Osteoporosis

Osteoporosis

Drink your milk, then go outside and play.’’ Good advice when you were six. Good advice at 46. Turns out, that’s even good advice at 60 or 86, if you want to stave off osteoporosis.

Osteoporosis, which literally means “holes in the bones,”occurs when the loss of bone tissue exceeds its replacement, a process that begins in your midthirties. A silent disease in that there are no symptoms or pain until a fracture occurs, osteoporosis robs bones of their strength over many years. Once this silent thief has done its work, bones can be so fragile that everyday actions like sneezing or lifting a bag of groceries can cause a fracture.

While women are four times more likely to develop the disease, men also suffer from osteoporosis. Women lose bone mass rapidly in the years following menopause, because their bodies produce less estrogen; yet by age 65 or 70, women and men lose bone mass at the same rate, experts say, and calcium absorption decreases in both sexes. Osteoporosis in men has been recognized as an important public-health issue, given that the number of men over 70 is estimated to double between 1993 and 2050.

Fractures resulting from osteoporosis typically occur in the hips, spine, and wrists, frequently costing an individual her independence. Yet although it affects nearly half of all people over the age of 75, doctors say osteoporosis is not an inevitable part of aging.

Bone tissue renewal continues throughout life. So with proper diet and lifestyle changes, you can slow, or even stop, osteoporosis, says James Webster, M.D., director of the Buehler Center of Aging at Northwestern University in Chicago. The time to combat osteoporosis, he emphasizes, is before your bones start to break.

Try This First

Up your calcium. You might not like milk, but you have to get enough calcium. Up to age 65, doctors recommend 1,000 milligrams of calcium a day for all men and for women on estrogen replacement therapy (ERT). Women who are past menopause but who are not receiving ERT should consume 1,200 milligrams of calcium daily, as should everyone over age 65.

To reach or surpass the goal of 1,000 milligrams through diet alone, strive for drinking 2½ to 3 eight-ounce glasses of fat-free milk a day. The rest you’ll get through a healthy, balanced diet, says Robert P. Heaney, M.D., professor of medicine with the osteoporosis research center at Creighton University in Omaha, Nebraska.

Milk is fortified with vitamin D, which your body needs to assimilate calcium, so it’s really the best source. But there are other foods that supply calcium alone. You can get 1,000 milligrams from eating 2½ cups of nonfat yogurt or five ounces of Cheddar cheese. Other good sources of calcium are sardines (with bones), collards, tofu, and calcium-fortified orange juice.

Other Wise Ways

Consider supplements. It’s best to get calcium through food, but if you can’t get enough in your diet, supplements offer the elemental calcium your body needs, says Dr. Webster. If you’re ill or if you’ve had kidney stones, however, talk to your doctor before taking any supplements.

For best absorption, take supplements in divided doses of 500 to 600 milligrams at a time, and 1,000 to 1,200 milligrams per day, advises Elizabeth Lee Vliet, M.D., founder and medical director of HER Place: Health Enhancement and Renewal for Women and clinical associate professor in the department of family and community medicine at the University of Arizona College of Medicine in Tucson. “Your body will absorb a smaller amount better than taking your daily dose all at one time.”

Calcium carbonate and calcium citrate are two common supplements available over the counter. Dr. Vliet says calcium carbonate can cause bloating or gas; calcium citrate doesn’t, but these tablets contain less calcium, so you’ll have to take more. Do not use bone meal or dolomite supplements, she warns, because they may contain lead and other toxic metals.

Maximize with magnesium. Magnesium is another crucial mineral to help build strong bones as well as help bowel function, prevent leg cramps, and improve sleep, according to Dr. Vliet. “But the sad fact is that most American women’s diets are seriously deficient in magnesium.” She recommends taking 250 milligrams in the morning and another 250 milligrams at night. Try a capsule formulation since it’s better absorbed. For women with significant bone loss, problems with constipation, or nighttime leg cramps, the dose may need to be increased to 400 milligrams twice a day, suggests Dr. Vliet. Talk to your doctor first before taking supplemental magnesium. It may cause diarrhea. Also, people with heart or kidney problems should not take it.

Get Ds every day. To absorb calcium and build strong bones, your body needs vitamin D. Several studies have shown that when vitamin D and calcium are taken together, bone mineral density increases and the number of fractures decreases. Unfortunately, there aren’t many good sources. Milk is fortified, as we’ve mentioned, and so are some cereals—so read labels to see how much of the Daily Value you’re getting. Apart from that, your best source is sunlight, which triggers vitamin D production in your body. As little as 10 minutes of summer sun exposure on your hands, face, and arms is enough, says Dr. Vliet. Sunscreens with sun protection factors (SPF) of eight or above prevent vitamin D synthesis, so apply them immediately after your 10 minutes for vitamin D.

If you can’t get outdoors, dietary vitamin D intake should be at least 400 international units (IU) but not more than 600 IU a day, recommends Dr. Vliet. One cup of fortified milk—whole, low-fat, or fat-free—has 100 IU, and most multivitamins provide 400 IU. Too much vitamin D can have harmful effects, including kidney damage, so don’t decide to take supplements above the DV of 400 IU without first consulting your doctor.

Make room for “fit-bits.” Weight-bearing exercise helps bones grow stronger. Start doing any exercise—walking, running, aerobics, pumping iron—that forces your bones and muscles to work against gravity.

