wrist snaps; or a friend hugs you and cracks your rib; or you step off a curb and break your hip. Don’t let this happen to you. Learn what you can do to safeguard your bones throughout your life.
Without bones, you would be like a marionette with no strings. But, in addition to helping you stand upright and tall, your skeleton supports muscles, protects vital organs and provides a reservoir for calcium, a mineral that’s essential for various vital functions. Many people think that bones are hard and lifeless, when, in fact, they are living, growing tissue. Throughout your life, old bone is constantly being broken down and removed, and new bone tissue is built to replace it. However, the rate of bone building changes as we age. Up to about age 35, new bone is added to the skeleton more rapidly than old bone is removed. After that, bone is lost more quickly than it is built; as a result, the skeleton becomes less dense. Osteoporosis develops when the bones dwindle so much that they break. Over nine million American women currently have osteoporosis, and another 16 million are at risk for fractures due to low bone density.
Women are at highest risk for osteoporosis because they have lighter frames than do men. What’s more, decreasing levels of the hormone estrogen at menopause accelerate bone loss and make women more susceptible to fractures. Osteoporosis is a huge health problem: one out of every two women age 50 and over will develop a fracture caused by osteoporosis. And one out of every five women who has a hip fracture will not survive more than a year.
But osteoporosis isn’t a normal part of aging. It is preventable, and new insights into the disease are making it more detectable and treatable than ever before.
Risk Factors for Osteoporosis
Aside from simply being a woman, a variety of other factors can increase your chances of developing this condition:
- Age. The older you are the greater your risk because bone begins to lose density after your mid-thirties.
- Bone structure and body weight. Having a thin, small-boned frame puts you at greatest risk for the disease because there is less bone mass to begin with. Caucasian and Asian women are at highest risk, while African American and Hispanic women are at lower but still significant risk.
- Decreases in sex hormones. One-third of all women develop osteoporosis after menopause because of the decline in estrogen. Early menopause, either natural or resulting from the surgical removal of the ovaries, increases the likelihood of developing fragile bones. In addition, women who stop menstruating early because of conditions such as anorexia, bulimia, amenorrhea (the abnormal absence of menstruation), or excessive physical exercise, may be at greater risk.
- Medications. Prolonged use of medications like corticosteroids (a group of hormones used as anti-inflammatory medications to treat such conditions as asthma, arthritis and certain cancers), thyroid hormones and some anti-seizure medications, can increase a person’s risk of osteoporosis. For more information, request the free booklet Medications & Bone Loss by writing to the National Osteoporosis Foundation at P.O. Box 96616, Dept. M.E., Washington, DC, 20077-7456.
- Certain medical conditions. Osteoporosis is known to be a complication of several conditions, including endocrine disorders (such as an overactive thyroid), gastrointestinal surgery and immobilization.
- Lifestyle. Consuming a diet low in calcium, being sedentary, smoking cigarettes and • drinking alcohol excessively, can all increase your chances of developing osteoporosis. For example, the National Osteoporosis Foundation says regular consumption of as little as two to three ounces of alcohol per day may be damaging to bones even in relatively young men or women.
- Heredity. You have a higher risk of developing osteoporosis if older family members, especially women such as your mother or grandmother, suffer from broken bones or stooped posture.
Osteoporosis is not only a concern of old age. Measures to prevent the disease should start early in life when young girls and women are able to build maximum bone mass. After age 35, it is important to maintain bone mass or to prevent further bone loss when osteoporosis is present. The following tips can help you accomplish these goals:
- Diet. Calcium is an essential building material for your bones, yet recent studies indicate that most adults get only one-third to one-half of their recommended daily calcium requirement. Furthermore, the National Institutes of Health have found that the Recommended Dietary Allowance (RDA) doesn’t account for people’s calcium needs as they grow older (check chart below for the NIH recommendations). It’s also important that you get enough Vitamin D, which is necessary for the proper absorption of calcium. Sunlight helps your body manufacture vitamin D, and it is also found in enriched milk products. Although the RDA for vitamin D is 200 IU, many nutrition experts now recommend 400 IU. You might want to check with your physician before taking any supplements in doses that exceed the recommended amounts.
Caffeinated coffee drinking has recently been linked to decreased bone density. But drinking a glass of milk daily can offset the calcium lost.
