Ask the Expert: Osteoporosis
by Andrea Sikon, MD, FACP
Who is at risk?
Osteoporosis is mistakenly thought of as a disease of older white women. In fact, according to the National Osteoporosis Foundation, osteoporosis and low bone mass affect 44 million women and men age 50 and older in the United States. That’s a staggering 55 percent in that age group.
There are many risk factors that increase your chance of developing osteoporosis including gender, age, race, bone structure and body weight, nutrition, lifestyle, medication and family history. Smoking and excessive alcohol consumption also increase your risk of developing osteoporosis.
There is a direct relationship between menopause and the development of osteoporosis. In the five to seven years following menopause, a woman can lose up to 20 to 30 percent of her bone mass. This makes midlife a prime time to prevent and treat low bone density so that women stay strong in later years.
An ounce of prevention
A combination of good health and exercise, supplementation with calcium and vitamin D, and possibly a regimen of either hormone therapy or a prescribed bone therapy can treat osteopenia (less than average bone density) and prevent osteoporosis.
To maintain strong, healthy bones, you have to consume a diet rich in calcium throughout your life. Your need for calcium becomes even greater as you age. The U.S. Recommended Daily Allowance (USRDA) for calcium is 1,000 milligrams per day. Postmenopausal women who are not taking estrogen should get 1,500 milligrams per day. One cup of skim or 1 percent fat milk contains 300 milligrams of calcium. Besides dairy products, other good sources of calcium are salmon with bones, sardines, kale, broccoli, calcium-fortified juices and breads, dried figs and calcium supplements. If you can’t get the proper amount of calcium through your daily diet, supplements are an accessible, relatively safe choice. Always consult your physician before beginning a supplement routine.
In addition, adults need at least 1,000 to 2,000 international units (IU) of vitamin D daily in order to absorb calcium. vitamin D deficiency is very common, particularly in northern latitudes such as Northeast Ohio.
Maintaining a healthy lifestyle can reduce the degree of bone loss. Establish a regular exercise program and avoid excessive use of alcohol and tobacco. Exercises that make your muscles work against gravity (such as walking, jogging, aerobics and weight lifting) are best for strengthening bones.
Checking your bone health
Your physician will determine whether you need a bone mineral density (BMD) test based on your clinical history and risk factors. A BMD is a quick and painless x-ray test that enables the physician to get a snapshot of bone health by measuring the mineral density in your bones. The amount of certain minerals, including calcium, is an indicator of bone health and strength.The test also will assess your risk for fracture and determine your rate of bone loss if it is conducted at interval of two or more years.
I recommend BMD testing within two years of menopause – earlier for patients with a family history of osteoporosis, low vitamin D levels or long-term steroid medication use. Women who have unexplained bone fractures, skipped menses or who have taken treatments that lower hormone levels also should be tested.
Depending on the severity of bone loss, a woman may be able to improve bone density through lifestyle changes alone. But this isn’t enough for many women. There are several FDA-approved medications that prevent or slow down loss of bone density. For menopausal women who are at particularly high risk of developing osteoporosis or who already are losing bone mass, I recommend hormone therapy in a pill or patch form. If you can’t take hormone therapy or don’t want to, there are other options.
You’ve probably seen advertisements for several bisphosphonates on the market today. They are antiresorptive treatments, meaning they slow or stop the dissolving of bone tissue in the normal bone cycle without slowing the formation of new bone. But not all bisphosphonates are the same and not all reduce the risk of non-spine fractures like hip fractures. At the least, a woman on bisphosphonates will not lose bone faster than she can replace it. Your physician can discuss the variety of options to determine the most appropriate treatment for you.
Andrea Sikon, MD, FACP, is the Director of Women’s Primary Care in Cleveland Clinic’s Medicine Institute.