Exercise stimulates bones to lay down new tissue, says Dr. Webster. Ideally, everyone should follow the American College of Sports Medicine’s suggested minimum of 20 minutes of aerobic exercise a day at least three times a week, but for some older people that much exercise at one time is not realistic, explains Dr. Webster.

If you can’t handle 20 minutes of walking or weight-lifting, he recommends breaking it down into “fit-bits.” Any exercise that has you carrying your own body weight, lifting weights, or pressing against some resistance is going to help, notes Dr. Webster. Easy fit-bits are exercises like a 10-minute stroll around the block or 5 minutes of biceps curls using one-pound weights. Just do enough fit-bits in a day to total 20 minutes of aerobic exercise.

But don’t take it too easy on yourself, says Dr. Webster. “Doing as much as you can handle is going to give you the best results.” Walking will strengthen the bones of your hips and lower back, he says, but if you can add light leg weights, that’s even better.

Don’t strain. Exercise is an effective means of combatting osteoporosis, but the exercise you choose shouldn’t put any sudden or excessive strain on your bones.

Dr. Webster says to take care when lifting heavy objects and to avoid exercises where you bend forward or twist your spine. These movements tend to encourage compression fractures in the spine. Instead, lift with your thigh muscles by squatting.

Not surprisingly, doctors often suggest that patients with brittle bones give up golf, tennis, and basketball because of the twisting motions associated with these sports and their impact upon joints. Ask your doctor what type of exercises you can do safely to preserve bone, or ask for a referral to a physical therapist who specializes in osteoporosis.

Whatever activity you choose, keep in mind that you want to minimize your chances of breaking a bone. And remember, says Dr. Webster, that the benefits of exercise last only as long as you maintain the program.

Increase protein. Bones are not made of calcium alone. In fact, the matrix of your bone—the close weave of tissue that holds the calcium—incorporates a great deal of protein. Too often, experts say, the diets of older Americans are short on protein, which adds to the osteoporosis risk.

Dr. Webster suggests adding a packet of instant breakfast or another protein supplement to a glass of low-fat or fat-free milk twice a day to increase bone strength. protein should make up 30 to 40 percent of your diet, he says, noting that skinless chicken breasts are a good source of inexpensive protein.

Stand tall on a wall. Doctors believe that exercises for persons with osteoporosis should emphasize balance, flexibility, and upper-body strengthening. Choose an exercise that improves balance, like tai chi, suggests Kay Solar, M.D., board-certified obstetrician/gynecologist in Baton Rouge, Louisiana. Or do simple posture exercises at home, she says, like shoulder blade squeezes or pressing your spine against a wall until your back is as straight as possible.

Take fall-safe measures. With osteoporosis, bones break more easily when you take a tumble. If you want to decrease your risk of debilitating fractures, you have to prevent falls, say doctors.

Remedying unsafe situations is an important part of changing the way you do things, Dr. Solar says. The best way to do this is to evaluate your everyday routine. Take a moment to think about what you’re about to do, whether it’s washing dishes or getting the newspaper, and consider if it may cause extra stress on your bones. You want to avoid sudden movements. Learn to move slowly and wisely.

Think about your surroundings at work or home. Is there anything that could cause you to trip or fall? If so, correct the problem, says Dr. Solar. In the kitchen, store frequently used items within easy reach. Avoid using step stools. Put handrails on both sides of a staircase. Get rid of throw rugs.

Don’t smoke your bones. Smoking accelerates bone loss both in men and in women, according to Dr. Vliet. For women on ERT, it poses an extra threat, she says. Smoking speeds the rate at which the body burns estrogen, the hormone that helps prevent rapid bone loss. Since women get good doses of estrogen when they have ERT, the therapy could be a big benefit. But if you smoke, the bone-preserving properties of estrogen are quickly diminished.

Don’t booze away bone. If you drink more than two ounces of hard liquor a day, cut back. In large amounts, alcohol hinders the formation of bones, Dr. Solar says, not to mention the adverse effect it can have on your equilibrium. Limit yourself to one standard alcoholic beverage a day, which is a 12-ounce beer, 5-ounce glass of wine, or 1 1/2-ounce shot of liquor.

Limit the calcium flushers. If you drink coffee, tea, or soft drinks with caffeine, limit yourself to two to three cups of liquid per day, says Dr. Solar. Beyond that, caffeine acts as a diuretic, flushing calcium from the body.

Hold the salt. As with caffeine, too much salt causes your body to excrete calcium. Check food labels, advises Dr. Solar. Avoid products with more than 300 milligrams of salt per serving, and limit your daily sodium intake to 2,400 milligrams a day.

Choose the right shoes. Preventing falls starts from the ground up. Choose athletic shoes because they provide good balance and support. For dressy occasions, choose flat shoes with a broad, flexible sole. Avoid high heels or clogs, says Dr. Vliet. Not only are you more likely to fall but also these types of shoes aren’t good for your back.

Build bone if you’re blue. Researchers at the National Institute of Mental Health (NIMH) in Bethesda, Maryland, have found decreased bone mineral density in women with past or current depression. Researchers speculate that the link may be due to hormonal changes, changes in physical activity, or other changes associated with depression.

While the link is being investigated, NIMH researchers suggest that women who’ve been diagnosed with depression take steps to maximize bone building.