Osteoporosis is an ever increasing health problem as our "baby boomers" are now becoming senior citizens, but osteoporosis doesn't have to be a natural part of aging. It's a disease that can be prevented. Here is an article with current information about this condition. If you find this newsletter of interest, feel free to share it with your friends and family.

Of course, our website www.gihealth.com has much more information about digestive health and nutrition.

Bone Is Living Tissue
Your bones are not dead tissue like your fingernails. Rather, bone is living tissue like your heart, lungs, liver, and skin. Bone tissue is constantly being remodeled as old bone cells are destroyed and new ones form. This process of turnover is important for bone health. New bone is formed by cells called osteoblasts. Old bone is removed by cells called osteoclasts. In the growing years, bone formation is more active than bone resorption and bones grow stronger. After about age 25 -30, there is a delicate balance between the osteoblasts and osteoclasts and bone mass remains constant. Later in life, especially after menopause, bone resorption by osteoclasts is greater than bone-build up by osteoblasts and bone mass begins to decline.

What Causes Osteoporosis?
Another way to think of above process is 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. Later in life, 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. The National Osteoporosis Foundation reports that 44 million American men and women aged 50 or older now suffer from osteoporosis and osteopenia (low bone mass). By 2010, this number is expected to rise to 52 million. By 2020, it is estimated that over 61 million Americans will be affected. 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 who were 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 since approximately 30% of bone mass must be lost before it shows up. However, there are simple 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. It is the best method for measuring bone density with high precision, low radiation dose, and the best indicator of fracture risk. For the test, a patient lies down on an padded table, and the scanner rapidly directs x-ray energy from two different sources towards the bones in your spine, hip and/or wrist, the most common sites of fractures due to osteoporosis. The entire process takes about ten minutes and involves no injections or invasive procedures. There is no fasting required and you do not need to disrobe except for metal belts. The information from a bone density test enables your doctor to determine whether you are at risk for fracture.

In general, the lower your bone density, the higher your risk for fracture. DEXA results are reported by comparing your values to a normal standard - the mean bone mass of normal 30 year old women. This is called a ÒT-score.Ó

T-Score	Interpretation
0 to -1	Normal bone mass
-1 to -2.5	Osteopenia (low bone mass)
below -2.5	Osteoporosis

By ordering periodic bone densitometry testing, your doctor can best estimate your risk of osteoporosis. Unfortunately, a recent study found that fewer than 2% of American women have had such a bone mineral density assessment. The National Osteoporosis Foundation recommends testing for all women over age 65. Those under 65 with one or more risk factors should also be tested. DEXA scaning is also used to follow bone density over time - especially in high risk patients and those on treatment. Scans are often repeated at 1 - 2 year intervals. Changes in bone density occur slowly so more frequent scans add no value. When possible, repeat scans should be performed on the same scanner to improve consistent and accurate results.

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:

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 Dilantin (phenytoin) seizure therapy 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. The National Osteoporosis Risk Assessment Study found that almost half of post-menopausal women had low bone mass, placing them at risk for osteoporosis-related fractures.

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.

1. Fosamax (alendronate) and Actonel (risedronate) are two prescription drugs that have been shown to actually strengthen weak bones. They do this by slowing down osteoclasts cells and bone resorption - giving the osteoblasts a chance to build up new bone tissue. They can be taken daily or, more conveniently, just once weekly with a higher dose formulation.

2. Miacalcin (calcitonin) is given as a nasal spray once a day and reduces bone loss.

3. Women may lose up to 1/3 of the bone mass in their spines in the first six 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 woman'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. It is called a Selective Estrogen Receptor Modulator, or SERM. and helps build bone without negatively affecting the heart, breast, or uterus.

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. 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 is a silent and debilitating disease. The good news is that it doesn't have to be a natural part of aging. It is a disease that can be prevented. A DEXA scan is a quick noninvasive test to assess bone health. An assessment of risk factors and DEXA scan can identify those at risk before a debilitating fracture occurs.

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 Òbone bankÓ accounts are full of calcium before they reach adulthood. Don't let the next generation be affected....

For more information about osteoporosis, visit the National Institutes of Health or National Osteoporosis Foundation websites. If you have young girls in your family, direct them to Powerful Bones, Powerful Girls, a fun website that helps teach young girls how to build strong bones.

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