No Bones About It

What everyone should know about osteoporosis.

Now more than ever, women should be asking themselves one very important question—“Got milk?”

According to the first ever Surgeon General’s Report on Bone Health and Osteoporosis, it is estimated that 10 million Americans have osteoporosis, in addition to the 34 million currently at risk, with women making up the highest percentage of each category. In addition, of those who experience hip fractures from osteoporosis, one in four will die prematurely within one year.

While osteoporosis is a crippling and dangerous disease, the good news is that it is almost entirely preventable and reversible. The bad news, however, is that there are absolutely no outward symptoms until it’s too late— earning the disease its pseudonym of “silent killer.”

Joy Bauer, nutritionist and author of Cooking With Joy, says that a very common misconception among her female patients is that osteoporosis is simply a sign of aging and not something that can be prevented while they’re still young.

“To think you just have to sit back and accept the fact that once you are older, you’ll most likely be hunched over and crippled is completely false,” Bauer says. “There are plenty of things that can be done right now that will drastically reduce your chances of having osteoporosis later on in life.”

One of the most important of these preventative measures recommended by Bauer is introducing more calcium into your diet, which she says she understands can sometimes be easier said than done.

“With the schedules of most women today, it’s amazing they find time to eat, let alone plan and prepare a nutritionally balanced meal for themselves and/or their families,” she says. “More often than not, their health and well-being takes a backseat to everything else going on in their lives; their kids, jobs, etc.”

While a calcium-rich diet is an extremely important factor, it is a not a guarantee for preventing osteoporosis. Many other factors also play a role in suppressing the deadly disease— namely, exercise. According to Bauer, weight-bearing exercises such as walking and running are ideal for keeping the bone matrix dense over time. Even a minimal weight training program can make a world of difference, by building muscle, which in turn protects the bone.

Dr. Lynn Friedman, assistant professor of obstetrics and gynecology at Mount Sinai Medical Center, agrees that weight-bearing exercise is indeed a vital component in the prevention process. “Weight-bearing exercise is a great way to ward off your chances of getting osteoporosis, because when you engage in activities where you are supporting your own weight, you end up actually stimulating bone formation at the same time,” she says.

Another important preventative measure in the battle against osteoporosis is making sure the body has plenty of Vitamin D to work with. Since very few dietary items besides milk contain Vitamin D naturally, without being fortified, it’s important to make sure that you’re getting enough through other means. While some people may prefer dietary supplements, most people can get their daily intake of Vitamin D simply by soaking up some sun. Getting outside for as little as 15 minutes a day allows the body to produce Vitamin D in the liver and kidneys.

Avoiding, or at least using in moderation, cigarettes and alcohol, is also very important, due to the fact that each creates a negative calcium balance in the body, zapping vital calcium usually used for building up bone density.
Although most doctors are unsure of the exact cause of this negative balance, Dr. Friedman says one thing doctors are sure of is that smokers and excessive drinkers are definitely at a higher risk for developing the disease. Some speculate that it may be due to the fact that alcohol and other toxins prohibit the body from metabolizing estrogen, a substance vital for bone formation.

Hormones themselves play a very important role in osteoporosis prevention for both women and men. Estrogen and testosterone, the two most prominent of the sex hormones, help to prevent the breakdown of bone, and control the formation and duration of both osteoclasts (bone breakers) and osteoblasts (bone builders) throughout one’s lifetime. This relationship between sex hormones and osteoporosis is the reason why women who are undergoing or have undergone menopause are at a much greater risk for bone loss with the loss of estrogen they experience as their bodies are changing. According to Dr. Friedman, this is also the reason why men have a much lower risk factor for osteoporosis, due to the fact that they produce most of their sex hormones later in life and more rapidly than women do.

Although women are usually screened for bone loss at different times depending on the extent of their risk factors and/or family history, Bauer and Friedman both agree that all women, even those with low risk factors, should begin annual bone density scans by their late 40s— the age when many women are at the beginning stages of menopause.

“It’s very important that women know their own medical history, due to the fact that there is a proven genetic risk for a woman whose mother, grandmother, etc. has had problems with bone loss,” Friedman says. “It’s because of this that I screen high-risk patients as early as 40, so they can avoid a similar fate.”

Though it can be difficult to reverse bone loss once osteoporosis sets in, there are several different treatment options available, including non-hormonal bi-phosphonates, such as Fosamax, Activil and Miacalcin, which Dr. Friedman says are the most common of the treatments she prescribes, and the most effective. She reminds her patients, however, that no medication will prove completely effective without also adhering to the common preventative methods, such as getting adequate calcium, nutrition and exercise and avoiding excessive drinking and smoking.

While all these preventative methods are extremely important, Bauer says she often reminds patients that the absolute most effective way to prevent osteoporosis is for parents to make sure their children are eating foods rich in calcium, especially between the ages of 9 and 18, which are the most vital of the “bone-forming” years and ultimately determine your overall bone density and structure as an adult.

By keeping informed of preventative measures and the latest treatment methods, women can finally put the “silent killer” to rest.