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STRONG, HEALTHY BONES
By: Linda Hepler, BSN, RN
Chances are, you worry less about your bone health than you do about your heart health. After all, when you think about someone with poor bone health, it’s likely you envision an elderly woman with a walker, and that isn’t you – not yet, anyway. But osteoporosis, or a weakening of the bones, and its precursor, low bone density, is not just an occurrence that strikes aged women. It can affect those in mid-life or even younger. It can also happen, although less commonly, to men. The good news is, there are things you can do right now to protect your bone health in the years to come.
The most important thing to understand about bones is that they aren’t static, but a living and growing tissue. “Bones are in a constant state of turnover,” says Nathan Wei, MD, FACP, FACR, a rheumatologist practicing in Frederick, Maryland.
Bone is continually in a state of renewal, he adds, with old bone cells being removed (and absorbed by the body) and new bone cells being laid down. You build bone when more bone is laid down than is removed (although as we age, the bone-building cycles are less efficient). And you lose bone when more is removed than replaced. The greatest accumulation of bone mass occurs prior to young adulthood, when you attain your peak bone density. After this time, says Dr. Wei, “there’s a slow decline in bone density in both genders.”
If bone density declines enough, then you will develop osteoporosis, a condition that weakens the bones and leads to fractures, especially of the hip, wrist and spine, says Terrence Crowder, MD, an orthopedic surgeon practicing in Phoenix, Arizona. And you don’t have to have a severe injury to experience an osteoporosis related fracture, either, he adds. “An osteoporotic fracture can occur from a non-traumatic injury such as rolling over in bed or a minor fall from a standing position.”
According to the National Osteoporosis Foundation, one in two women and one in four men ages 50 or older will break a bone due to osteoporosis. In fact, men older than 50 are more likely to break a bone due to osteoporosis than they are to get prostate cancer. And women older than 50 have a higher risk of breaking a hip due to osteoporosis than their combined risk of breast, uterine and ovarian cancers.
The greatest concern with broken bones sustained due to osteoporosis: a high risk of death. According to research by the University of Maryland School of Medicine, 29 percent of older persons who break a hip die within a year of that fracture. And, says Dr. Crowder, “If you have a compression fracture of the lumbar spine, your risk of death over the next five years raises by 20 percent.”
How to avoid being a part of these statistics? The best way, says Dr. Crowder, is to recognize your risk factors and to change those things that you can in order to protect your bone health. You should also, especially if you have risk factors you can’t change, speak to your healthcare provider about bone density testing and treatment for osteoporosis if necessary. Risks for low bone density and resulting osteoporosis include:
Age – The older you are, the greater your risk of osteoporosis. In general, people with no other risk factors experience low bone density by age 65 in women and age 70 in men.
Gender – “Women start out with less bone mass in general,” says Dr. Wei. And after menopause, when bone-protective estrogen decreases, bone density declines rapidly.
Body size – Small, thin persons, especially women, are at greater risk, because they have less bone mass.
Family history – Osteoporosis runs in families. If you have a close relative with osteoporosis or low bone density, it’s more likely that you will, too.
Low sex hormones – Low estrogen levels in women due to menopause or lack of regular menstrual periods in women, and low testosterone levels in men can decrease bone density. »
Low calcium and vitamin D intake – Calcium, found in dairy and fortified foods such as orange juice, and vitamin D, found in oily fish, eggs and fortified foods, such as milk, are necessary for bone formation. But it is hard for many people to eat a sufficient amount of these foods to assure adequate nutrient intake.
Sedentary lifestyle – Lack of physical activity can weaken bones.
Overtraining – Although we know that exercise can strengthen bones, “There’s such a thing as too much exercise,” says Dr. Wei. Intense exercise and extremely low body weight are linked with lower levels of bone-protective estrogen in women. And excess physical activity over a long period of time can set up a chronic inflammation in both genders, which causes increased bone loss.
