Osteoporosis

Osteoporosis

Don't Give Your Bones a Break

Your bones seem like steel girders--strong, permanent, a structure you can depend on.

But for one in every four women, this skeletal structure is eroding, the girders weakening and wearing away.

The cause is osteoporosis.

Osteoporosis is a disease of thinning bones, fractured hips and hunched spines, a disease of aging that you can prevent--if you start today.

Now you can't stop your bones from thinning. Every woman loses some bone over time, usually at the rate of 1 percent a year. But in women with osteoporosis, the loss is a lot faster than normal, and bones can become so brittle and fragile that they break when you step off a curb or bump your hip on the edge of a table. In fact, the bones in your spine--your vertebrae--can even break under their own weight.

Besides making you look older, osteoporosis can make you feel that way. "Suddenly, women are afraid to go outside, take walks, wash the windows, clean out the tub. They're afraid that if they trip or fall, they'll break a bone," says Clifford Rosen, M.D., director of the Maine Center for Osteoporosis Research and Education in Bangor.

Dr. Rosen says "women" because osteoporosis strikes four women to every man. Women have less bone to start with, and during menopause, there's a drop-off in the production of the female hormone estrogen, which holds calcium in your bones like a dam.

But your bones may start to thin too fast even before menopause arrives, a slow and symptomless draining of your body's interior strength that begins in your thirties or forties. If you don't do anything to stop it--things such as taking in calcium, doing exercise, trying hormone replacement therapy or taking other preventive actions discussed later--it becomes osteoporosis. And that's serious.

Some women with osteoporosis become hunched and shorter as the bones in their spines break. These fractures might be painless or misinterpreted as back problems (at least at first). "A woman may have back pain that hurts for a while and then goes away. She may attribute it to a muscle spasm when she really has a compression fracture," says Dr. Rosen.

Some women break their wrists, another vulnerable spot.

And some women break their hips. Of these women, 10 to 20 percent will die in the next year.

Are You a Candidate?

If your mother has osteoporosis, you may also be prone to these frightening fractures, says Dr. Rosen. "Up to 70 percent of your peak bone mass, which you reach in your twenties, is determined by heredity," he says. Very small or thin women are also more susceptible to osteoporosis, he adds, since they have less bone mass than other women.

One of the biggest causes of osteoporosis is too little calcium in your diet. Although estimates of how many women are short on this basic bone-building nutrient vary from 10 to 25 percent, experts agree that calcium deficiency is extremely common. Another nutrient vital to bone health is vitamin D, because it aids in the absorption of calcium. If you're not getting enough vitamin D, your body won't be able to take advantage of even generous amounts of calcium.

And if your exercise isn't the kind that stimulates bone growth, your bones will become more porous--and more easily broken.

Other factors that also contribute to osteoporosis are smoking and heavy drinking, experts say. Certain prescription medicines may also erode bone strength, particularly if taken for many years or in extremely high doses.

But you don't have to sit back and surrender to osteoporosis. You can minimize your risks and take definite steps to build stronger bones. What matters most is that you start now.

Banking Bone

Picture your bones as a kind of bank account. Throughout your life, your body is constantly depositing bone in and withdrawing bone from your skeleton. When you're young, you deposit more bone than you withdraw, says Dr. Rosen. But by the time you reach your mid-thirties, the trend is reversed--you withdraw more than you deposit. To prevent bone bankruptcy, you need to deposit as much bone as possible before menopause.

But what if you're only a few years away from menopause or you're already there and you don't really know how much bone is in your account? Although all doctors don't agree that every woman should be tested for osteoporosis, Dr. Rosen recommends that you play it safe and get a bone density measurement of your hip and spine when you are between the ages of 45 and 55, when thinning bone is first detectable. The best test is called dual energy x-ray absorptiometry, or DEXA, and costs about $100 to $250. Most community hospitals and all large city hospitals should have DEXA scanners, Dr. Rosen says. But if a DEXA machine is not available in your community, your doctor can assess your bone health with a computerized axial tomography (or CAT) scan instead.

Doctors agree that women at greatest risk for the disease--women with family histories of osteoporosis or personal histories of smoking or heavy drinking--should be tested before age 45.

If your test shows a higher than normal level of bone loss, don't despair--it's probably not too late to start building bone.

Healthy Habits for Life and Limb

Here are the best ways to strengthen your skeleton.

Pump up your calcium. Calcium is to your bones what air is to your lungs--the element they need to be healthy. Ninety-nine percent of the calcium in your diet goes straight to your bones. If you don't get enough calcium, you can't make enough bone--it's as simple as that.

Although the Recommended Dietary Allowance (RDA) for women is 800 milligrams a day, you need more calcium in adolescence and after menopause, Dr. Rosen says. Women should get at least 1,000 milligrams before menopause and 1,500 milligrams after menopause. Although food is the best way to get calcium, what matters most is that you take in the recommended amount, says Dr. Rosen. If that's through food, fine; if it's through a combination of food and calcium supplements, fine. Just make sure the numbers add up.

