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Dr. Robert D. Fusco, Medical Director    
Preventing Osteoporosis

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What Is Osteoporosis?
Simply put, osteoporosis is the development of weak bones that are so brittle that they fracture with the slightest injury. A slight fall, lifting a heavy bag of groceries - even hard coughs or hugs - all present a risk. Osteoporosis is not rare, especially in women. Each year, there will be more osteoporotic fractures in women than strokes, heart attacks, and breast cancers combined. Up to half of women over age 50 will break a bone due to osteoporosis in their lifetime.

Each year, over 1.5 million fractures occurring in the United States are due to osteoporosis. Most of these are wrist, spine, and hip. The toll in pain and suffering in the elderly is great. Many "golden years" are lost due to disability from osteoporosis and the medical costs nationally are over $14 billion each year. Hip fractures especially take a toll since they are often the last straw. About one-fourth of elderly patients with hip fractures never regain an independent life-style and are confined to a nursing home until they die. Spinal "crush" fractures lead to loss of height, a rounded hunched forward appearance, and incapacitating back pain.

What Causes Osteoporosis?
Think of your bones like a "bank account." From birth to about age 30, the extra calcium in your diet is deposited in your "bone bank" making your bones denser and stronger and resistent to injury. But after age 30 or so, it is difficult to add to your account. The account is almost closed. Instead, you begin to make withdrawals. To maintain your blood level of calcium, your body begins to take calcium out of your bones. The trick to avoiding osteoporosis is to build up such a big balance in youth, that your bone bank lasts you a lifetime. However, if you enter middle age with a "low balance" in your account, your bones will run out of calcium long before you die. There are no warning symptoms until the weakened bones begin to break. That is osteoporosis.

How Serious Is Osteoporosis?
Very. Many scientists feel that osteoporosis will be the epidemic of the future as millions of "baby boomers" pass from middle age to Medicare age. For centuries, children drank milk as their main beverage. All during their formative years, calcium was being deposited into their bones. The baby boomers are the first generation that was raised on Diet Coke and Dr. Pepper which, of course, contain no calcium for the "bone bank." Thus, the bank may be empty when it is time to make withdrawals.

How is Osteoporosis Diagnosed?
This is a silent disease. You can't see or feel bone loss. There are no symptoms until the bone breaks. Then it is too late. A standard x-ray like a chest x-ray is not reliable. But there are simple painless tests that can accurately measure bone mineral density. They must be ordered by your doctor. All are painless, noninvasive and safe. Dual Energy X-ray Absortiometry, or DEXA scanning, is currently the most widely used method to measure bone mineral density. For the test, a patient lies down on an examining table, and the scanner rapidly directs x-ray energy from two different sources towards the bone being examined in an alternating fashion at a set frequency. The tests measure bone density in your spine, hip and/or wrist, the most common sites of fractures due to osteoporosis. The information from a bone density test enables your doctor to identify where you stand within ranges of normal and to determine whether you are at risk for fracture. In general, the lower your bone density, the higher your risk for fracture. A bone density more than 2.5 standard deviations below the mean is diagnositic for osteoporosis. Less severe findings are labeled osteopenia, or low bone mass. By ordering periodic bone densitometry testing, your doctor can best estimate your risk of osteoporosis.

Who Is At Risk?
Any adult can develop osteoporosis, but certain factors can increase your personal risk of developing this disorder. There are many - including:

  • Those with abnormal bone density on DEXA scan
  • Female sex
  • Caucasian or Asian heritage
  • Small, thin frame
  • Lack of regular weight-bearing exercise
  • Poor calcium intake in diet
  • Family history of osteoporosis
  • Early menopause or removal of ovaries
  • Low testosterone levels in men
  • Tobacco use or heavy alcohol use
  • Overactive thyroid
  • Thyroid hormone pills
  • Long-term prednisone use
  • Diabetes
  • Prior ulcer surgery
  • Celiac Sprue
  • Crohn's disease
  • Eating disorders like anorexia

Why Are Women At Highest Risk?
It's just because bigger is better. Osteoporosis causes symptoms when bone mass drops and bones become more fragile and susceptible to fracture. Men are born with "thicker" bones which tend to grow denser because they are generally more physically active than women. Since most women have thinner bones than men to begin with, they are more likely to develop fractures as osteoporosis progresses. Women account for 80% of those affected.

Also, the sex hormones estrogen (women) and testosterone (men) play a big role. During youth, these hormones protect your bones. After menopause, the production of estrogen in a woman's body declines. The deficiency of this bone-protecting hormone speeds up bone loss particularly in the first five years following natural menopause or surgical removal of the ovaries. A man's sex hormones stay relatively stable until about the age of 70, offering him protection much later in life.

How Can You Prevent Osteoporosis?
The American College of Rheumatology has recently published guidelines for preventing osteoporosis. While there is no guarantee that any measure can totally prevent this disorder, evidence suggests that you can minimize your risk of osteoporosis in these ways.