Any disease that causes inflammation – such as Lupus or rheumatoid arthritis.
Asthma – It’s not asthma itself that causes low bone density, says Dr. Crowder, “but medications used to treat the disease, such as prednisone (a corticosteroid), can do so.”
Hyperthroidism or hypothyroidism – can interfere with calcium levels, bone formation and bone reabsorption.
Smoking – “Smoking suffocates the bone,” says Dr. Crowder. “Nicotine is a vasoconstrictor, shutting down the small blood vessels that feed the bones.”
Excess alcohol – Over time, excessive drinking can inhibit the production of osteoblasts, a specialized cell that deposits new bone tissue.
While the best time to begin protecting your bone health is during childhood, it’s never too late to start, says Adam Wollowick, MD, an adult and pediatric spine surgeon who practices at Montefiore Medical Center in New York. The three most crucial things you can do to build and maintain healthy bones, according to Dr. Wollowick:
“Eat a healthy, well-balanced diet with lots of fresh fruits and vegetables. In people over 50, and those younger who are at risk, supplementation with vitamin D and calcium is critical.”
Don’t smoke and avoid excessive alcohol consumption.
“Participate in a regular exercise program, which has been shown to strengthen our bones. An appropriate regimen includes weight-bearing activities, aerobic fitness and muscle strengthening.”
TREATMENT FOR OSTEOPOROSIS
If you are diagnosed with osteoporosis (or low bone density with a high risk for fractures), your doctor may prescribe one of the medications approved by the FDA for this disease. The most common medications used are:
Bisphosphonates – such as Fosamax, Boniva, Actonel and Atelvia, slow the bone cell breakdown, preserving bone density. They are taken by mouth daily, weekly, biweekly or monthly. They can cause stomach upset or heartburn. In women who experience these side effects, there is an intravenous injection form of Boniva, given four times per year, that causes less stomach upset. Another bisphosphonate medication called Reclast, is given by intravenous infusion once a year or once every two years.
Calcitonins – such as Fortical and Miacalcin are naturally occurring hormones. Given by nasal spray or injection, they help to regulate calcium in the body to help with the bone building process. They are used in those who don’t tolerate bisphosphonate medications. Side effects of calcitonins include runny nose, nasal discomfort or bleeding.
It’s important to remember that even if you’re taking a medication for osteoporosis, you still need to exercise, take in sufficient amounts of vitamin D and calcium and decrease alcohol intake.
Whole Foods or Supplementation?
Should you get your calcium and vitamin D from foods or from supplements? Most experts agree that while it’s always best to take in nutrients through food sources, it is difficult for many individuals to get enough calcium or vitamin D through foods. In addition, says Adam Wollowick, MD, an adult and pediatric spine surgeon who practices at Montefiore Medical Center in New York, “Supplementation with calcium and vitamin D is recommended for all adults who are more than 50 years old.” Dr. Wollowick cautions that all individuals should consult with their physician prior to beginning nutritional supplementation.
When Should You Have a Bone Density Test?
A bone mineral density (BMD) test, also known as a DEXA scan, measures how much bone you have at the hip and spine. It’s a bit like having an x-ray, but with less radiation. It can identify low bone density or osteoporosis, and help to determine your risk for fractures.
While some medical groups, such as the American Academy of Family Physicians, believe that most women don’t need a BMD until age 65 (age 70 if you’re a man), many physicians recommend the test starting at age 50. Terrence Crowder, MD, an orthopedic surgeon practicing in Phoenix, Arizona, is one of those physicians who recommends early testing. “I think there’s a significant number of middle-aged people who have osteoporosis or low bone density and don’t know it. If you don’t get tested, you won’t know if you have a problem until you have a fracture,” he says. It’s important to discuss with your physician whether you should have a bone density test at age 50, especially if you are or have been a smoker, if you’ve used steroid medications regularly, if you have low body weight or if you’ve ever had a fracture in the past. MS&F