osteoporosis what it is and how you can fight and avoid it

Osteoporosis: What it is and How You Can Fight and Avoid It


In spite of protestations to the contrary, aging is a disease...period. Nothing, absolutely nothing about our bodies improves over time.

And our bones are as subject to the damage that aging inflicts on any other body part. The older you are, the higher your chance of having osteoporosis.

Women's bones are thinner than men's, and bone density rapidly declines after menopause.

Therefore, it's not surprising that about 80% of Americans with osteoporosis are women.

But men can be stricken with this affliction as well. Granted, osteoporosis is much more common in women, but men are at risk, too.

In fact, about 25% of men over 50 will have an osteoporosis-related fracture. Osteoporosis may be under-diagnosed in men because it is often considered a "woman's disease" and men may not be tested.

When considering what you can do to prevent osteoporosis, you first need to be aware of what causes it, and why some people develop it and some don't.

There are specific risk factors beyond your control:

  • Thin, small-framed women are more likely to develop osteoporosis.
  • Heredity. If osteoporosis runs in your family, the odds are higher that it may strike you as well
  • Ethnicity. It is more common among whites and Asians, though African-Americans and Hispanics may still be at risk
  • Other health conditions. Some conditions, such as type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, and hormonal disorders are also linked to bone loss.

The Good News? There Are Risk Factors You Can Control

Smoking, an inactive lifestyle, and a diet low in calcium and vitamin D place you at higher risk for osteoporosis. Excess alcohol consumption is also linked to bone loss and a chance of fractures.

Corticosteroids, anti-inflammatory drugs used to treat asthma and other conditions, increase your risk of bone loss. Eating disorders (anorexia nervosa or bulimia) can also take a toll on bone health.

How Do You Know if You are Developing Osteoporosis?

Your doctor may recommend a bone mineral density test if:

  • You're over 50 and have broken a bone
  • You are a woman over 65 or a man over 70
  • You are in menopause or past menopause and have risk factors
  • You are a man between 50-69 with risk factors

DXA (dual X-ray absorptiometry) uses low-dose X-rays to measure bone density in the hip and spine. The test takes less than 15 minutes.

Testing: What Your T-Score Means

The test compares your bone mineral density (BMD) with that of a healthy 30-year-old. This is the age that bone mass is at its peak. The results come as a T-score in these ranges:

  • -1.0 and higher is normal bone density
  • Between -1.0 and -2.5 shows low bone density (osteopenia) but not osteoporosis
  • -2.5 or below indicates osteoporosis
  • As your bone density decreases, your T-score gets smaller

Treatment: Bone-Boosting Drugs May Help, but they can also be a Double-Edged Sword

If you are diagnosed with osteoporosis, you may be prescribed a bisphosphonate: Actonel, Boniva, Fosamax, or Reclast.

They can reduce bone loss and fracture risk and may help build some bone density.

But they can also deliver some hellish side effects: if taken orally, they can cause gastrointestinal problems such as ulcers in the esophagus, acid reflux, and nausea. Injectable bisphosphonates, given one to four times a year, can produce brief flu-like symptoms.

Bisphosphonates may increase the risk of jaw bone destruction. Hormone replacement therapy, once used widely for menopause symptoms, is an option for osteoporosis, but it's used less than other medications because of concerns about the risk of cancer, blood clots, heart disease, and stroke.

Evista is not a hormone but can provide similar bone-strengthening effects to estrogen without the cancer risks. Risks include blood clots and increased hot flashes.

Forteo, a synthetic parathyroid hormone, requires daily injections and builds new bone. Leg cramps and dizziness have been reported with Forteo use.

Prolia is a lab-produced antibody that slows the breakdown of bone. Given as an injection twice a year, it is for postmenopausal women at high risk for fractures who can't tolerate other osteoporosis drugs or who haven't been helped by other medications.

Side effects include back pain, muscle pain, bone pain, a higher risk of infections, and lower calcium levels. Most medications for osteoporosis reduce bone loss or slightly increase bone density.

Forteo helps build new bone, but requires daily injections and can only be used for two years because of potential side effects. But there's a glimmer of hope for a cure for osteoporosis.

New research in animals indicates that an experimental drug that blocks serotonin from being synthesized in the gut could build new bone and reverse bone loss.

How to Avoid the Drug Merry-Go-Round

There is no debating the fact that the ancient cliché: “an ounce of prevention is worth a pound of cure,” applies to osteoporosis as well.