Recommended Calcium Intake
|Sex||Age||Daily Calcium Intake (mgs)|
|Pregnant & Lactating (any age)||1,200–1,500|
|50–65 (postmenopausal taking estrogen)||1,000|
|50–65 (postmenopausal not taking estrogen)||1,500|
Source: National Institutes of Health Consensus Panel, Optimal Calcium Intake, 1994
- Exercise. Did you know that most people have five percent more bone in the arm they use most often? That is a clear-cut illustration of how physical activity increases bone mass. Weight-bearing exercises, which work the muscles against gravity, are the best way to build and maintain bone mass. Good bone-building activities include walking, dancing, golfing, tennis and weight-lifting. Walking is excellent because it strengthens the back, legs and stomach muscles. Exercise is also important because it strengthens muscles that support your bones and improve balance. Scientists speculate that the tug of muscles against each patch of bone, boosted by the extra pull of gravity, fires up the bone-building cells in that area. In a recent study, a group of postmenopausal women who participated in high-intensity strength training for forty minutes twice a week were compared to a similar group of women who simply maintained their usual level of physical activity. The results, published in the December 1994 issue of The Journal of the American Medical Association, showed that the exercise group maintained or increased their bone density while the non-exercise group actually lost bone density.
- Avoid alcohol and cigarettes. Alcohol is directly toxic to the cells that build bone and excessive use of it reduces estrogen levels. Cigarette smoking has the same effect on hormone levels. Studies show that women who smoke, experience menopause earlier and have a lower bone density than nonsmokers. For more information on how alcohol affects your bones, request a free copy of Alcohol and Hormones by writing to the National Institute on Alcohol Abuse and Alcoholism, Attn. Alcohol Alert, Office of Scientific Affairs, Scientific Communications Branch, Willco Bldg., Ste. 400, 6000 Executive Blvd., Bethesda, MD 20892-7003.
- Hormones. Experts often recommend estrogen replacement therapy (ERT) for post-menopausal women at high risk for osteoporosis and for women who have experienced early menopause, whether from natural causes or the removal of the ovaries.
Many people are unaware that there are a variety of safe, accurate, and painless tests that can detect whether a woman’s bone mass is above or below average for her age or confirm whether fractures have already occurred. With such information in hand, women and their doctors can decide what course of action to take. Women who have risk factors for osteoporosis are advised to get a bone density test at the time of menopause. The following are the most common bone density measurement techniques:
- Dual-energy absorptiometry (DXA or DEXA) is the most accurate and advanced technique now available, according to the National Osteoporosis Foundation. It uses a very small dose of radiation, emitted through a beam that’s so focused a radiology technician can sit right next to the examination table to monitor the procedure on a computer. DXA examinations of the hip or spine take about five minutes or less.
- Single-energy x-ray absorptiometry (SXA) also uses a very low dose x-ray source and measures bones of the wrist or heel. Single photon absorptiometry (SPA) is an earlier version of SXA.
- Quantitative Computed Tomography (QCT) uses a conventional CT scanner with special computer software. This method is effective in measurement of the spine, but emits a higher dose of radiation than DXA and usually costs more than other methods.
- Radiographic absorptiometry (RA) uses a specialized x-ray technique of the hand to calculate bone density.
The vast majority of states now provide coverage for SPA, RA and DXA testing. To find out what the policy is in your area, call your local Medicare carrier.
Since bone density testing equipment has only recently become more widely available, call the National Osteoporosis Foundation’s Action Hotline at 800-464-6700 to find out where there is a testing location. Operators are available Monday through Friday from 8 a.m. to 9 p.m. ET, and Saturday and Sunday from 9 a.m. to 5 p.m.
A fracture is the endpoint of osteoporosis. It’s ideal to detect the disease and start treatment before a fracture occurs. To accomplish this, doctors usually prescribe a combination of increased calcium intake, exercise and medications, as well as regular monitoring of the patient’s bone density. At present there are only a few medications approved by the Food and Drug Administration (FDA) for the treatment of osteoporosis. These are:
- Hormone Replacement Therapy (HRT). Researchers at Tufts University in Boston reported in 1990 that bone loss was more rapid during the first five years following menopause and then slowed down. Taking estrogen can help minimize this loss. In the September 1990 issue of the Annals of Internal Medicine, Swedish scientists reported that combined estrogen-progestin therapy started at menopause or soon after can lower a woman’s risk of breaking a hip during the next ten years by 60 percent. However, HRT may not be right for women with a history of cancer of the breast or endometrium, liver disease, blood clots, large uterine fibroids, stroke or heart attack. Moreover, no definitive answer has been found on whether it increases a woman’s risk for breast cancer.
