Reducing your risk for osteoporosis. Many people consider osteoporosis to be a condition of the elderly. Whatever your definition of advanced age, the fact is half of all women over 50 will have an osteoporosis-related fracture in the years ahead. Good information, but until it affects you or someone you love, it doesn’t really alter your day-to-day existence. Last summer my 65-year-old mother was gardening. She was walking on her grass, tripped and fell. Naturally she put her hands out to stop her from hitting her head. Unfortunately, her right wrist took the brunt of the impact. After looking at her X-ray, her orthopedic surgeon said her crushed wrist bone looked like kitty litter. She underwent surgery, got a metal plate installed and spent 10 weeks in a cast. She was home from work most of that time because she couldn’t type or write with her dominant hand. The ill effects didn’t stop there. She underwent physical therapy and still has limited range of motion. Not only was the experience physically painful, but also the restriction in activity made her feel a wee bit bonkers.
Ironically, I had sent her a resistance exercise tube because I thought she looked like just skin and bones; all her muscle had disappeared. What happened to my big, strong mother? Many birthdays, lots of smoking, a sedentary lifestyle and a serious dislike of milk probably have something to do with her shrinking, frail physique.
ARE YOU AT RISK?
A number of risk factors affect your chances of developing osteoporosis, which literally means porous bones. You build bone mass until about age 30, then your bones begin to thin. A sedentary lifestyle, smoking, excessive drinking and low calcium intake all contribute to bone loss. The good news is you can minimize or avoid these risks with basic lifestyle changes. The younger you start and the longer you stick with them, the better off you’ll be. Other factors are beyond your control. Being aware of them can help you and your doctor make health care decisions, as well as provide an incentive for you to stay healthy. These risk factors include:
• Being female: Women have a five times greater risk than men.
• Thin, small-boned frame.
• Broken bones or stooped posture in older family members, especially women, which suggest a family history of osteoporosis.
• Early estrogen deficiency in women who experience menopause before age 45, either naturally or resulting from surgical removal of the ovaries.
• Estrogen deficiency caused by abnormal absence of menstruation (as may accompany eating disorders).
• Ethnic heritage: White and Asian women are at highest risk; African American and Hispanic women are at lower, but significant, risk.
• Advanced age.
• Prolonged use of some medications, such as excessive thyroid hormone; some anti-seizure medications; and glucocorticoids (certain anti-inflammatory medications, such as prednisone, used to treat conditions such as asthma, arthritis and some cancers).
• Growth hormone deficiency in children and youth.
Bone loss and menopause are a natural part of the aging process. Unfortunately, menopause increases your risk for developing osteoporosis because your body’s natural production of the hormone estrogen declines. Estrogen helps keep bones strong. However, new studies have shown that postmenopausal hormone therapy, available as a combination of estrogen and progestin (a synthetic form of the hormone progesterone) or estrogen therapy alone, poses small but serious health risks. New, lower-dose versions of the hormone therapies used to treat symptoms of menopause are currently being developed. The FDA recently approved a low-dose version of the combination estrogen-progestin treatment sold as Prempro. Ask your health care professional for more information about risks and benefits of menopausal hormone therapy.
Michael S. Anger, M.D., clinical professor of medicine at the University of Colorado Health Sciences Center, says the only real way to know if you have osteoporosis (or osteopenia, a thinning of the bones that leads to osteoporosis), is to measure the thickness of the bones with a bone mineral density (BMD) test. This simple, painless X-ray uses computer analysis. It takes about 15 minutes to measure bones in the spine, hip and forearm to determine if osteoporosis is present. “I recommend the test to all my patients at the time of menopause and if there are other risk factors, such as the use of certain medications such as the steroid prednisone,” says Dr. Anger, who also practices at the Osteoporosis Center of Thornton. “Unless you develop a fracture, you may not know you have osteoporosis,” warns Dr. Anger. “The importance and benefit of having a BMD test is it can detect the disease before serious symptoms arise.” He says other suggestive signs of the disease are height loss and kyphosis, the hump back often seen in elderly women.
The United States Preventive Services Task Force recommends that all women aged 65 and older routinely have a bone mineral density test to screen for osteoporosis. If you have a higher risk for fractures, routine screening should begin at age 60. If you are diagnosed with the disease, Dr. Anger says treatment may include the use of calcium and vitamin D, estrogens, non-estrogen receptor modulators (Evista), synthetic parathyroid hormone (Forteo), also a non-estrogen, or medications known as bisphosphonates (Fosamax, Actonel or Boniva) or calcitonins (Miacalcin Nasal Spray). Once you’ve had a fracture caused by osteoporosis, your risk of future fractures is increased. It is important to prevent the first fracture. Taking preventive steps and reviewing risk factors now are especially helpful approaches for women of all ages.
PREVENTION IS KEY
“The best treatment for osteoporosis is prevention,” says Dr. Anger. “Though we can’t control our genetics, we are able to modify other risk factors.” He suggests five simple preventive steps:
1. Increase the amount of calcium and vitamin D in your diet.
2. Exercise regularly. Bones and muscles respond to physical activity, especially weight-bearing exercise, by becoming stronger.