There's no question that the drugs mentioned earlier can work wonders for some people.

But for others, the side effects may be worse than the disease.

Therefore, you owe it to yourself to try to avoid needing those drugs in the first place. Eating calcium-rich foods can help protect your bones no matter what your age.

Drinking a glass of vitamin D-fortified milk is one of the best ways to get your calcium. You need the equivalent of about three and a half 8-ounce glasses of milk a day.

Fish such as salmon, tuna, and herring also contain vitamin D, which helps us absorb calcium, and leafy green vegetables also provide magnesium, which helps maintain good bone quality.

Some foods and drinks such as cereals and orange juice are also fortified with calcium and vitamin D.

Foods to Avoid That are Bad to the Bone

Some foods can sap your body's calcium, such as...

  • Salty foods such as canned soups and processed meats. These foods are loaded to the gills with sodium. We do need some sodium, but this need can be satisfied by eating foods in their natural state as much as possible
  • A cup or two of coffee daily can deliver health benefits. But several cups may be too much of a good thing, since that amount may inhibit your body's absorption of calcium.
  • Moderate drinking is fine if restricted to moderation (two drinks per day for men and one for women), but heavy alcohol use can lead to bone loss.

Don't Forget Supplements

Most Americans get enough calcium, except girls ages 9-18. Two types of calcium supplements are commonly available: calcium carbonate and calcium citrate, which are equally beneficial.

Dividing your dose by taking half in the morning and a half later in the day improves absorption. Too much calcium can lead to kidney stones, so be sure to research the upper limit for calcium.

Getting adequate vitamin D aids the absorption of calcium.

The Crucial Role of Exercise

Weight-bearing exercise can help you build bone and maintain it. That includes walking, jogging, tennis, and other activities where you move the full weight of your body.

Using small weights in many different activities helps bones. Women who walk just a mile a day have four to seven more years of bone reserve, researchers have found. But you need to be cautious.

Yoga and Pilates can work wonders with balance and flexibility, and both are strongly recommended. However, too much twisting or forward-bending can increase the risk of spinal compression fractures in people who have osteoporosis.

High-impact activities also can be risky for people with low bone density. Swimming and bicycling can be great exercise, but they are not weight-bearing and won't provide bone-health benefits.

Another form of exercise to help increase your balance is the stability ball. There are several different movements performed on and with the ball that can add stability to your walking, and give help in preventing falls.

Books, magazines, the Internet, and personal trainers can all offer instruction on using a stability ball. Falling is a grave concern for anyone, especially senior citizens.

Many seniors never recover from a severe fall, so the time to work on balance and flexibility is now! Avoiding fractures is also key to keeping your bones healthy, whether you have bone loss or not.

In addition to exercise, fall prevention includes minimizing clutter and ensuring that your area rugs are anchored to the floor. Toss throw rugs and loose cords. Wearing sturdy, rubber-soled shoes also can reduce the risk of falling.

Osteopenia: Borderline Bone Loss

If you have the beginnings of bone loss but not enough to be osteoporosis, you may have a condition called osteopenia. As with osteoporosis, there are no physical symptoms. Osteopenia can progress to osteoporosis, but with the changes in diet and exercise recommended above, you can slow the bone loss. Your doctor will evaluate you to see if you need medication.

Get an Early Start to Prevent This Nightmare

Healthy habits as a child or teenager can pay off years down the road with stronger bones. Young people can build their bones by eating calcium-rich foods, getting enough vitamin D (through sunshine or diet), and exercising regularly. Here are the recommended daily intakes of calcium by age:

  • Under one year: 200-260 mg
  • 1-3 years: 700 mg
  • 4-8 years: 1,000 mg
  • 9-18 years: 1,300 mg
  • 19-50 years : 1,000 mg
  • 51-70 men: 1,000 mg
  • 51+ women: 1,200 mg
  • 71+ years: 1,200 mg

By age 30, the average woman has built 98% of her peak bone mass.

More Good News: It's Never Too Late for Bone Health

Many people don't find out about their bone loss until they are in their 60s or older. But you can still benefit from boosting a low calcium intake to recommended levels and exercising regularly.

And never forget this: osteoporosis doesn't have to interfere with your life. In fact, being inactive or immobile will worsen bone health. So keep moving!

Ask for help carrying heavy grocery bags or other items, and use railings, a cane or walker if you need stability.


An overview and management of osteoporosis

The Epidemiology and Pathogenesis of Osteoporosis


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