Osteoporosis is a debilitating disease in which bones become fragile and are more likely to break. In most cases, it can be prevented and treated, but if steps are not taken, it progresses painlessly until a bone breaks. Your bones resemble the circular cells in honeycombs. With osteoporosis, spaces in this honeycomb grow larger. The bone that forms the honeycomb gets smaller and the outer shell of your bone gets thinner. This loss makes your bones weaker and more prone to fractures.
Osteoporosis is a major health threat for an estimated 44 million Americans. In the United States today, 10 million individuals already have osteoporosis and 34 million more have low bone mass, placing them at increased risk for developing this disease. Eighty percent of those affected by osteoporosis are women.
The consequences of osteoporosis can be devastating. Each year in the United States, this disease leads to 1.5 million fractures, mostly of the hip, spine and wrist, although any bone can be affected. Low bone density can be identified, and appropriate steps can be taken before osteoporosis and fractures occur.
Who is at risk?
These factors can increase your chances of developing osteoporosis:
- Gender: Women are more likely to develop osteoporosis than men due to thinner, lighter bones and the decrease in estrogen production that occurs during menopause.
- Age: The longer you live, the greater the likelihood of developing osteoporosis. Although all of us lose bone tissue as we age, the amount and rate of loss varies widely with each individual.
- Family history: Susceptibility to osteoporosis is due in part to heredity. If you have had a fracture as an adult or a parent has had a fracture, you are more likely to have lower bone mass than your peers.
- Ethnicity: Caucasian and Asian women are at higher risk; African American and Hispanic women have a lower, but significant, risk.
- Body size: Low body weight (under 127 pounds) and a small-boned frame place you at an increased risk.
- Lifestyle: A diet low in calcium, inadequate vitamin D, little or no exercise, current cigarette smoking, or excessive use of alcohol are all risk factors for this debilitating disease.
Four Steps to Optimal Bone Health
A calcium-rich diet, adequate vitamin D, appropriate exercise, and, in some cases, medications work together to reduce your risk for developing osteoporosis. If you already have osteoporosis, these steps can slow or stop bone loss, increase bone density and reduce your risk of fractures.
- Calcium: All foods contain vitamins, minerals and other important nutrients that help keep your body healthy. Calcium is especially important for bone health. It is also needed for heart muscles and nerves to function properly, and for blood to clot normally. If your daily calcium intake is low, calcium will be removed from your bones to perform these functions.
- Dairy products are a good source of calcium, as well as protein, phosphorus and other nutrients. The calcium in dairy products is easily absorbed by the body. Other calcium sources include fruits, vegetables, grains and fish.
- Supplements: Taking more calcium that what you need is not beneficial and may even be harmful. When you take too much calcium from supplements, the excess calcium is excreted through your kidneys into your urine. In some people, this increases the risk of kidney stones. Some studies have also suggested a link between calcium supplements and heart disease; however, these findings are not conclusive.
- Taking too many supplements can also flood your body’s absorption sites, preventing you from getting enough iron, magnesium and zinc. To play it safe, the National Osteoporosis Foundation recommends trying to meet your daily calcium needs by eating calcium-rich foods. Only supplement the estimated amount you do not get through your diet. Calcium is best absorbed when taken in small amounts (500 milligrams or less) throughout the day. Please refer to the chart below for recommended daily calcium intake.
- Consult your physician about possible interactions between calcium supplements or over-the-counter medications. Ask your pharmacist to recommend a supplement and drink plenty of fluids whenever taking a supplement.
- Vitamin D: This vitamin plays an important role in calcium absorption and in bone health. Vitamin D allows calcium to leave the intestine and enter the bloodstream to be absorbed. It is formed naturally in the body after 15 minutes of exposure to sunlight. Studies show that vitamin D production increases in the winter and is lower in people who are elderly or housebound. These individuals may require vitamin D supplements to ensure a daily intake of at least 400 international units (IU) and should discuss this with their physician. Most multivitamins and some calcium supplements contain vitamin D. Check the label for the amount. Other sources are fortified dairy products, egg yolks, saltwater fish and liver.
- Exercise: This is an important part of any osteoporosis prevention or treatment program. While exercise alone cannot prevent osteoporosis, weight-bearing and resistance-training exercises have been shown to play an important role in balance and coordination. Exercise helps maintain bone mass, which in turn lowers the risk of developing this disease. Exercise that forces you to work against gravity – weight-bearing exercises – are most beneficial. Examples include walking, jogging, racquet sports, hiking, dancing and stair climbing.
- If you have osteoporosis, you should speak to your doctor or ask for a referral to a specialist in physical medicine to learn what type of exercises you can do safely not only to preserve bone, but also to strengthen your back and hips, and maintain flexibility and balance.
- Walking is one exercise that is appropriate for almost everyone. Most people find walking outdoors more satisfying that walking indoors, but if the climate or your circumstances make this undesirable, walking indoors is a good substitute. Many enclosed malls encourage “mall walking,” and some even have organized walking clubs. Some community centers and schools make their indoor track facilities available to members of the community after school hours.
To determine if you have osteoporosis or may be at risk for the disease, your doctor will ask you questions about your lifestyle, medical history and whether anyone in your family has suffered from osteoporosis or if they have fractured any bones. Specialized tests, called bone density tests, can measure the bone density in various sites of the body. A bone density test can detect osteoporosis before a fracture occurs, predict your chances of fracturing in the future and determine your rate of bone loss. Many tests are able to monitor a person’s response to treatment if they are conducted at intervals of a year or more.
Medications for Treating Osteoporosis
The FDA has approved the following medications to prevent and/or treat osteoporosis:
- Alendronate or risedronate
- Estrogen/hormone replacement therapy (ERT/HRT)
All of these medications may increase bone mass and reduce bone loss and fracture risk to varying degrees. Alendronate is approved for treatment of osteoporosis in men and is also approved for use in treating glucocorticoid-induced (steroid) osteoporosis in men and women. Risendronate is approved for prevention and treatment of glucocorti cold-induced osteoporosis in men and women. Recently, teriparatide, a form of human parathyroid hormone, was approved to treat osteoporosis in post-menopausal women and men at risk for fracture. This is the first osteoporosis treatment that builds new bones.
How to Avoid Falls
You may need to make certain changes in your daily life to avoid falls or other situations likely to cause an injury. Making your environment fall proof is not difficult – here are a few suggestions:
- Wear sturdy, low-healed, soft-soled shoes; avoid floppy slippers and sandals.
- Ask your doctor whether any medication you are taking can cause dizziness, light-headedness or loss of balance.
- Minimize the clutter in your home.
- Secure all rugs in your home.
- Keep halls, stairs and entries well lit; use nightlights in the bedroom and bathroom.
- Use grab bars and nonskid tape in the shower or tub.
- Use nonskid rubber mats in the kitchen around the sink and stove.
Recent studies indicate that most adults get only one-third to one-half of their daily calcium requirement. Below are the recommended daily intakes of calcium (milligrams per day) from the National Academy of the Sciences (NAS).
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