3. Maintain a healthy body weight. Being underweight or losing weight increases your risk of bone loss and fracture.
4. Quit smoking. Cigarette smoking can reduce bone mass and increase the risk of fracture.
5. Drink alcohol in moderation, if you drink. Excessive consumption of alcohol increases your risk of osteoporosis and fractures from falls.
“Though it is never too late to start, it’s best to stress the importance of calcium and vitamin D at a young age, such as in your daughters, because of the bone growth and development that occurs in childhood and adolescence,” he says. “Think of it as banking calcium for the many withdrawals your body will make in later life.”
If you have asthma, allergies, a thyroid condition or other chronic medical condition, you may need an even higher daily calcium intake.
Good sources of calcium include:
• Low-fat dairy products, such as milk, yogurt, cheese and ice cream. Three 8-ounce glasses of milk plus calcium from a normal diet will meet daily calcium requirements.
• Dark green, leafy vegetables such as broccoli, collard greens, bok choy and spinach.
• Sardines and salmon with bones.
• Fortified tofu.
• Soy milk.
• Calcium-fortified foods and beverages such as orange juice, cereals and breads.
A quick and easy way to boost the calcium content of many meals is to add nonfat powdered dry milk to puddings, homemade cookies, breads or muffins, soups, gravy, casseroles and even a glass of milk. A single tablespoon of nonfat powdered dry milk adds 52 mg of calcium, and two to four tablespoons can be added to most recipes.
The good news is science has linked calcium intake from dairy products with maintaining a healthy body weight. But what if you’re lactose intolerant? If that’s the case, consider yogurt with active cultures, buttermilk and cheddar and Swiss cheeses, which are high in calcium but low in lactose, the sugar found in milk and milk products. Many people mistakenly believe they are lactose intolerant when a simple sensitivity to dairy products or some other food substance is really the case. Check with your health care professional before you avoid dairy products. Products that contain lactose (such as Lactaid) can help people with lactose intolerance to consume dairy products.
When your diet isn’t providing enough calcium, you may wish to take calcium supplements. Since there are several different types of calcium and a variety of supplements available, you should discuss the choice of calcium with your doctor. Multivitamins generally do not provide enough calcium to meet the daily needs of a postmenopausal woman. In fact, “the mineral” calcium isn’t always included in a multivitamin preparation, so be sure to read the label if you are relying on your vitamin supplement to meet your calcium requirement. Dr. Anger says expensive brands aren’t necessarily better. “You can test the quality of your calcium tablet by dissolving one in a glass of white vinegar. It should completely dissolve within 20 to 30 minutes. If not, you may not absorb much of it,” he says. Calcium carbonate (also called oyster shell calcium) is best taken with food to enhance absorption and should be taken with vitamin D. Calcium citrate is a somewhat more expensive supplement, but is better absorbed. “As a result the daily dose needed is somewhat less than calcium carbonate — 1000 milligrams per day vs. 1500 milligrams per day,” says Dr. Anger.
Your diet should also be rich in vitamin D. This nutrient helps your body absorb calcium more efficiently and minimize bone loss. Most of us get the vitamin D we need for calcium absorption from exposure to sunlight. You’ll also find plenty of this essential vitamin in fortified milk and cereals, as well as vitamin supplements. If your exposure to sunlight is limited, you may want to consider increasing your average intake of vitamin D. At least 400 units (I.U.) of vitamin D daily are recommended for menopausal women, but it’s wise to talk to your health professional about your particular needs. Higher doses of up to 800 I.U. may benefit women over the age of 65.
Bone and muscle respond to physical activity by becoming stronger. Although all exercise is beneficial to overall good health, two kinds of exercise are most effective for preventing osteoporosis: weight-bearing, in which you work against gravity, and resistance exercises, such as weight lifting. Weight-bearing exercise is any exercise in which your feet and legs bear your weight while you perform it, such as brisk walking, dancing, racket sports, gardening and aerobics. This creates high pressure on the bone that helps to build and maintain its strength.
Resistance exercises that strengthen muscle may also be beneficial, particularly for the large muscles of the shoulder, pelvis, hips, back and trunk. Because falls are the most common cause of fractures, balance-improving activities, such as tai chi and strength training, may also reduce your risk for falls by as much as 47 percent.
DON’T BE A STATISTIC
According to the National Women’s Health Resource Center, as many as eight million American women already have osteoporosis, and 34 million have low bone density, putting them at risk for developing the disease. “In the past, osteoporosis, height loss and fractures were a part of growing older,” says Dr. Anger. “Now with more information, diagnostic tools such as BMD and a selection of medications, there is much that can be done to avoid and treat this disorder.”
BONE DENSITY SCANNING CENTERS
Colorado Arthritis Center and Osteoporosis Center of South Denver
Approximate cost: $245
Osteoporosis Center of Thornton
Approximate cost: $280
Colorado Center for Bone Research
Approximate cost: $310
Osteoporosis Center of Highlands Ranch
Approximate cost: $225
Invision Osteoporosis Center
Approximate cost: $342
Approximate cost: $280
By KELLY A. GOFF