    1. Getting enough calcium in your diet is essential to maintaining bone strength and can play a vital role in preventing osteoporosis-related fractures. Since calcium cannot be manufactured internally, the body relies on diet to provide it with foods rich in calcium. New guidelines issued in 1997 by the National Academy of Sciences recommend that adults get between 1000 and 1300 mg. of calcium each day. Currently, 90% of females 11 years of age and older fall short of that goal. One way to increase the amount of calcium in your diet is to eat calcium-rich foods like low-fat milk, yogurt, cheese, broccoli, and others. Four glasses of low fat milk every day would meet that goal. Other good sources are the new calcium-fortified orange juices and rice. Calcium is most important before age 30, but still important throughout life.

    2. Another recommendation for high risk patients is to take calcium supplements with vitamin D. Vitamin D aids calcium absorption. We recommend Citracal caplets + D which can be purchased without a prescription in the vitamin section of your local pharmacy. Take two tablets twice daily with food. This will provide an extra 1260 mg. of calcium and 800 mg. of vitamin D each day. More vitamin D can be harmful.

    3. Modify your life-style. Avoid all tobacco and excessive alcohol consumption, both of which may worsen bone loss.

    4. Exercise can also be helpful in building and maintaining strong bones. Exercise that forces you to work against gravity - so called weight-bearing exercises such as walking or jogging - are most beneficial. Other helpful exercises include racquet sports, hiking, aerobic dance, and stair climbing. The benefits of exercise last only as long as you maintain the program. Perform a weight-bearing exercise for 30 minutes per day. Exercises such as sit-ups and others that excessively flex the spine should be avoided to reduce the risk of spinal fracture. Always check with your doctor before beginning an exercise program.

    5. Women may lose up to 1/3 of the bone mass in their spines in the first 6 years after menopause. Estrogen replacement is an effective treatment to prevent bone loss in postmenopausal women. It is also effective in the prevention of fractures in women with established low bone mass or osteoporosis - reducing fractures over 50%. However, recent studies that have suggested estrogen replacement may increase a women's risk of heart disease and cancer have made this a less attractive option for most women. It is still a good option in selected cases. Another related option is Evista (raloxifene). Evista is neither an estrogen nor a hormone. EVISTA is a Selective Estrogen Receptor Modulator, or SERM. It helps build bone without negatively affecting the heart, breast, or uterus.

    6. The silent process of bone loss with age may no longer be inevitable. New prescription drugs show great promise in prevention of osteoporosis. Miacalcin (calcitonin) is given as a nasal spray once a day and reduces bone loss. Fosamax (alendronate) and Actonel (risedronate) are two other prescription drugs that have been shown to actually strengthen weak bones. They slow down the normal loss of bone. They are given as a tablet only one day a week. Much research is being done and other new drugs are on the way.

Osteoporosis Is Not Arthritis
Surveys show that most women confuse osteoporosis with osteoarthritis and other forms of arthritis. They wait for swollen joints, stiffness, and pain before they are concerned about osteoporosis. But, these two conditions are not the same. Arthritis is a painful inflammation of the joints between the bones. Osteoporosis is a painless weakening of the bones themselves and there are no symptoms until a fracture occurs.

What If You Already Have Osteoporosis?
Don't panic. It is never too late to add extra calcium and some vitamin D to your diet. Every little bit helps. The good news is that with drugs like Fosamax and Actonel it is now possible to reverse early osteoporosis.

Be Careful Out There
If you have thinning bones, take extra precautions against falls and other accidents. Avoid poor fitting slippers and shoes, slippery walking surfaces, steep stairs, loose wires, poor lighting, and unstable furniture. Avoid the use of throw rugs. Use a night light. Consider bathroom support bars in shower or tub. When you were young you had to "baby-proof" your home to make it safer for your children. As you age, you must make it safer for yourself.

The Future....
Osteoporosis doesn't have to be a natural part of aging. It's a disease that can be prevented. Even though the symptoms of osteoporosis usually appear late in life, prevention should begin early in life. In fact, you might think of osteoporosis as a disease of teenage years. That is when most of the damage is done. Spread the word to your children and grandchildren. Make sure that their bone bank accounts are full of calcium before they reach adulthood. Don't let the next generation be affected.



Good Sources of Dietary Calcium

 
1 cup

1 cup

1 cup

1/2 cup

1 cup

1 cup

1 oz.

10

1 oz.

1 cup

1/2 cup
   
plain yogurt

nonfat milk

calcium fortified OJ

calcium fortified rice

1% chocolate milk

leaf spinach

swiss cheese

dried figs

cheddar cheese

broccoli, chopped

frozen yogurt
   
450 mg

300

300

290

285

277

270

269

205

177

105
 


What is Your Risk?
  • 1. Do you have a small, thin frame or are you Caucasian or Asian?
  • 2. Has a female member of your immediate family broken a bone as an adult?
  • 3. Are you a postmenopausal woman?
  • 4. Have you had an early or surgically induced menopause?
  • 5. Have you been taking thyroid medication or prolonged treatment with prednisone or other cortisone-like drugs for asthma, arthritis, colitis, or other diseases?
  • 6. Is your diet low in dairy products and other sources of calcium?
  • 7. Are you physically inactive?
  • 8. Do you smoke cigarettes or drink alcohol in excess?
  • 9. Do you have an intestinal or eating disorder?
If you answered two or more of the above questions as true, you may be in a high risk group for developing osteoporosis. Ask your doctor about a more complete evaluation and possible treatment. Remember, osteoporosis can be effectively treated if caught early.

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