Ounce for ounce, milk and milk products are the best sources of dietary calcium. One eight-ounce serving of nonfat yogurt provides about 450 milligrams of calcium. One cup of skim milk offers more than 300 milligrams. Many other foods contain calcium, but the nutrient isn't as easily absorbed from these foods as it is from dairy products.

Don't forget the D. Bones don't absorb calcium unless they have plenty of vitamin D, says Michael F. Holick, M.D., Ph.D., director of the Vitamin D, Skin and Bone Research Laboratory at Boston University Medical Center. Without vitamin D, your body absorbs about 10 percent of the calcium it takes in; with vitamin D, it can absorb 80 to 90 percent. "Vitamin D tells the small intestine 'Here comes the calcium. Open up and let it in,' " explains Dr. Holick. The RDA for vitamin D is five micrograms or 200 IU--easily found in fortified foods such as milk, breads and cereals.

Besides getting some of your daily vitamin D through food, your body can make it from sunshine, which triggers a vitamin D manufacturing process in your skin. Five to 15 minutes of bright sunshine every day, before you apply sunscreen, will supply your needs, says Dr. Rosen. If you live north of New York City, however, you can't depend on the sun. In that case, you'll need to be sure you're getting enough vitamin D from dietary sources. (If you're getting plenty in your diet, you won't need time in the sun at all.)

Review your medication. Certain medications--thyroid medications, anti-inflammatory steroids such as hydrocortisone (Locoid), cortisone (Cortone Acetate) and prednisone (Key-Pred 50), anticonvulsants such as phenytoin (Dilantin), depressants such as phenobarbital (Barbita) and the diuretic furosemide (Lasix)--can cause osteoporosis, particularly when they're taken regularly in high doses over a number of years. Thyroid medications in normal doses should pose no problem, however, says Dr. Rosen, and the risk from diuretics can be offset by taking additional calcium. The most serious osteoporosis risk is from steroids, Dr. Rosen says. If you require long-term steroid medication, your doctor may recommend additional anti-osteoporosis medication such as calcitonin (Cibacalcin) or hormone replacement therapy in addition to calcium and vitamin D supplements, he says.

Keep 'em dry and healthy. "Alcohol actually poisons the cells that build bone," says Susan Allen, M.D., Ph.D., assistant professor of internal medicine at the University of Missouri­Columbia School of Medicine. A beer or glass of wine now and then probably won't cause you much harm. But avoid drinking to excess, she says--more than two to three drinks a day.

Don't puff. Smoking lowers your levels of estrogen, says Barbara S. Levine, Ph.D., associate clinical professor of nutrition in medicine and director of the Calcium Information Center at Cornell University Medical College in New York City. And lower estrogen, she says, means less protection against bone loss.

Consider hormone replacement therapy. For some women past menopause, hormone replacement therapy can thicken bones. Ask your doctor whether you're a candidate for it.

Interior Bodybuilding

An exercise program builds muscle and bone, says Gail Dalsky, Ph.D., director of the Exercise Research Laboratory at the University of Connecticut Health Center in Farmington. "The bone density of women who are good exercisers is 5 to 10 percent higher than that of other women," she says.

And exercise not only increases bone density but also improves your dexterity and reflexes, so you're less likely to fall and break a bone, says Dr. Allen.

Enjoy weight-bearing exercise. To strengthen bones, you need activities in which you're bearing weight on your bones, Dr. Allen says. Weight-bearing exercises include brisk walking, jogging and dancing, which actually stimulate bone cells to build more bone, particularly in your back and hips, where you most need it, Dr. Allen says.

You're doing a weight-bearing exercise if your feet are hitting the ground with at least the impact that brisk walking produces, says Dr. Rosen. "Basically, you can count on any exercise that makes heavy use of gravity," he says. "Swimming doesn't, for example, but most aerobics classes and tennis do."

Pumping iron is also an ideal way to build bone strength, because it increases the weight of gravity on your bones. It's good sense to make weight lifting part of your weight-bearing exercise. Any lifting done in a standing position is particularly helpful for the spine and hips. If you've never used weights before, be sure to get your doctor's clearance and a trainer's advice on the safest routine.

Do it regularly. Once you've found the weight-bearing exercises you like, keep at them for 30 minutes to one hour three to four times a week, Dr. Allen says.

Concentrate on the back and hips. If you're exercising for weight loss and muscle tone, you're probably doing something for your upper body, and that's good. But remember, says Dr. Allen, the bones that are most vulnerable to osteoporosis are the hips and the spinal vertebrae in the mid- to lower back. Walking, jogging and aerobic dancing are particularly helpful for your back and hips, she says.