Discuss the pros and cons of HRT with your physician. You can also get the free booklet Hormone Replacement Therapy: Facts to Help You Decide, from the American Association of Retired Persons (AARP) by calling 888-687-2277.
- Calcitonin. This hormone inhibits the breakdown of bone and has been reported to reduce back pain from spine fractures. Studies are now under way to determine if calcitonin can also prevent fractures. Until recently, calcitonin was only approved in an injectable form, which made it an unpleasant prospect for most patients. But now there is an alternative: A nasal spray formula has recently been approved for use in women five years after menopause. Although rare, some women using the spray develop nasal ulceration. An examination of the nose is recommended before starting the spray.
- Alendronate. The first non-hormonal osteoporosis treatment approved by the FDA, alendronate is already used to treat Paget’s disease (a condition characterized by excessive but fragile bone formation). Two large, three-year studies found that the drug reduced the proportion of postmenopausal women experiencing new spine fractures by 48 percent. Alendronate was also shown to increase bone mineral density at the spine and hip by 7 to 8 percent. Mild side-effects associated with the drug include nausea, heartburn and abdominal pain.
As increasing numbers of baby-boomers march into middle-age, more emphasis is being put on developing new osteoporosis prevention, detection and treatment methods. For example, a new urine test is being studied that gauges bone breakdown by measuring a fragment of collagen that comes from bone. The problem with this test is that it doesn’t show an important part of the equation: How much new bone is being created to replace it. Other tests are needed to measure how fast bone is being formed. In addition, a new form of sodium fluoride (slow-release), developed by scientists at the University of Texas Southwestern Medical School, has been shown to reduce the risk of fractures and has been recommended for approval by the FDA for the treatment of osteoporosis.
Even though a cure for osteoporosis is still not in the horizon, you can help fight the battle for your bones. Your best bet is to build peak bone density while you can and reduce its loss as much as possible. Both of these measures can be accomplished through a well-balanced, calcium-rich diet and regular weight-bearing exercise. It is also important to be aware of any risk factors you may have so you can take steps to head-off fractures.
Our thanks to Sydney Lou Bonnick, M.D., F.A.C.P., Director, Osteoporosis Services, Center for Research on Women’s Health, Texas Woman’s University, Denton, TX, for reviewing this article.
Getting the Calcium Your Body Needs
About 99 percent of the calcium in your body is stored in your bones and teeth. But calcium doesn’t just make bones dense. It is also involved in other essential functions, such as blood-clotting and regulating your heart beat. That’s why when we don’t eat enough calcium-rich food to meet the body’s needs, the mineral is drawn from the bones to maintain a relatively constant supply in the bloodstream. This, in turn, speeds up the loss of bone mass.
To make sure you get adequate calcium, keep a record of how much of the mineral you are eating for a week on your regular diet. To do this, check the nutrition labels of processed foods and keep tabs on the amounts of calcium-rich foods you are eating. If you are not getting the recommended amount for your age group , try to add more of the foods listed below to your meals or take a calcium supplement (women who have had kidney stones should talk to their doctors before taking supplements). For more information on calcium, call the Calcium Information Center at 800-321-2681.
TIP: Calcium is best absorbed when taken in small amounts throughout the day, so avoid taking more than 500 to 600 milligrams at one time. Also, avoid taking calcium with high-fiber meals or with bulk-forming laxatives since fiber can interfere with absorption.
|FOOD||SERVING SIZE||CALCIUM (in milligrams)|
|Milk (skim and low-fat)||1 cup||300|
|Tofu set with calcium||1/2 cup||258|
|Yogurt (average of low-fat brands)||1 cup||250|
|Orange juice (calcium-fortified)||8 ounces||240|
|Ready-to-eat cereal (calcium-fortified)||1 cup||200|
|Mozzarella cheese (part-skim)||1 ounce||183|
|Canned salmon with bones||3 ounces||181|
|Collards||1/2 cup cooked||179|
|Ricotta cheese (part-skim)||1/4 cup||169|
|Bread (calcium-fortified)||2 slices||160|
|Cottage cheese (1 percent fat)||1 cup||138|
|Parmesan cheese||2 tablespoons||138|
|Navy beans||1 cup cooked||128|
|Turnips||1/2 cup cooked||125|
|Broccoli||1 cup cooked||94|
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