Think Bone Health in May and Beyond
Celebrate National Osteoporosis Month
By HOLLY L. THACKER, M.D.
A staggering 55 percent of women and men age 50 and older have low bone mass and osteoporosis in the United States. But most won’t know it until they break a bone. That’s a shame, since like many diseases, osteoporosis is preventable and treatable. Why not take steps today to protect your bone health before you run into trouble?
WHY DO BONES WEAKEN OVER TIME?
To understand osteoporosis, you first have to understand the important role that bones play in the body. You probably associate bones with a hard, lifeless skeleton. Actually, bone is a complex living tissue. In addition to supporting the body and protecting vital organs, bones store calcium and other minerals. When the body needs calcium, it breaks down and rebuilds bone in a process known as remodeling.
From the time we are born until about 30, we build more bone than we lose. After age 35, bone breakdown outpaces bone buildup, resulting in a gradual loss of bone mass. Osteoporosis significantly increases an individual’s risk of fracture. A woman’s risk of hip fracture alone is equal to the combined risk of developing breast, uterine and ovarian cancer.
WHO IS AT RISK?
There are many signs that will help you and your doctor assess your risk of osteoporosis:
- The risk of hip fracture doubles for women whose mothers have had a hip fracture.
- Having a first-degree relative with bone fragility or fracture means you may have inherited the same susceptibility.
- Three or more falls in one year raises your risk of fracture, particularly of the hip, and any woman who suffers a fracture after the age of 50 increases her risk of a hip fracture. Fractures, however, may be caused by other medical conditions, so a full evaluation by your doctor is critical.
- Certain diseases and conditions, such as endocrine, kidney or gastrointestinal disorder, are associated with loss of bone density.
- Alcohol consumption of two or more drinks per day reduces bone density, as does smoking.
- Prolonged absence of periods due to excessive exercise, an eating disorder, or menopause can cause estrogen deficiency, which hastens loss of bone density. Premature menopause is an additional risk factor for osteoporosis. Late onset of menses may predispose a woman to low peak bone mass.
- Lifelong insufficient intake of calcium, vitamin D or other nutrients can weaken your bones.
- Excessive caffeine intake can rob the bones of key minerals.
- A sedentary lifestyle does nothing to strengthen bones; exercise must involve bearing weight to have a positive impact on bone health.
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) of calcium is 1,000 milligrams per day. Postmenopausal women who are not taking estrogen should get 1,500 milligrams of calcium. One cup of skim milk or 1 percent fat milk contains 300 milligrams of calcium. Besides dairy products, other good sources of calcium are:
- salmon with bones
- calcium-fortified juices
- dried figs
- 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. Women in this part of the country are advised to take at least 1,000 IU of vitamin D daily. 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 are best for strengthening bones, such as:
- weight lifting
CHECK YOUR BONE HEALTH
Bone-density screening should begin at age 65, or sooner in those who have risk factors such as a family history of osteoporosis, previous use of steroids or chemotherapy, smoking or having already suffered a bone fracture. Screening every two to three years will detect any bone thinning.
HOW IS OSTEOPOROSIS TREATED?
Depending on the severity of bone loss, a woman may be able to improve bone density through lifestyle changes alone. But when this isn’t enough there are several FDA-approved medications that prevent or slow loss of bone density. For menopausal women who are at particularly high risk of developing osteoporosis or who already are losing bone mass, hormone therapy is available in pill or patch form. For those who can’t, or choose not to take hormone therapy, there are other options.
The drugs approved to treat osteoporosis fall into two types:
- Antiresorptives (which slow down the breakdown of bone)
- Anabolics (which speed up the rate of bone formation)
There are several bisphosphonates on the market, including Fosamax, Actonel, Boniva and Reclast. 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 for non-spine fractures like hip fractures. A new drug on the market, Prolia, a fully human antibody produced in the lab, inactivates the body’s mechanism for breaking down bone. It’s the first “biological therapy” to be approved for postmenopausal women with osteoporosis and high risk of fracture, and when other osteoporosis medicines have failed.
Talk to a woman’s health specialist to determine the most appropriate treatment for you.
Dr. Thacker is the founder of the interdisciplinary Cleveland Clinic Center for Specialized Women’s Health and is a trailblazer in women’s health. She is the executive director of the Speaking of Women’s Health, a national program that educates women to make informed decisions about health, well-being and personal safety for themselves and their families.